A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents

Abstract

Despite being a significant public health concern, the role of opioid prescriptions in potentiating risk of opioid misuse in the context of pediatric pain has been underinvestigated. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. A multilevel model of mechanisms through which opioid prescriptions may impact pain and other negative outcomes in youth, including risk for opioid misuse and related problems, is proposed with particular attention paid to the role that psychologists can play in informing policies and developing preventative interventions in healthcare settings.

Keywords

chronic pain opioid prescription children/adolescents risk factors

Prevention of chronic pain states is a critical piece of a comprehensive approach to reduce the negative impact of chronic pain in children and adolescents. The benefits of opioid analgesics in youth experiencing noncancer pain must be thus weighed against the potential risks of opioid use. Pediatric medical settings are a point of entry to opioid use for youth, including youth who would otherwise not seek out psychoactive substances. Eighty percent of high school students reporting medical use of opioids prior to misuse indicated sourcing the substance from their own previous prescription (McCabe, West, Teter, & Boyd, 2012), demonstrating that even legitimate receipt of an opioid prescription potentiates risk for problem use. As rates of adult prescription misuse have been connected to persistent and serious negative sequelae, including the transition from opioid prescriptions to heroin use and overdose death (Banerjee et al., 2015; Bartels, Binswanger, & Hopfer, 2016; Martins et al., 2017), an examination of risk factors for youth who receive legitimate opioid prescriptions in the context of pain experiences is warranted.

With limited exceptions, such as the use of amphetamines as treatment for Attention Deficit/Hyperactivity Disorder, youth are not routinely introduced to substances with abuse potential (e.g., cannabis, alcohol) by adults providing medical care. Use of medical cannabis in adolescents is highly contentious (Choo, Feldstein Ewing, & Lovejoy, 2016), and no medical professional would recommend anyone under legal drinking age consume alcohol (Feldstein Ewing, Lovejoy, & Choo, 2017). In fact, where legal, the age of recreational use for alcohol and cannabis is 21 and therefore much closer to the close of neural development (approximately age 25; Giedd & Rapoport, 2010). However, pediatric medical providers in the United States routinely prescribe prescription opioids with addictive properties to children, most frequently to 12- to 17-year-olds (Dowell, Haegerich, & Chou, 2016; Livingstone, Groenewald, Rabbitts, & Palermo, 2017), and often do so in an “off label” manner. Postoperative pain, sickle cell disease, and pain due to cancer are the only pain conditions for which opioids are indicated in pediatrics, yet numerous other pain conditions frequently yield an opioid prescription (Berde & Sethna, 2002; Friedrichsdorf et al., 2016). As a result, almost 20% of high school students have received at least one opioid prescription by their senior year (McCabe et al., 2012). While these prescriptions may be needed for controlling pain in medical settings, the result is a large proportion of youth who have been introduced to this addictive substance, placing them at increased risk for opioid misuse and addiction.

Traditional models of adolescent health risk and addiction do not fit well with this unique route of entry that occurs for prescription opioid misuse. Most adolescent addiction models emphasize the interaction between predisposing factors (e.g., genetic factors, peer factors, environmental context) and the pattern of neuromaturation during this period, which favors enhanced reward sensitivity coupled with less developed control systems (Casey, 2015; Conrod & Nikolaou, 2016; Ernst, 2014; Feldstein Ewing, Tapert, & Molina, 2016; Shulman et al., 2016). Furthermore, because almost all substances are illegal for youth, a defining feature of most adolescent substance use is the adolescent’s willingness to violate a rule or norm in order to obtain the desired substance (Asghari & Nicholas, 2001; Conrod & Nikolaou, 2016; Osilla et al., 2014). In the case of prescription opioids, youth need not effortfully obtain a substance that they should not have, as that step has been circumvented by the medical system treating them. This creates opportunity for experimentation for youth who may otherwise never have sought out a substance of abuse and even opens a door for experimentation among those who highly disapprove of substance use (Miech, Johnston, O‘Malley, Keyes, & Heard, 2015).

Among adults, chronic pain treatment guidelines now recommend against the initiation of long-term opioid therapy for chronic pain, indicating a lack of high-quality evidence of benefit compounded by growing evidence of harms (Dowell et al., 2016; Volkow & Koroshetz, 2017). Yet few have addressed how legitimate opioid prescriptions might contribute to the development and persistence of opioid misuse and pain in pediatric populations. To address this gap, the present review identifies theory-based hypotheses about these associations, reviews the extant literature on opioid prescriptions that supports these hypotheses, and provides routes for future empirical studies. A multilevel model of mechanisms through which opioid prescriptions may impact pain and other negative outcomes in youth, including risk for opioid misuse and related problems, is proposed with particular attention paid to the role that psychologists can play in informing policies and developing preventative interventions in healthcare settings.

Pediatric Opioid Prescribing

Analgesic medication is routinely overprescribed in pediatric patients (Yaster et al., 2015). However, disjointed timelines of data collection foster difficulty in adequately assessing the progression of opioid use trends among youth. According to Center for Behavioral Health Statistics and Quality (CBHSQ, 2016) data from 2015, 22.7% of youth age 12 to 17 used and 3.9% misused pain relievers in the past year. A decline in overall use rates (both medical and nonmedical/misuse) among adolescents has been observed since 2013 (McCabe et al., 2017), and initially prescription rates for adolescents appeared to decline between 1996 and 2012 (Groenewald, Rabbitts, Gebert, & Palermo, 2016). Contrary to expectations, provision of opioid prescriptions to youth with noncancer pain increased between 2005 to 2014 (Pielech, Rivers, Bailey, & Vowles, 2016). Further, subgroups of youth with specific pain conditions are more likely to receive an opioid prescription. For instance, in a study of over 8,000 youth with headache, 46% received at least one opioid prescription in the 1-year period following initial diagnosis (DeVries et al., 2014). This is in the face of prescribing guidelines delineating that opioids are not an indicated treatment for this condition and thus should not be the first-level treatment for headache or other primary pain conditions in children (Berde & Sethna, 2002; Chou et al., 2009; Friedrichsdorf et al., 2016; Tepper, 2012). Despite efforts to improve prescribing guidelines to reduce overprescribing (e.g., Dowell et al., 2016), prescription of opioid analgesics to children and adolescents merits close attention given the cataclysmic outcomes being observed among opioid-addicted adults (Wilkerson, Kim, Windsor, & Mareiniss, 2016) and the increased risk of future misuse among youth who use prescription opioids, even as directed by a medical provider (Miech et al., 2015).

Efficacy of Opioid Treatment for Pain Conditions

Despite also not being indicated for most acute pain conditions, most youth receive opioid prescriptions for acute pain (Berde & Sethna, 2002). Many providers report that most acute pain can be managed easily and well for children and adolescents without opioids (Dowell et al., 2016), but this is a tricky empirical question, as little research has evaluated the comparative efficacy or effectiveness because of a historical reluctance to conduct clinical trials in this young age group (Berde & Sethna, 2002; Coté, Kauffman, Troendle, & Lambert, 1996).

Within the extant literature, opioid analgesics do indeed appear to be effective in assuaging acute moderate to severe postsurgical pain in youth (Committee on Psychosocial Aspects of Child and Family Health, 2001; Tyler, Woodham, Stocks, Leary, & Lloyd-Thomas, 1995). In addition, a number of trials have shown no advantage to opioids over nonsteroidal anti-inflammatory drugs (NSAIDs) in terms of postoperative pain reduction in children and adolescents, such as in tonsillectomy and minor orthopedic surgeries (Best et al., 2017; Kelly et al., 2015; Poonai et al., 2017). There is also evidence from multiple trials for common pain experiences in adults (e.g., acute low back pain, wisdom tooth extraction) that opioids coupled with NSAIDs do not add significant pain relief over NSAIDs alone (Best et al., 2017; Friedman et al., 2015). Thus, acute pain experiences may, in fact, represent a highly preventable route of opioid access in a legitimate context, as opioids are not indicated as a primary treatment for a majority of the acute pain conditions for which they are prescribed.

Similarly, there is a dearth of research regarding the efficacy of opioid therapy as a long-term treatment of chronic noncancer pain in youth. It is also not recommended for primary pain disorders in pediatric populations because of poorer clinical outcomes (Friedrichsdorf et al., 2016). While indicated for youth with sickle cell disease and/or pain due to cancer (Berde & Sethna, 2002), no experimental studies—in any age group—have addressed the effectiveness of long-term opioid therapy (i.e., greater than 1 year) for chronic noncancer pain compared to placebo or to no opioid therapy (Chou et al., 2015; Dowell et al., 2016).

Outcomes for shorter term treatment episodes shed light on the role of opioids in pain management and treatment. This research has been primarily conducted in adults. A meta-analysis by Furlan, Sandoval, Mailis-Gagnon, and Tunks (2006) examined the efficacy of various opioid medications, both strong (e.g., morphine) and weak (e.g., tramadol), in the treatment of chronic noncancer pain (i.e., nociceptive, neuropathic, fibromyalgia, mixed) in adults over 3 to 9 weeks. This team found that while opioids outperform placebo, they are not superior to nonopioid analgesics (e.g., NSAIDs), particularly in functional outcomes and for nonopioid analgesics as compared with weak opioids (Furlan et al., 2006). These data suggest that medications such as NSAIDs could take precedent as a first line of treatment in patients without severe pain, for whom the greatest risk without associated benefit is likely to be derived. Furthermore, the benefits of long-term opioid therapy have been repeatedly called into question with assertions that there is inadequate evidence regarding its efficacy for managing chronic pain in both adults and children, and the current guidelines for opioid treatment include recommendations for using nonpharmacological/behavioral strategies as part of a comprehensive approach to pain management (Chou et al., 2014, 2015; Dowell et al., 2016; Friedrichsdorf et al., 2016; Volkow & Koroshetz, 2017).

Individual Risk Factors for Opioid Misuse in the Context of Pain

Preexisting contextual risk factors

Demographics

A number of sociodemographic factors of both patients and their providers contribute to the receipt and utilization of prescription opioids. Pediatric patient characteristics that predict receipt of an opioid prescription include age, gender, race/ethnicity, insurance type, and quality of health; older, insured, European American children in fair to poor parent-reported health receive the most prescriptions (Groenewald et al., 2016). African American children are significantly less likely to receive a codeine prescription than European American children (Kaiser et al., 2014), despite that African American children frequently report higher pain scores (Sadhasivam et al., 2012). Provider characteristics include geographic region and provider type, with northeast providers and physicians more likely to prescribe than unlicensed medical providers (Kaiser et al., 2014). The most recent Centers for Disease Control and Prevention (CDC, 2017) data also reflect regional and urban/rural differences in prescribing patterns by county.

Socioeconomic status (SES) also factors into receipt of opioid prescriptions for pain. Among adults who presented to the emergency department (ED) for pain, Joynt and colleagues (2013) found that patients from low-SES and high-poverty neighborhoods were less likely to receive opioids for their pain. African American patients were prescribed fewer opioids than European American patients at all SES levels (Joynt et al., 2013), reflecting a comparable pattern of prescriber bias across children and adults (Kaiser et al., 2014). Similarly, adult Hispanic patients less frequently received opioid prescriptions for moderate to severe pain as compared with non-Hispanic patients. Overall, high-SES European American patients presenting to the ED for moderate to severe pain appear to be most likely to receive an opioid prescription (Joynt et al., 2013).

Experience of pain conditions commonly treated with opioids

Long-term opioid use frequently begins with opioid treatment for acute pain (Edlund et al., 2014; Shah, 2017). Approximately 10% of adolescents’ and young adults’ non-injury-related visits and 14.5% of injury-related visits yield an opioid prescription, most commonly in ED settings (Fortuna, Robbins, Caiola, Joynt, & Halterman, 2010). Of all outpatient visits for 15- to 19-year-olds, the highest rates of opioid prescriptions stemmed from treatment for back/musculoskeletal pain (21.5%/11.3%), injury (15.0%), and headache (12.7%; Fortuna et al., 2010). For noncancer pain in outpatient settings, acute musculoskeletal pain or injury (e.g., sprain, fracture, back pain), postsurgical or procedural pain (e.g., dental surgery, tonsillectomy), and pain flares in the context of recurrent pain (e.g., recurrent headache, abdominal pain; Fortuna et al., 2010) are the conditions that most often generate opioid prescriptions for youth. However, notably, opioids are only indicated for pediatric postsurgical pain (Berde & Sethna, 2002). Dental and medical procedures account for 65% of child and adolescent opioid prescriptions (Groenewald et al., 2016). In these cases, relatively brief recovery periods are expected, with natural discontinuation of medication expected within 3 months of prescription. Within the United States, physicians most frequently prescribe opioids with the expectation that children and adolescents will stop taking the medication as soon as their pain resolves (Holman, Stoddard, Horwitz, & Higgins, 2014). However, even short-term (e.g., 5 days) use of opioids for acute pain sharply increases risk for later and continued use, even when used as prescribed by a medical provider (Shah, 2017).

Psychological distress

Psychological distress can confer significant additional risk for opioid misuse, particularly when it co-occurs in the pain context. Among adults, both mental health problems (Boscarino et al., 2010; Edlund et al., 2010; Swendsen et al., 2010) and pain-related factors (Blanco et al., 2016; Liebschutz et al., 2010; Sullivan, Von Korff, Banta-Green, Merrill, & Saunders, 2010) are associated with chronic opioid use, misuse, and use disorder. Specifically, these vulnerabilities can synergistically exacerbate risk for both chronic pain and opioid misuse. Mental health vulnerabilities, most commonly anxiety and depression (Richardson et al., 2012), have been shown to increase risk for opioid misuse in adolescents (Edlund et al., 2015). The avenue through which this may occur is via use of prescribed analgesics to alleviate symptoms of mental health conditions (Geisser, Cano, & Foran, 2006; Lord, Brevard, & Budman, 2011; Wasan et al., 2007), an effect that is compounded when acute pain persists.

About one third of youth presenting for acute pain treatment report clinically significant depressive symptoms, which can, in turn, increase persistence of pain (Lewandowski Holley, Wilson, Cho, & Palermo, 2017). This can subsequently enhance risk of protracted opioid use for relief of both pain and depressive symptoms. Among adolescents admitted to the hospital for acute injury and given an opioid prescription, those who reported depressive symptoms at intake reported significantly more sustained prescription opioid use postrelease (Whiteside et al., 2016). Additionally, youth experiencing comorbid chronic pain and mental health diagnoses show two times the risk for developing long-term opioid use as compared to no use (Richardson et al., 2012).

Childhood trauma can also contribute to increased risk of adverse pain and opioid use outcomes, independent of mental health diagnoses such as anxiety and depression (Tietjen et al., 2010). Physical and emotional abuse in childhood are associated with various pain diagnoses in adulthood, including chronic migraines, arthritis, irritable bowel syndrome, and fibromyalgia (Tietjen et al., 2010). Further, individuals reporting childhood trauma are also more likely to experience comorbid pain conditions in adulthood (Tietjen et al., 2010), and higher subjective pain and multiple pain complaints are associated with higher risk of opioid misuse (Sehgal, Manchikanti, & Smith, 2012). Additionally, childhood trauma is associated with increased incidence of mental health symptoms, particularly anxiety and depression (Hovens et al., 2010), subsequently compounding risk for opioid abuse via potentiating mental health vulnerabilities.

Distress intolerance

Distress intolerance, or the perceived inability to tolerate painful, aversive physical and emotional states, represents a risk factor for prescription opioid misuse among adults with chronic pain (McHugh et al., 2016). Adolescents who experience pain, including relatively greater distress, and have less ability to navigate, mitigate, or tolerate this distress, can experience a positive reduction in physical and psychological pain in the context of opioid use. Prescription opioids not only possess analgesic properties but also induce a euphoric state that can alleviate negative affect (Brady, McCauley, & Back, 2015). Adolescents’ perception of pain severity can be a stronger predictor of long-term use than injury severity itself (Whiteside et al., 2016). Similar findings have demonstrated that fear of pain in children with new-onset pain predicts higher pain-related disability (Lewandowski Holley et al., 2017). Further, anxiety sensitivity predicts pain chronicity (Page, Stinson, Campbell, Isaac, & Katz, 2013). Consequently, youth experiencing high levels of distress intolerance may be at increased risk for both opioid misuse as well as adverse consequences of pain experience. This may turn into a feed-forward loop, as chronic pain and pain-related disability are also associated with long-term opioid use, thereby creating a multidirectional pattern of long-term synergistic risk for opioid consumption compounded by the interaction of psychophysiological and somatic processes (Roeckel, Le Coz, Gavériaux-Ruff, & Simonin, 2016).

Postprescription risk factors

Persistent pain

Given that chronic postoperative pain has been observed in pediatric samples (Fortier, Chou, Maurer, & Kain, 2011) and impacts up to one quarter of children (Page et al., 2013; Rabbitts, Fisher, Rosenbloom, & Palermo, 2017), it is important to account for the compounded risk of opioid misuse in youth whose pain persists and intensifies. Among high school students reporting nonmedical use of prescription opioids, previous medical use was associated with pain relief motives to use (McCabe & Cranford, 2012). This indicates both persistent pain within this population and the risk of postprescription nonmedical use that is facilitated by a legitimate prescription and motivated by ongoing, untreated pain.

Pain catastrophizing

Pain catastrophizing has been associated with increased opioid misuse in adults (Martel, Wasan, Jamison, & Edwards, 2013; Morasco, Turk, Donovan, & Dobscha, 2013). In contrast, low pain catastrophizing and higher pain self-efficacy can be protective (Asghari & Nicholas, 2001; Kalapurakkel, Carpino, Lebel, & Simons, 2015; Ramirez-Maestre, Esteve, Ruiz-Parraga, Gomez-Perez, & Lopez-Martinez, 2017); youth with higher pain self-efficacy are less likely to become disabled in the context of chronic pain (Kalapurakkel et al., 2015) and possibly acute pain (Sandborgh, Johansson, & Soderlund, 2016). Additionally, in adults, prescription opioid use predicts sustained pain and disability as well increased pain sensitivity (Chou et al., 2015; Dobscha et al., 2016; Dowell et al., 2016; Edwards et al., 2016). Thus, seeking to achieve pain relief can perpetuate opioid misuse among adolescents (McCabe & Cranford, 2012; McCabe, West, & Boyd, 2013b; Whiteside et al., 2016).

Positive opioid experience

Receipt of a legitimate opioid prescription can and, unintentionally, does expose previously substance-naïve youth to a pleasurable “high” experience (Brady et al., 2015; McCabe & Cranford, 2012), often under the assumption of safety derived from a prescription from, and presumed oversight by, a medical professional. Youth with little to no drug experience, nonexistent or ambiguous expectations regarding substance use, or negative perceptions of substance use may find these secondary benefits of opioid use to be pleasurable, or at least beneficial in terms of assuaging physical or emotional pain. Thus, non-drug-seeking youth may inadvertently be at elevated risk for opioid misuse simply because they experienced a pain condition and received a legitimate prescription (McCabe & Cranford, 2012; Miech et al., 2015). Among adolescents with minimal exposure to and high disapproval of illicit substances, a legitimate opioid prescription predicted misuse of opioids after high school, potentially because of pain relief and a safe drug experience that contradict negative expectations and high-risk perception (Miech et al., 2015). This is worthy of note, as positive initial drug experience is highly associated with future misuse (Lynskey et al., 2003). In turn, exposure to positive analgesic and stress-reducing aspects of opioids can thus exacerbate both neural and behavioral risk for continued use, even for non-drug-seeking youth, during this highly sensitive period of neurodevelopment.

Peer Group Risk Factors for Opioid Misuse in Youth

Preexisting contextual risk factors

Peer(s) with substance use

As reviewed in recent overviews of the impact of peers on adolescent substance use (Caouette & Feldstein Ewing, 2017), the proportion of substance-using friends continues to be one of the strongest predictors of adolescents’ decision to engage in substance use (Connell, Gilreath, Aklin, & Brex, 2010). Furthermore, adolescents’ perception of peer substance use relates to current and future substance use (D’Amico & McCarthy, 2006; Kilmer et al., 2006). This parallels findings from studies with adolescents and emerging adults (ages 14 to 21), in which peer behavior contributed to much poorer alcohol and cannabis use outcomes as distally as 7 years post-initial examination (Feldstein Ewing, Filbey, Loughran, Chassin, & Piquero, 2015).

Given the high impact of peers on adolescent substance use across the fields of cannabis, alcohol, and tobacco, numerous prevention and treatment teams have increasingly been incorporating peers into their intervention programming in an effort to enhance adolescent treatment response (Colder et al., 2017; Lee et al., 2014), including on electronic/social-media peer platforms (Steers, Moreno, & Neighbors, 2016). Given the strong relationships between peer behavior and risky substance use in other substances of abuse, it is probable that similar effects exist for prescription opioids; however, there is, to date, no research addressing peer influence on prescription opioid use in the context of pediatric pain. Youth with pain are more likely to be bullied and isolated from peers (Forgeron et al., 2010); it therefore stands to reason that, among youth experiencing pain, navigating peers may increase risk of engaging in substance use, including use of opioids, for the purpose of regaining social capital or fitting in. Although there is not yet enough evidence to distinguish youth’s specific motives for opioid use in terms of pain mitigation versus social navigation, this represents a salient risk and potential point of intervention for high-school-aged youth in light of the influential nature of peer relationships on youth engagement in substance use.

Low perceived risk of harm from opioid use

There is an inverse relationship between perception of risk and engagement in substance use (Johnston, O’Malley, Bachman, & Schulenberg, 2012; Lipari, 2013), such that perceived risk of harm is associated with greater likelihood of delayed transition to experimentation and use (Feldstein Ewing et al., 2017; Grevenstein, Nagy, & Kroeninger-Jungaberle, 2015; Piontek, Kraus, Bjarnason, Demetrovics, & Ramstedt, 2013). Opioids are unique by virtue of the fact that they are provided by medical professionals in the context of treatment, potentially resulting in mixed signals with respect to their associated risks; a majority of college students do not perceive great harm from regular use of prescription opioids (Lord et al., 2011). While there is minimal research addressing the trajectory of risk perception surrounding prescription opioids in children and adolescents, low perceived harmfulness is related to misuse of prescription opioids in college students, and high perceived harmfulness is a protective factor (Arria, Caldeira, Vincent, O‘Grady, & Wish, 2008).

Given the evidence that perceived risk of substances is connected to adolescents’ willingness to experiment with substances (Kosterman et al., 2016; Lipari, 2013), teens with low perceived risk of opioids are likely to feel less urgency around limiting their prescription opioid use to the context of pain management. In contrast, they may be more likely to experiment with their peers’ opioid prescriptions and/or transition to misuse of their own opioid prescriptions (Johnston, O’Malley, Bachman, & Schulenberg, 2008; McCabe, Boyd, Cranford, & Teter, 2009; McCabe & Cranford, 2012); this behavior is facilitated by the frequent abundance of leftover medication that remains even after pain remits and easy accessibility of parents’ medications (Friese, Moore, Grube, & Jennings, 2013; Voepel-Lewis, Zikmund-Fisher, Smith, Zyzanski, & Tait, 2015). For example, youth who have low perceived risk of harm from opioids may be at increased risk of using not to manage pain but rather to derive other perceived positive benefits (e.g., mood-enhancing, stress-reducing, and anxiolytic effects). In contrast, adolescents with high perceived risk of harm may be better able to terminate use of prescribed opioids as soon as pain remits. At the same time, a positive first experience within a medically legitimate context can lower perception of risk and increase positive expectancies of pain medication, even among those reporting strong negative feelings about substance use (Miech et al., 2015).

Postprescription risk factors

Available peer opioid prescriptions

Among adolescents, peers are a leading source of prescription opioids that facilitate illicit use (McCabe & Boyd, 2005; McCabe, Cranford, Boyd, & Teter, 2007). Preliminary work shows 12- to 17-year-olds who struggle with opioids obtain them from their peers (Russell, Trudeau, & Leland, 2015); although the proportion of youth who obtain opioids from their peers for pain management versus recreational use remains unknown, these groups are not mutually exclusive (McCabe et al., 2009; McCabe & Cranford, 2012). Among high school seniors who report misuse of prescription opioids, 55% endorsed receiving them for free from a friend or relative, 37.9% endorsed buying them from a friend or relative, and 22.2% endorsed taking them from a friend or relative without asking (McCabe, West, & Boyd, 2013a). It is notable that using prescription opioids received from peers, but not from parents, is associated with riskier routes of administration (e.g., intranasal) and more problematic substance use behavior (McCabe et al., 2007, 2013a). Additionally, adolescents who use opioids nonmedically but were introduced to them in a medical context are more likely to seek out prescription opioids illicitly for pain relief, rather than experimental, reasons as compared to those who initiated opioid use recreationally (McCabe & Cranford, 2012).

Peer norms regarding opioids

Throughout the extensive biopsychosocial changes of adolescence (Windle et al., 2008), peer behavior remains a steadfast predictor of adolescent substance use. Adolescents experience a surge in self-consciousness, becoming keenly attuned to peers’ opinions (Sebastian, Burnett, & Blakemore, 2008) in response to both actual and presumed levels of peer scrutiny (Elkind, 1967). Youth spend less time with parents and peer input takes primacy (Ernst, Pine, & Hardin, 2006; Sebastian et al., 2008), particularly for youth with difficult parent relationships (Windle et al., 2008). Simultaneously, most youth begin to make decisions about whether and when to engage in substance use, situations that most often arise in peer-based contexts (Caouette & Feldstein Ewing, 2017). In light of this, adolescents are particularly susceptible to perceived normative behavior of peers and are more likely to engage in substance use behavior that they believe to be standard in their peer group (Litt & Stock, 2011); roughly 16% of high school seniors report using prescription opioids nonmedically to fit in (McCabe et al., 2009). Many adolescents overestimate the amount of substance use, including prescription opioids, in their peer group (McCabe, 2008; Sanders, Stogner, Seibert, & Miller, 2014), which makes them more susceptible to substance use and related problems (Haug, Ulbricht, Hanke, Meyer, & John, 2011; Perkins, 2012). Youth experiencing pain are vulnerable to bullying from peers (Forgeron et al., 2010), potentially also increasing their vulnerability to peer influence and perceptions of normative peer behavior.

Familial Risk Factors for Opioid Misuse in Youth Experiencing Pain

Preexisting contextual risk factors

Parent(s) with chronic pain

The genetic heritability of chronic pain is well established (Hestbaek, Iachine, Leboeuf-Yde, Kyvik, & Manniche, 2004), and the burden experienced by parents with chronic pain often extends to their children (Stone & Wilson, 2016). A growing body of research reflects increased risk of chronic pain and disability in offspring of adults with chronic pain (Coenders et al., 2014; Hoftun, Romundstad, & Rygg, 2013; Piira & Pullukat, 2006; Stanford, Chambers, Biesanz, & Chen, 2008). While there is a dearth of research specifically on opioid use outcomes in children of parents with chronic pain, parental chronic pain increases the risk for other types of adolescent substance use, including alcohol and tobacco use (Kaasboll, Lydersen, & Indredavik, 2014). Consequently, there is reason to believe that parental chronic pain enhances the risk of adolescent opioid misuse via increased adolescent pain experience, persistence of adolescent pain problems, and, while the mechanisms of effect are unknown, increased risk for overall substance misuse (Stone & Wilson, 2016).

The social and emotional climate in the home can even more substantially impact both pain experience and risk of substance use, particularly among adolescents who live with parents (Hestbaek et al., 2004; Hoftun et al., 2013; Mikkelsson, Kaprio, Salminen, Pulkkinen, & Rose, 2001; Palermo, Valrie, & Karlson, 2014). Parents with chronic pain demonstrate a disruption of parenting and attachment styles that are linked to substance use (Hoffmann & Bahr, 2014; Wilson & Fales, 2015). This effect is compounded in children with two parents experiencing chronic pain (Hoftun et al., 2013; Stone & Wilson, 2016). Children living with at least one parent with chronic pain are at increased risk for chronic pain and psychological problems (Evans, Shipton, & Keenan, 2006; Higgins et al., 2015), factors that themselves exacerbate risk for opioid misuse and addiction (Boscarino et al., 2010; Edlund et al., 2010; Liebschutz et al., 2010; Swendsen et al., 2010). This is concerning in light of findings that mothers with chronic pain exhibit a more permissive parenting style (Evans et al., 2006), also associated with adolescent substance use (Donaldson, Nakawaki, & Crano, 2015; Steinberg, Fletcher, & Darling, 1994). Additionally, these youth are often exposed to chronic stressors, such as poor family functioning, family stress, and low family cohesion, that place them at increased risk for adverse physical and mental syndromes including heart disease, hypertension, depression, and anxiety (Repetti, Taylor, & Seeman, 2002; Stone & Wilson, 2016).

Parents with chronic pain catastrophize about their child’s pain more, subsequently communicating high-threat information about pain; this can, and does, influence their child’s beliefs about experiencing pain (Langer, Romano, Levy, Walker, & Whitehead, 2009; Stone & Wilson, 2016). This also leads to communication that rapid pain amelioration through administration of analgesics is the best method to negotiate pain. Moreover, evidence supports a relationship between maternal medicating behavior and administration of over-the-counter analgesics to their children (Jensen et al., 2014). This transmission of information, modeling of pain experience, and connection of pain to impaired function leads to higher child-reported pain and activity restriction (Stone & Wilson, 2016).

Parent behaviors

There are numerous routes whereby parent factors exacerbate substance use risk. Family substance use history can contribute to differential brain processing in the context of substance use and rewarding positive experience of substance use, subsequently increasing adolescent likelihood of use (Cservenka, Alarcón, Jones, & Nagel, 2015). Similarly, parent substance use at home, including norms of use around the house and approval of recreational substance use, impacts adolescents’ perception of when, where, and how substances should be used (Epstein et al., 2015; Gilligan & Kypri, 2012).

In turn, one of the most modifiable parental behaviors around substance use includes parental monitoring (Karoly, Callahan, Schmiege, & Feldstein Ewing, 2015). Less monitored youth have more opportunities to experiment with illicit substances without consequence. They also tend to maintain social ties with peers who use substances, which, in turn, increases likelihood of substance use. Low parental monitoring predicts positive attitudes toward substance use and ties to social environments and peers in which substance use is tolerated or viewed positively, factors associated specifically with opioid misuse (Donaldson et al., 2015). Similarly, parental involvement is a protective factor against opioid misuse in youth (Sung, Richter, Vaughan, Johnson, & Thom, 2005). Parent history, parenting style, and disruptive home environments can impact development of pain and use of analgesic medication in children (Skarstein, Lagerlov, Kvarme, & Helseth, 2016). Finally, the majority of parents who have addictive prescription drugs in the home do not take recommended precautions (e.g., use of a safe) to keep teens from accessing these drugs (Friese et al., 2013), providing easy access to the substance and opportunity to use, particularly among less monitored youth.

Postprescription risk factors

Parents’ perceived risk of opioids

Parents are an influential factor in modeling their children’s pain responses. Social Learning Theory posits that children’s responses to pain may be learned through observation of their parents’ responses to pain (Bandura, 1977). When children are younger, they are strongly influenced by their parents, rendering parental behavioral modeling of medication use highly impactful during early developmental stages. Thus, parent beliefs and behaviors around pain, pain medication, and medical treatment influence children’s beliefs through this observational learning (Bandura, 1977; Levy et al., 2004; Van Tilburg et al., 2015) and are a contributing factor to adolescents’ attitudes about analgesic medication (Holmstrom, Bastholm-Rahmner, Bernsten, Roing, & Bjorkman, 2014). Parents model pain medication use (routine use or with increased pain), which is influenced by their own perceptions of opioid risk (Kosterman et al., 2016). Particularly in younger age groups, parental beliefs about medication, its dangers, and its utility influence children’s medication compliance (Kankkunen, Vehviläinen-Julkunen, Pietilä, Kokki, & Halonen, 2003). For parents of children undergoing elective outpatient surgery, (mis)information about pain medication predicted dose of analgesic medication (Rony, Fortier, Chorney, Perret, & Kain, 2010), resulting in poor control of their child’s pain and a surplus of opioid analgesic medication in the home (Porucznik et al., 2010; Voepel-Lewis et al., 2015).

Household opioid availability, storage, and monitoring

Prescription opioid availability in the home is also a critical contributing factor, particularly for youth experiencing pain. Many parents, particularly those of younger children, may very carefully administer medication such that they are left with a large amount of leftover medication (Mazer-Amirshahi, Mullins, Rasooly, van den Anker, & Pines, 2014; Rony et al., 2010). Ultimately, 79% of families have enough leftover medication to treat pain for 2 to 3 additional weeks after initial symptom resolution (Voepel-Lewis et al., 2015). Similarly, parents are frequently prescribed more opioids than they need or use and keep the remainder at home (Porucznik et al., 2010). Given the high cost of many medications, it is not surprising that many parents often do not dispose of leftover medication and report intent to keep the medications in the home for future use (Abou-Karam et al., 2015). Furthermore, parents infrequently lock prescription medications, and over 50% of teens report easy access to medication in their parent’s medicine cabinet (Friese et al., 2013). These factors result in a cache of opioids around the house that can be easily misused or overtaken by children and adolescents (Burghardt et al., 2013). Given the connection between availability and transition to abuse (Gillespie, Neale, & Kendler, 2009), household availability can serve as a context for opioid prescription misuse, particularly among youth whose pain has been undertreated (McCabe & Cranford, 2012). In fact, 40% of high school seniors report sourcing misused opioids from accessing their own previous prescription (Johnston et al., 2008), and a significant portion report being given prescription opioids by family members or simply taking them without permission (McCabe et al., 2013a). Additionally, household availability is a significant risk factor for youth who experience and remember positive pain resolution and emotional outcomes from opioids (Casey et al., 2010; Conrod & Nikolaou, 2016; Hollenstein & Lougheed, 2013).

Parents also influence adolescent opioid use via medication monitoring. A majority of adolescents report no parental supervision of their opioid medication (Ross-Durow, McCabe, & Boyd, 2013). This can set the stage for difficulties knowing when or how to discontinue legitimate use after pain abatement as well as exacerbate misuse following medical use (Johnston et al., 2008; Miech et al., 2015). There are limited data on how medication is managed within the family (i.e., parent monitoring of pain and medication) and which youth continue to experience pain symptoms and pain-related anxiety when they stop opioids or seek continued medication despite resolution of pain.

Parent pain catastrophizing

Adolescents with chronic pain conditions are able to accurately observe and report on parental pain behaviors, indicating that pain-specific social learning is an influential factor in the development of chronic pain conditions (Bandura, 1977; Stone & Wilson, 2016). Parental catastrophizing of a child’s pain is associated with greater pain and pain-related disability in the child (Rabbitts, Zhou, Groenewald, Durkin, & Palermo, 2015; Wilson, Moss, Palermo, & Fales, 2014). Thus, parents can model maladaptive pain responses and reinforce these behaviors in their children (Stone & Wilson, 2016). Given that pain experience is linked to licit and illicit opioid use, parents can indirectly impact their child’s opioid use behavior through pain catastrophizing. Furthermore, parents who are highly fearful of and/or reactive to pain may increase their child’s vulnerability to pain through teaching pain responses, such as overprotecting children from the threat of bodily pain via use of analgesic medication at the expense of normalizing the experience of pain, communicating appropriate levels of pain tolerance, and modeling nonpharmacological approaches to coping with it.

Risks and Adverse Outcomes Associated With Opioid Treatment for Pain

Chronic pain, disability, and hyperalgesia

Among adults, there is evidence for an iatrogenic relationship between opioids and pain, wherein continued use of opioids increases pain sensitivity (Edwards et al., 2016). In adults, chronic opioid use increases risk for persistent pain, disability, and opioid-induced hyperalgesia (Roeckel et al., 2016; Yi & Pryzbylkowski, 2015). In both VA and other health care system patients, adults prescribed the highest doses of opioids are most likely to have comorbid pain-related diagnoses, comorbid psychiatric and substance use disorders, and higher pain intensity (Kobus et al., 2012; Morasco, Duckart, Carr, Deyo, & Dobscha, 2010; Morasco et al., 2017). Continued opioid prescriptions are also associated with less sustained improvement in adults (Dobscha et al., 2016). While these poorer outcomes could be due to chronic opioid therapy patients being more likely to evidence severe or unremitting pain conditions, adult initiates of long-term opioid therapy for chronic pain have poorer pain and activity interference outcomes than do patients with minimal or no opioid use, even within comparable pain types (Turner et al., 2016). Given the observed trajectories for adults administered prescription opioids in medical settings, it is plausible that children and adolescents with similar pain and opioid treatment experiences are also at increased risk for poorer outcomes in terms of pain and disability and opioid misuse trajectories. It is important to note that the directionality and causality of chronic opioid use and these adverse outcomes are unclear, as there is a lack of long-term (i.e., over 1 year) research directly comparing opioid therapy as compared to no treatment. Thus, those patients who received long-term opioid therapy (beyond 3 months) and/or high doses may be at risk for adverse outcomes simply by the nature of their pain condition.

Continued use of opioid prescription, refills, and dosage

One highly relevant risk factor for which data are lacking regards which adolescents are likely to obtain a refill and how refills impact later opioid misuse. Even less is known about which adolescents are able to terminate opioid use. Physician instruction to discontinue use within a certain timeframe does influence opioid cessation after injury, but it is not standard practice to provide specific instructions about how and when to stop (Holman et al., 2014). Prescriptions are dispensed with limited label instructions (e.g., “take 1–2 tablets as needed every 4 hours”), and written instructions are often inadequate, poorly comprehended, and misplaced by patients (Osborne & Bryant, 2003; Spandorfer, Karras, Hughes, & Caputo, 1995). Thus, decisions about when and how to discontinue use is often left up to youth and their parents.

While the majority of longitudinal research exists in adult populations, emerging evidence with adolescents suggests that that legitimate use of prescription opioids in adolescence increases risk of long-term opioid use for pain management (McCabe, Veliz, & Schulenberg, 2016; Miech et al., 2015). Clearly, the pain experience necessarily predicates receipt of an opioid prescription. However, the initial utilization of opioids for acute pain increases risk for continued use of opioids as a primary method of analgesia (Shah, 2017), potentially at the expense of other less risky methods of treatment. Furthermore, continued use of opioids to treat chronic pain is associated with increased sensitivity to pain, physiological tolerance to opioids, and opioid use disorder (Blanco et al., 2016; Roeckel et al., 2016), further perpetuating opioid use and its cyclical relationship with poor pain outcomes.

Opioid-related substance abuse problems

Among adolescents and young adults who use heroin, easy access to prescription opioids through personal prescriptions, home availability, and access through friends were key factors in transitioning from oral use of prescription opioids (Lankenau et al., 2012). Both accidental and intentional opioid overdose and poisoning have also become increasingly common among both younger children and adolescents (Burghardt et al., 2013). These phenomena are more consistently established in adult research: Among adults, opioid misuse has been connected to the transition into heroin use, opioid overdose, and death (Banerjee et al., 2015; Bartels et al., 2016; Martins et al., 2017).

Nonpharmacologic approaches to pain treatment

Little is known about the role of nonpharmacologic, self-management, or complementary and integrative medicine (CIM) pain treatments that may reduce the need for opioid refills in the context of acute pain or opioid prescription in youth (Ali, Drendel, Kircher, & Beno, 2010; Le May et al., 2016). Nonpharmacologic approaches are recommended as part of acute pain management guidelines for children and adolescents (Committee on Psychosocial Aspects of Child and Family Health, 2001). CIM for youth involves specific techniques to optimize pain management, including the PRICE method (protection, rest, ice, compression, and elevation). It also includes broader nonmedication approaches, including short-term immobilization via splint or cast as well as distraction and breathing. Thermal regulation and massage can also mitigate chronic pain (Ali et al., 2010).

In adults, CIM approaches show promise for helping phase out opioid use and misuse (Garland et al., 2017; Mehl-Madrona, Mainguy, & Plummer, 2016). Prior pediatric work shows that youth with chronic pain prefer noninvasive CIM approaches (Groenewald, Wright, & Palermo, 2015; Toliver-Sokol, Murray, Wilson, Lewandowski, & Palermo, 2011; Tsao, Meldrum, Kim, Jacob, & Zeltzer, 2007). Family income has been associated with increased utilization of these approaches (Toliver-Sokol et al., 2011). Preliminary data suggest the promise of intensive interdisciplinary approaches to obviate the need for opioid medications in youth with chronic pain (Bruce et al., 2017).

In addition to CIM, there are a number of behavioral treatments for chronic pain that psychologists, particularly those working in hospital settings, are well poised to implement. There is evidence for behavioral (Block, Kremer, & Gaylor, 1980; Fordyce, Roberts, & Sternbach, 1985; McCracken & Turk, 2002; van Tulder et al., 2000), cognitive behavioral (McCracken & Turk, 2002), and mindfulness-based approaches (Morone, Greco, & Weiner, 2008; Veehof, Oskam, Schreurs, & Bohlmeijer, 2011; Veehof, Trompetter, Bohlmeijer, & Schreurs, 2016) for coping with pain. These approaches contribute to successful chronic pain management in the absence of opioid-based pharmacologic interventions, particularly in reducing pain, distress, and improving daily functioning. The greatest benefit has been observed for adult patients with mild to moderate, rather than severe, pain (McCracken & Turk, 2002). These strategies are also showing true promise in pediatric patients (Eccleston et al., 2014).

Diathesis-Stress Model of Peer and Parent Influences on Pain Outcomes and Opioid Use

While opioid prescriptions are made in response to a patient’s pain presentation, adolescent addiction models typically do not consider the role of pain characteristics, including pain chronicity and expected pain recovery (McCabe et al., 2016). Summarizing the paths of review, the proposed integrated theoretical model (see Fig. 1) draws from diathesis-stress models in which children with high genetic loading for addiction are predisposed to develop substance abuse in the context of exposure to substances (Lorenzetti et al., 2016), developmental models of adolescent substance abuse (e.g., Conrod & Nikolaou, 2016; Prado et al., 2009), and intergenerational models of pain (e.g., Palermo et al., 2014; Stone & Wilson, 2016), with unique consideration for factors relevant to opioid prescriptions and pain. This expanded model posits risk and protective factors at several levels, both pre- and postprescription, including bidirectional and interactive effects, and expands consideration across individual, parental, and peer influences on pain and opioid outcomes. Further, paths are suggested wherein which inherited and environmental individual risks for adverse outcomes lead to lowered resilience in the face of pain experiences, increased availability of prescription opioids, and higher susceptibility to opioid misuse, particularly in risky peer and family contexts.

Fig. 1.

Integrated theoretical model of risk and protective factors for pain and opioid use outcomes among youth receiving an opioid prescription.

Limitations and future directions

While the presented model identifies individual, peer, and familial risks that heighten risk for misuse both before and after prescription receipt, future longitudinal research will help unravel the long-term trajectory of youth experiencing pain who receive opioid prescriptions, including differential use and sequelae for youth with various and distinct motives for their use. Initial steps are being taken in this direction; data regarding refill rates, increasing dosage, and increased pain sensitivity in youth receiving legitimate prescriptions will improve with future studies in this area.

Particularly important to consider in the context of opioid access to children and adolescents with chronic pain is the legal provision of a substance with abuse potential via a medical system accessed for the purpose of treatment. Thus, while models of substance abuse and addiction in youth often integrate the notion that rules and norms are violated in order to engage in such behavior (Conrod & Nikolaou, 2016), the provision of opioids to children and adolescents in a medical setting exposes youth who may not seek out these kinds of illicit experiences to potentially addictive substances. While many youth may express high disapproval of substance use, they are receiving legitimate prescriptions from doctors and are susceptible to increased risk of opioid use disorder even if taking their medication as prescribed (Hah, 2016; McCabe et al., 2016; Miech et al., 2015). Facilitating this effect is the lack of physician-provided information regarding use and discontinuation of use of prescription opiates (Holman et al., 2014), particularly among youth (Dowell et al., 2016; Schechter & Walco, 2016), leaving much of the decision-making regarding adolescent opioid administration up to youth and their parents.

Conclusion

This model offers one initial perspective to inform future development of effective prevention programs for children and adolescents experiencing pain who may be at increased risk for opioid-related problems. Many of the proposed risk and protective factors can be identified and targeted in medical settings, which could lead to the development of prevention programs designed to reduce opioid misuse and abuse. For instance, prevention efforts designed to reduce pain catastrophizing, increase utilization of nonopioid approaches to treating and reducing pain, and provide detailed information on tapering off of opioids might be provided as a means of mitigating the potential risks for opioid misuse. Psychologists working in medical settings are in a unique position to provide input on policies and guidelines that can reduce risk for misuse and abuse among youth prescribed opioids for pain.

Supplemental Material

Dash_Open_Practices_Disclosure – Supplemental material for A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents

Supplemental material, Dash_Open_Practices_Disclosure for A Model of the Intersection of Pain and Opioid Misuse in Children and Adolescents by Genevieve F. Dash, Anna C. Wilson, Benjamin J. Morasco and Sarah W. Feldstein Ewing in Clinical Psychological Science

Footnotes

Action Editor

John J. Curtin served as action editor for this article.

Author Contributions

G. F. Dash, A. C. Wilson, and S. W. Feldstein Ewing contributed to conceptualization and development of review topic, scope, and content. G. F. Dash drafted the manuscript, and A. C. Wilson, B. J. Morasco, and S. W. Feldstein Ewing provided critical contributions to sections of relative expertise as well as revisions to the manuscript in its entirety. All the authors approved the final version of the manuscript for submission.

Declaration of Conflicting Interests

The author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article.

Funding

This work was supported by National Institute on Alcohol Abuse and Alcoholism Grant 1R01-AA023658-01 (to S. W. Feldstein Ewing), Eunice Kennedy Shriver National Institute of Child Health and Human Development Grant R01-HD082200-01 (to A. C. Wilson), National Institute on Drug Abuse Grant R01-DA034083 (to B. J. Morasco), and National Institute on Drug Abuse Grant 1R01-DA044778-01A1 (to A. C. Wilson and S. W. Feldstein Ewing).

References

Abou-Karam

Dube

Kvann

H. S.

Mollica

Racine

Bussieres

J. F.

. . . Thibault

(2015). Parental report of morphine use at home after pediatric surgery. Journal of Pediatrics, 167(3), 599–604, e591–e592. doi:10.1016/j.jpeds.2015.06.035

Ali

Drendel

A. L.

Kircher

Beno

(2010). Pain management of musculoskeletal injuries in children: Current state and future directions. Pediatric Emergency Care, 26(7), 518–524.

Arria

A. M.

Caldeira

K. M.

Vincent

K. B.

O‘Grady

K. E.

Wish

E. D.

(2008). Perceived harmfulness predicts nonmedical use of prescription drugs among college students: Interactions with sensation-seeking. Prevention Science, 9(3), 191–201. doi:10.1007/s11121-008-0095-8

Asghari

Nicholas

M. K.

(2001). Pain self-efficacy beliefs and pain behaviour: A prospective study. Pain, 94(1), 85–100.

Bandura

(1977). Social learning theory. Englewood Cliffs, NJ: Prentice-Hall.

Banerjee

Edelman

E. J.

Barry

D. T.

Becker

Cerda

Crystal

. . . Marshall

B. D.

(2015). Incident non-medical use of prescription opioids is associated with heroin initiation among U.S. veterans: A prospective cohort study. Drug and Alcohol Dependence, 156, e14–e15. doi:10.1016/j.drugalcdep.2015.07.958

Bartels

Binswanger

I. A.

Hopfer

C. J.

(2016). Sources of prescription opioids for nonmedical use. Journal of Addiction Medicine, 10(2), 134. doi:10.1097/ADM.0000000000000192

Berde

C. B.

Sethna

N. F.

(2002). Analgesics for the treatment of pain in children. New England Journal of Medicine, 347(14), 1094–1103.

Best

A. D.

De Silva

Thomson

Tong

D. C.

Cameron

C. M.

De Silva

H. L.

(2017). Efficacy of codeine when added to paracetamol (acetaminophen) and ibuprofen for relief of postoperative pain after surgical removal of impacted third molars: A double-blinded randomized control trial. Journal of Oral and Maxillofacial Surgery, 75(10), 2063–2069.

10.

Blanco

Wall

M. M.

Okuda

Wang

Iza

Olfson

(2016). Pain as a predictor of opioid use disorder in a nationally representative sample. American Journal of Psychiatry, 173(12), 1189–1195. doi:10.1176/appi.ajp.2016.15091179

11.

Block

A. R.

Kremer

E. F.

Gaylor

(1980). Behavioral treatment of chronic pain: The spouse as a discriminative cue for pain behavior. Pain, 9(2), 243–252.

12.

Boscarino

J. A.

Rukstalis

Hoffman

S. N.

Han

J. J.

Erlich

P. M.

Gerhard

G. S.

Stewart

W. F.

(2010). Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction, 105(10), 1776–1782. doi:10.1111/j.1360-0443.2010.03052.x

13.

Brady

K. T.

McCauley

J. L.

Back

S. E.

(2015). Prescription opioid misuse, abuse, and treatment in the United States: An update. American Journal of Psychiatry, 173(1), 18–26.

14.

Bruce

B. K.

Ale

C. M.

Harrison

T. E.

Bee

Luedtke

Geske

Weiss

K. E.

(2017). Getting back to living: Further evidence for the efficacy of an interdisciplinary pediatric pain treatment program. The Clinical Journal of Pain, 33(6), 535–542.

15.

Burghardt

L. C.

Ayers

J. W.

Brownstein

J. S.

Bronstein

A. C.

Ewald

M. B.

Bourgeois

F. T.

(2013). Adult prescription drug use and pediatric medication exposures and poisonings. Pediatrics, 132(1), 18–27. doi:10.1542/peds.2012-2978

16.

Caouette

J. D.

Feldstein Ewing

S. W.

(2017). Four mechanistic models of peer influence on adolescent cannabis use. Current Addiction Reports, 4(2), 90–99.

17.

Casey

B. J.

(2015). Beyond simple models of self-control to circuit-based accounts of adolescent behavior. Annual Review of Psychology, 66, 295–319. doi:10.1146/annurev-psych-010814-015156

18.

Casey

B. J.

Jones

R. M.

Levita

Libby

Pattwell

S. S.

Ruberry

E. J.

. . . Somerville

L. H.

(2010). The storm and stress of adolescence: Insights from human imaging and mouse genetics. Developmental Psychobiology, 52(3), 225–235. doi:10.1002/dev.20447

19.

Center for Behavioral Health Statistics and Quality. (2016). 2015 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Heath Services Administration.

20.

Centers for Disease Control and Prevention. (2017). Opioid prescribing: Where you live matters. CDC Vital Signs. Retrieved from https://www.cdc.gov/vitalsigns/opioids/infographic.html#graphic-b

21.

Choo

E. K.

Feldstein Ewing

S. W.

Lovejoy

T. I.

(2016). Opioids out, cannabis in: Negotiating the unknowns in patient care for chronic pain. JAMA, 316(17), 1763–1764. doi:10.1001/jama.2016.13677

22.

Chou

Deyo

Devine

Hansen

Sullivan

Jarvik

J. G.

. . . Turner

(2014). The effectiveness and risks of long-term opioid treatment of chronic pain. Evidence Report/Technology Assessment No. 218 (AHRQ Publication No. 14-E005-EF). Rockville, MD: Agency for Healthcare Research and Quality.

23.

Chou

Fanciullo

G. J.

Fine

P. G.

Adler

J. A.

Ballantyne

J. C.

Davies

. . . Fudin

(2009). Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain. The Journal of Pain, 10(2), 113–130.

24.

Chou

Turner

J. A.

Devine

E. B.

Hansen

R. N.

Sullivan

S. D.

Blazina

. . . Deyo

R. A.

(2015). The effectiveness and risks of long-term opioid therapy for chronic pain: A systematic review for a National Institutes of Health Pathways to Prevention Workshop. Annals of Internal Medicine, 162(4), 276–286. doi:10.7326/M14-2559

25.

Coenders

Chapman

Hannaford

Jaaniste

Qiu

Anderson

. . . Champion

(2014). In search of risk factors for chronic pain in adolescents: A case-control study of childhood and parental associations. Journal of Pain Research, 7, 175–183. doi:10.2147/JPR.S48154

26.

Colder

C. R.

Read

J. P.

Wieczorek

W. F.

Eiden

R. D.

Lengua

L. J.

Hawk

L. W.

Jr. . . . Lopez-Vergara

H. I.

(2017). Cognitive appraisals of alcohol use in early adolescence: Psychosocial predictors and reciprocal associations with alcohol use. The Journal of Early Adolescence, 37(4), 525–558.

27.

Committee on Psychosocial Aspects of Child and Family Health. (2001). The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 108(3), 793–797.

28.

Connell

C. M.

Gilreath

T. D.

Aklin

W. M.

Brex

R. A.

(2010). Social-ecological influences on patterns of substance use among non-metropolitan high school students. American Journal of Community Psychology, 45(1–2), 36–48. doi:10.1007/s10464-009-9289-x

29.

Conrod

P. J.

Nikolaou

(2016). Annual Research Review: On the developmental neuropsychology of substance use disorders. Journal of Child Psychology and Psychiatry, 57(3), 371–394. doi:10.1111/jcpp.12516

30.

Coté

C. J.

Kauffman

R. E.

Troendle

G. J.

Lambert

G. H.

(1996). Is the “therapeutic orphan” about to be adopted? Pediatrics, 98(1), 118–123.

31.

Cservenka

Alarcón

Jones

S. A.

Nagel

B. J.

(2015). Advances in human neuroconnectivity research: Applications for understanding familial history risk for alcoholism. Alcohol Research: Current Reviews, 37(1), 89–95.

32.

D’Amico

E. J.

McCarthy

D. M.

(2006). Escalation and initiation of younger adolescents’ substance use: The impact of perceived peer use. Journal of Adolescent Health, 39(4), 481–487. doi:10.1016/j.jadohealth.2006.02.010

33.

DeVries

Koch

Wall

Getchius

Chi

Rosenberg

(2014). Opioid use among adolescent patients treated for headache. Journal of Adolescent Health, 55(1), 128–133. doi:10.1016/j.jadohealth.2013.12.014

34.

Dobscha

S. K.

Lovejoy

T. I.

Morasco

B. J.

Kovas

A. E.

Peters

D. M.

Hart

. . . McFarland

B. H.

(2016). Predictors of improvements in pain intensity in a national cohort of older veterans with chronic pain. Journal of Pain, 17(7), 824–835. doi:10.1016/j.jpain.2016.03.006

35.

Donaldson

C. D.

Nakawaki

Crano

W. D.

(2015). Variations in parental monitoring and predictions of adolescent prescription opioid and stimulant misuse. Addictive Behaviors, 45, 14–21. doi:10.1016/j.addbeh.2015.01.022

36.

Dowell

Haegerich

T. M.

Chou

(2016). CDC guideline for prescribing opioids for chronic pain—United States, 2016. JAMA, 315(15), 1624–1645.

37.

Eccleston

Palermo

T. M.

Williams

A. C. d. C.

Holley

A. L.

Morley

Fisher

Law

(2014). Psychological therapies for the management of chronic and recurrent pain in children and adolescents. Cochrane Database of Systematic Reviews, 2, Article CD003968. doi:10.1002/14651858.CD003968.pub4

38.

Edlund

M. J.

Forman-Hoffman

V. L.

Winder

C. R.

Heller

D. C.

Kroutil

L. A.

Lipari

R. N.

Colpe

L. J.

(2015). Opioid abuse and depression in adolescents: Results from the National Survey on Drug Use and Health. Drug and Alcohol Dependence, 152, 131–138. doi:10.1016/j.drugalcdep.2015.04.010

39.

Edlund

M. J.

Martin

B. C.

Devries

Fan

M. Y.

Braden

J. B.

Sullivan

M. D.

(2010). Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: The TROUP study. The Clinical Journal of Pain, 26(1), 1–8. doi:10.1097/AJP.0b013e3181b99f35

40.

Edlund

M. J.

Martin

B. C.

Russo

J. E.

Devries

Braden

J. B.

Sullivan

M. D.

(2014). The role of opioid prescription in incident opioid abuse and dependence among individuals with chronic non-cancer pain: The role of opioid prescription. The Clinical Journal of Pain, 30(7), 557–564.

41.

Edwards

R. R.

Dolman

A. J.

Michna

Katz

J. N.

Nedeljkovic

S. S.

Janfaza

. . . Wasan

A. D.

(2016). Changes in pain sensitivity and pain modulation during oral opioid treatment: The impact of negative affect. Pain Medicine, 17(10), 1882–1891. doi:10.1093/pm/pnw010

42.

Elkind

(1967). Egocentrism in adolescence. Child Development, 38(4), 1025–1034.

43.

Epstein

Hill

K. G.

Nevell

A. M.

Guttmannova

Bailey

J. A.

Abbott

R. D.

. . . Hawkins

J. D.

(2015). Trajectories of marijuana use from adolescence into adulthood: Environmental and individual correlates. Developmental Psychology, 51(11), 1650–1663. doi:10.1037/dev0000054

44.

Ernst

(2014). The triadic model perspective for the study of adolescent motivated behavior. Brain and Cognition, 89, 104–111. doi:10.1016/j.bandc.2014.01.006

45.

Ernst

Pine

D. S.

Hardin

(2006). Triadic model of the neurobiology of motivated behavior in adolescence. Psychological Medicine, 36(3), 299–312. doi:10.1017/S0033291705005891

46.

Evans

Shipton

E. A.

Keenan

(2006). The relationship between maternal chronic pain and child adjustment: The role of parenting as a mediator. Journal of Pain, 7(4), 236–243. doi:10.1016/j.jpain.2005.10.010

47.

Feldstein Ewing

S. W.

Filbey

F. M.

Loughran

T. A.

Chassin

Piquero

A. R

. (2015). Which matters most? Demographic, neuropsychological, personality, and situational factors in long-term marijuana and alcohol trajectories for justice-involved male youth. Psychology of Addictive Behaviors, 29(3), 603–612. doi:10.1037/adb0000076

48.

Feldstein Ewing

S. W.

Lovejoy

T. I.

Choo

E. K

. (2017). How has legal recreational cannabis affected adolescents in your state? A window of opportunity. American Journal of Public Health, 107(2), 246–247. doi:10.2105/AJPH.2016.303585

49.

Feldstein Ewing

S. W.

Tapert

S. F.

Molina

B. S

. (2016). Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration. Neuroscience & Biobehavioral Reviews, 62, 109–114. doi:10.1016/j.neubiorev.2015.12.011

50.

Fordyce

W. E.

Roberts

A. H.

Sternbach

R. A.

(1985). The behavioral management of chronic pain: A response to critics. Pain, 22(2), 113–125.

51.

Forgeron

P. A.

King

Stinson

J. N.

McGrath

P. J.

MacDonald

A. J.

Chambers

C. T.

(2010). Social functioning and peer relationships in children and adolescents with chronic pain: A systematic review. Pain Research and Management, 15(1), 27–41.

52.

Fortier

M. A.

Chou

Maurer

E. L.

Kain

Z. N.

(2011). Acute to chronic postoperative pain in children: Preliminary findings. Journal of Pediatric Surgery, 46(9), 1700–1705. doi:10.1016/j.jpedsurg.2011.03.074

53.

Fortuna

R. J.

Robbins

B. W.

Caiola

Joynt

Halterman

J. S.

(2010). Prescribing of controlled medications to adolescents and young adults in the United States. Pediatrics, 126(6), 1108–1116. doi:10.1542/peds.2010-0791

54.

Friedman

B. W.

Dym

A. A.

Davitt

Holden

Solorzano

Esses

. . . Gallagher

E. J.

(2015). Naproxen with cyclobenzaprine, oxycodone/acetaminophen, or placebo for treating acute low back pain: A randomized clinical trial. JAMA, 314(15), 1572–1580.

55.

Friedrichsdorf

S. J.

Giordano

Desai Dakoji

Warmuth

Daughtry

Schulz

C. A.

(2016). Chronic pain in children and adolescents: Diagnosis and treatment of primary pain disorders in head, abdomen, muscles and joints. Children, 3(4), 42.

56.

Friese

Moore

R. S.

Grube

J. W.

Jennings

V. K.

(2013). How parents of teens store and monitor prescription drugs in the home. Journal of Drug Education, 43(3), 223–233. doi:10.2190/DE.43.3.b

57.

Furlan

A. D.

Sandoval

J. A.

Mailis-Gagnon

Tunks

(2006). Opioids for chronic noncancer pain: A meta-analysis of effectiveness and side effects. Canadian Medical Association Journal, 174(11), 1589–1594.

58.

Garland

E. L.

Bryan

C. J.

Finan

P. H.

Thomas

E. A.

Priddy

S. E.

Riquino

M. R.

Howard

M. O.

(2017). Pain, hedonic regulation, and opioid misuse: Modulation of momentary experience by Mindfulness-Oriented Recovery Enhancement in opioid-treated chronic pain patients. Drug Alcohol Depend, 173(Suppl. 1), S65–S72. doi:10.1016/j.drugalcdep.2016.07.033

59.

Geisser

M. E.

Cano

Foran

(2006). Psychometric properties of the mood and anxiety symptom questionnaire in patients with chronic pain. The Clinical Journal of Pain, 22(1), 1–9. doi:10.1097/01.ajp.0000146180.55778.4d

60.

Giedd

J. N.

Rapoport

J. L.

(2010). Structural MRI of pediatric brain development: What have we learned and where are we going? Neuron, 67(5), 728–734. doi:10.1016/j.neuron.2010.08.040

61.

Gillespie

N. A.

Neale

M. C.

Kendler

K. S.

(2009). Pathways to cannabis abuse: A multi-stage model from cannabis availability, cannabis initiation and progression to abuse. Addiction, 104(3), 430–438. doi:10.1111/j.1360-0443.2008.02456.x

62.

Gilligan

Kypri

(2012). Parent attitudes, family dynamics and adolescent drinking: Qualitative study of the Australian parenting guidelines for adolescent alcohol use. BMC Public Health, 12(1), 491.

63.

Grevenstein

Nagy

Kroeninger-Jungaberle

(2015). Development of risk perception and substance use of tobacco, alcohol and cannabis among adolescents and emerging adults: Evidence of directional influences. Substance Use and Misuse, 50(3), 376–386. doi:10.3109/10826084.2014.984847

64.

Groenewald

C. B.

Rabbitts

J. A.

Gebert

J. T.

Palermo

T. M.

(2016). Trends in opioid prescriptions among children and adolescents in the United States: A nationally representative study from 1996 to 2012. Pain, 157(5), 1021–1027. doi:10.1097/j.pain.0000000000000475

65.

Groenewald

C. B.

Wright

D. R.

Palermo

T. M.

(2015). Health care expenditures associated with pediatric pain-related conditions in the United States. Pain, 156(5), 951–957. doi:10.1097/j.pain.0000000000000137

66.

Hah

(2016). Taking adolescent prescription opioid use in context: Risk stratification in early mid-life based on medical and nonmedical use. Pain, 157(10), 2143–2144. doi:10.1097/j.pain.0000000000000655

67.

Haug

Ulbricht

Hanke

Meyer

John

(2011). Overestimation of drinking norms and its association with alcohol consumption in apprentices. Alcohol and Alcoholism, 46(2), 204–209.

68.

Hestbaek

Iachine

I. A.

Leboeuf-Yde

Kyvik

K. O.

Manniche

(2004). Heredity of low back pain in a young population: A classical twin study. Twin Research and Human Genetics, 7(1), 16–26. doi:10.1375/13690520460741408

69.

Higgins

K. S.

Birnie

K. A.

Chambers

C. T.

Wilson

A. C.

Caes

Clark

A. J.

. . . Campbell-Yeo

(2015). Offspring of parents with chronic pain: A systematic review and meta-analysis of pain, health, psychological, and family outcomes. Pain, 156(11), 2256–2266. doi:10.1097/j.pain.0000000000000293

70.

Hoffmann

J. P.

Bahr

S. J.

(2014). Parenting style, religiosity, peer alcohol use, and adolescent heavy drinking. Journal of Studies on Alcohol and Drugs, 75(2), 222–227.

71.

Hoftun

G. B.

Romundstad

P. R.

Rygg

(2013). Association of parental chronic pain with chronic pain in the adolescent and young adult: Family linkage data from the HUNT Study. JAMA Pediatrics, 167(1), 61–69. doi:10.1001/jamapediatrics.2013.422

72.

Hollenstein

Lougheed

J. P.

(2013). Beyond storm and stress: Typicality, transactions, timing, and temperament to account for adolescent change. American Psychologist, 68(6), 444–454. doi:10.1037/a0033586

73.

Holman

J. E.

Stoddard

G. J.

Horwitz

D. S.

Higgins

T. F.

(2014). Preoperative counseling on duration of postoperative opiate use in orthopaedic trauma surgery: A surgeon-based comparative cohort study. Journal of Orthopaedic Trauma, 28(9), 502–506.

74.

Holmstrom

I. K.

Bastholm-Rahmner

Bernsten

Roing

Bjorkman

(2014). Swedish teenagers and over-the-counter analgesics—Responsible, casual or careless use. Research in Social and Administrative Pharmacy, 10(2), 408–418. doi:10.1016/j.sapharm.2013.06.004

75.

Hovens

J. G.

Wiersma

J. E.

Giltay

E. J.

Van Oppen

Spinhoven

Penninx

B. W.

Zitman

F. G.

(2010). Childhood life events and childhood trauma in adult patients with depressive, anxiety and comorbid disorders vs. controls. Acta Psychiatrica Scandinavica, 122(1), 66–74.

76.

Jensen

J. F.

Gottschau

Siersma

V. D.

Graungaard

A. H.

Holstein

B. E.

Knudsen

L. E.

(2014). Association of maternal self-medication and over-the-counter analgesics for children. Pediatrics, 133(2), e291–e298.

77.

Johnston

L. D.

O’Malley

P. M.

Bachman

J. G.

Schulenberg

J. E.

(2008). Monitoring the Future national survey results on drug use, 1975-2007. Volume I: Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.

78.

Johnston

O’Malley

P. M.

Bachman

J. G.

Schulenberg

J. E.

(2012). Monitoring the Future national survey results on drug abuse, 1975–2011. Volume I: Secondary school students. Ann Arbor: Institute for Social Research, The University of Michigan.

79.

Joynt

Train

M. K.

Robbins

B. W.

Halterman

J. S.

Caiola

Fortuna

R. J.

(2013). The impact of neighborhood socioeconomic status and race on the prescribing of opioids in emergency departments throughout the United States. Journal of General Internal Medicine, 28(12), 1604–1610. doi:10.1007/s11606-013-2516-z

80.

Kaasboll

Lydersen

Indredavik

M. S.

(2014). Substance use in children of parents with chronic pain—The HUNT study. Journal of Pain Research, 7, 483–494. doi:10.2147/JPR.S67819

81.

Kaiser

S. V.

Asteria-Penaloza

Vittinghoff

Rosenbluth

Cabana

M. D.

Bardach

N. S.

(2014). National patterns of codeine prescriptions for children in the emergency department. Pediatrics, 133(5), e1139–e1147. doi:10.1542/peds.2013-3171

82.

Kalapurakkel

Carpino

E. A.

Lebel

Simons

L. E.

(2015). “Pain can’t stop me”: Examining pain self-efficacy and acceptance as resilience processes among youth with chronic headache. Journal of Pediatric Psychology, 40(9), 926–933. doi:10.1093/jpepsy/jsu091

83.

Kankkunen

Vehviläinen-Julkunen

Pietilä

A. M.

Kokki

Halonen

(2003). Parents’ perceptions and use of analgesics at home after children’s day surgery. Pediatric Anesthesia, 13(2), 132–140.

84.

Karoly

H. C.

Callahan

Schmiege

S. J.

Feldstein Ewing

S. W.

(2015). Evaluating the Hispanic paradox in the context of adolescent risky sexual behavior: The role of parent monitoring. Journal of Pediatric Psychology, 41(4), 429–440.

85.

Kelly

L. E.

Sommer

D. D.

Ramakrishna

Hoffbauer

Arbab-tafti

Reid

. . . Koren

(2015). Morphine or ibuprofen for post-tonsillectomy analgesia: A randomized trial. Pediatrics, 135, 307–313.

86.

Kilmer

J. R.

Walker

D. D.

Lee

C. M.

Palmer

R. S.

Mallett

K. A.

Fabiano

Larimer

M. E.

(2006). Misperceptions of college student marijuana use: Implications for prevention. Journal of Studies on Alcohol and Drugs, 67(2), 277–281.

87.

Kobus

A. M.

Smith

D. H.

Morasco

B. J.

Johnson

E. S.

Yang

Petrik

A. F.

Deyo

R. A.

(2012). Correlates of higher-dose opioid medication use for low back pain in primary care. Journal of Pain, 13(11), 1131–1138. doi:10.1016/j.jpain.2012.09.003

88.

Kosterman

Bailey

J. A.

Guttmannova

Jones

T. M.

Eisenberg

Hill

K. G.

Hawkins

J. D.

(2016). Marijuana legalization and parents’ attitudes, use, and parenting in Washington state. Journal of Adolescent Health, 59(4), 450–456. doi:10.1016/j.jadohealth.2016.07.004

89.

Langer

S. L.

Romano

J. M.

Levy

R. L.

Walker

L. S.

Whitehead

W. E.

(2009). Catastrophizing and parental response to child symptom complaints. Child Health Care, 38(3), 169–184. doi:10.1080/02739610903038750

90.

Lankenau

S. E.

Teti

Silva

Jackson Bloom

Harocopos

Treese

(2012). Initiation into prescription opioid misuse amongst young injection drug users. International Journal of Drug Policy, 23(1), 37–44. doi:10.1016/j.drugpo.2011.05.014

91.

Lee

C. M.

Neighbors

Lewis

M. A.

Kaysen

Mittmann

Geisner

I. M.

. . . Kilmer

J. R.

(2014). Randomized controlled trial of a Spring Break intervention to reduce high-risk drinking. Journal of Consulting and Clinical Psychology, 82(2), 189–201.

92.

Le May

Ali

Khadra

Drendel

A. L.

Trottier

E. D.

Gouin

Poonai

. (2016). Pain management of pediatric musculoskeletal injury in the emergency department: A systematic review. Pain Research & Management, 2016, 4809394. doi:10.1155/2016/4809394

93.

Levy

R. L.

Whitehead

W. E.

Walker

L. S.

Von Korff

Feld

A. D.

Garner

Christie

(2004). Increased somatic complaints and health-care utilization in children: Effects of parent IBS status and parent response to gastrointestinal symptoms. American Journal of Gastroenterology, 99(12), 2442–2451. doi:10.1111/j.1572-0241.2004.40478.x

94.

Lewandowski Holley

Wilson

A. C.

Cho

Palermo

T. M

. (2017). Clinical phenotyping of youth with new-onset musculoskeletal pain: A controlled cohort study. Clinican Journal of Pain, 33(1), 28–36. doi:10.1097/AJP.0000000000000371

95.

Liebschutz

J. M.

Saitz

Weiss

R. D.

Averbuch

Schwartz

Meltzer

E. C.

. . . Samet

J. H.

(2010). Clinical factors associated with prescription drug use disorder in urban primary care patients with chronic pain. Journal of Pain, 11(11), 1047–1055. doi:10.1016/j.jpain.2009.10.012

96.

Lipari

R. N.

(2013). Trends in adolescent substance use and perception of risk from substance use. In The CBHSQ report. Rockville, MD: Substance Abuse and Mental Heath Services Administration.

97.

Litt

D. M.

Stock

M. L.

(2011). Adolescent alcohol-related risk cognitions: The roles of social norms and social networking sites. Psychology of Addictive Behaviors, 25(4), 708–713. doi:10.1037/a0024226

98.

Livingstone

M. J.

Groenewald

C. B.

Rabbitts

J. A.

Palermo

T. M.

(2017). Codeine use among children in the United States: A nationally representative study from 1996 to 2013. Paediatric Anaesthesia, 27(1), 19–27. doi:10.1111/pan.13033

99.

Lord

Brevard

Budman

(2011). Connecting to young adults: An online social network survey of beliefs and attitudes associated with prescription opioid misuse among college students. Substance Use and Misuse, 46(1), 66–76. doi:10.3109/10826084.2011.521371

100.

Lorenzetti

Alonso-Lana

Youssef

G. J.

Verdejo-Garcia

Suo

Cousijn

. . . Solowij

(2016). Adolescent cannabis use: What is the evidence for functional brain alteration? Current Pharmaceutical Design, 22(42), 6353–6365.

101.

Lynskey

M. T.

Heath

A. C.

Bucholz

K. K.

Slutske

W. S.

Madden

P. A.

Nelson

E. C.

. . . Martin

N. G.

(2003). Escalation of drug use in early-onset cannabis users vs co-twin controls. JAMA, 289(4), 427–433.

102.

Martel

M. O.

Wasan

A. D.

Jamison

R. N.

Edwards

R. R.

(2013). Catastrophic thinking and increased risk for prescription opioid misuse in patients with chronic pain. Drug and Alcohol Dependence, 132(1–2), 335–341. doi:10.1016/j.drugalcdep.2013.02.034

103.

Martins

S. S.

Segura

L. E.

Santaella-Tenorio

Perlmutter

Fenton

M. C.

Cerda

. . . Hasin

D. S.

(2017). Prescription opioid use disorder and heroin use among 12-34 year-olds in the United States from 2002 to 2014. Addictive Behaviors, 65, 236–241. doi:10.1016/j.addbeh.2016.08.033

104.

Mazer-Amirshahi

Mullins

P. M.

Rasooly

I. R.

van den Anker

Pines

J. M.

(2014). Trends in prescription opioid use in pediatric emergency department patients. Pediatric Emergency Care, 30(4), 230–235.

105.

McCabe

S. E.

(2008). Misperceptions of non-medical prescription drug use: A web survey of college students. Addictive Behaviors, 33(5), 713–724. doi:10.1016/j.addbeh.2007.12.008

106.

McCabe

S. E.

Boyd

C. J.

(2005). Sources of prescription drugs for illicit use. Addictive Behaviors, 30(7), 1342–1350.

107.

McCabe

S. E.

Boyd

C. J.

Cranford

J. A.

Teter

C. J.

(2009). Motives for nonmedical use of prescription opioids among high school seniors in the United States: Self-treatment and beyond. Archives of Pediatrics & Adolescent Medicine, 163(8), 739–744.

108.

McCabe

S. E.

Cranford

J. A.

(2012). Motivational subtypes of nonmedical use of prescription medications: results from a national study. Journal of Adolescent Health, 51(5), 445–452.

109.

McCabe

S. E.

Cranford

J. A.

Boyd

C. J.

Teter

C. J.

(2007). Motives, diversion and routes of administration associated with nonmedical use of prescription opioids. Addictive Behaviors, 32(3), 562–575.

110.

McCabe

S. E.

Veliz

Schulenberg

J. E.

(2016). Adolescent context of exposure to prescription opioids and substance use disorder symptoms at age 35: A national longitudinal study. Pain, 157(10), 2173–2178. doi:10.1097/j.pain.0000000000000624

111.

McCabe

S. E.

West

B. T.

Boyd

C. J.

(2013a). Leftover prescription opioids and nonmedical use among high school seniors: A multi-cohort national study. Journal of Adolescent Health, 52(4), 480–485. doi:10.1016/j.jadohealth.2012.08.007

112.

McCabe

S. E.

West

B. T.

Boyd

C. J.

(2013b). Motives for medical misuse of prescription opioids among adolescents. Journal of Pain, 14(10), 1208–1216. doi:10.1016/j.jpain.2013.05.004

113.

McCabe

S. E.

West

B. T.

Teter

C. J.

Boyd

C. J.

(2012). Medical and nonmedical use of prescription opioids among high school seniors in the United States. Archives of Pediatrics and Adolescent Medicine, 166(9), 797–802. doi:10.1001/archpediatrics.2012.85

114.

McCabe

S. E.

West

B. T.

Veliz

McCabe

V. V.

Stoddard

S. A.

Boyd

C. J.

(2017). Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976-2015. Pediatrics, 139(4). doi:10.1542/peds.2016-2387

115.

McCracken

L. M.

Turk

D. C.

(2002). Behavioral and cognitive–behavioral treatment for chronic pain: Outcome, predictors of outcome, and treatment process. Spine, 27(22), 2564–2573.

116.

McHugh

R. K.

Weiss

R. D.

Cornelius

Martel

M. O.

Jamison

R. N.

Edwards

R. R.

(2016). Distress intolerance and prescription opioid misuse among patients with chronic pain. Journal of Pain, 17(7), 806–814. doi:10.1016/j.jpain.2016.03.004

117.

Mehl-Madrona

Mainguy

Plummer

(2016). Integration of complementary and alternative medicine therapies into primary-care pain management for opiate reduction in a rural setting. The Journal of Alternative and Complementary Medicine, 22(8), 621–626.

118.

Miech

Johnston

O‘Malley

P. M.

Keyes

K. M.

Heard

(2015). Prescription opioids in adolescence and future opioid misuse. Pediatrics, 136(5), e1169–e1177. doi:10.1542/peds.2015-1364

119.

Mikkelsson

Kaprio

Salminen

J. J.

Pulkkinen

Rose

R. J.

(2001). Widespread pain among 11-year-old Finnish twin pairs. Arthritis & Rheumatology, 44(2), 481–485.

120.

Morasco

B. J.

Duckart

J. P.

Carr

T. P.

Deyo

R. A.

Dobscha

S. K.

(2010). Clinical characteristics of veterans prescribed high doses of opioid medications for chronic non-cancer pain. Pain, 151(3), 625–632. doi:10.1016/j.pain.2010.08.002

121.

Morasco

B. J.

Turk

D. C.

Donovan

D. M.

Dobscha

S. K.

(2013). Risk for prescription opioid misuse among patients with a history of substance use disorder. Drug and Alcohol Dependence, 127(1), 193–199.

122.

Morasco

B. J.

Yarborough

B. J.

Smith

N. X.

Dobscha

S. K.

Deyo

R. A.

Perrin

N. A.

Green

C. A.

(2017). Higher prescription opioid dose is associated with worse patient-peported pain outcomes and more health care utilization. Journal of Pain, 18(4), 437–445. doi:10.1016/j.jpain.2016.12.004

123.

Morone

N. E.

Greco

C. M.

Weiner

D. K.

(2008). Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain, 134(3), 310–319.

124.

Osborne

Z. P.

Bryant

S. M.

(2003). Patients discharged with a prescription for acetaminophen-containing narcotic analgesics do not receive appropriate written instructions. American Journal of Emergency Medicine, 21(1), 48–50. doi:10.1053/ajem.2003.50038

125.

Osilla

K. C.

Pedersen

E. R.

Ewing

B. A.

Miles

J. N.

Ramchand

D’Amico

E. J.

(2014). The effects of purchasing alcohol and marijuana among adolescents at-risk for future substance use. Substance Abuse Treatment, Prevention, and Policy, 9(1), 38.

126.

Page

M. G.

Stinson

Campbell

Isaac

Katz

(2013). Identification of pain-related psychological risk factors for the development and maintenance of pediatric chronic postsurgical pain. Journal of Pain Research, 6, 167–180. doi:10.2147/JPR.S40846

127.

Palermo

T. M.

Valrie

C. R.

Karlson

C. W.

(2014). Family and parent influences on pediatric chronic pain: A developmental perspective. American Psychologist, 69(2), 142–152. doi:10.1037/a0035216

128.

Perkins

(2012). Misperceptions of peer substance use among youth are real. Addiction, 107(5), 888–889.

129.

Pielech

Rivers

Bailey

Vowles

(2016). (449) Pediatric opioid prescription rates for non-cancer pain: 2005-2014. Journal of Pain, 17(4S), S86–S87. doi:10.1016/j.jpain.2016.01.426

130.

Piira

Pullukat

(2006). Are the children of chronic pain patients more likely to develop pain? Enfance, 58(1). doi:10.3917/enf.581.0020

131.

Piontek

Kraus

Bjarnason

Demetrovics

Ramstedt

(2013). Individual and country-level effects of cannabis-related perceptions on cannabis use. A multilevel study among adolescents in 32 European countries. Journal of Adolescent Health, 52(4), 473–479. doi:10.1016/j.jadohealth.2012.07.010

132.

Poonai

Datoo

Ali

Cashin

Drendel

A. L.

Zhu

. . . Bartley

(2017). Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: A randomized controlled trial. Canadian Medical Association Journal, 189(40), E1252–E1258.

133.

Porucznik

Sauer

Johnson

Crook

Wrathall

Anderson

Rolfs

(2010). Adult use of prescription opioid pain medications-Utah, 2008. Morbidity and Mortality Weekly Report, 59(6), 153–157.

134.

Prado

G. J.

Schwartz

S. J.

Maldonado-Molina

Huang

Pantin

H. M.

Lopez

Szapocznik

(2009). Ecodevelopmental × intrapersonal risk: Substance use and sexual behavior in Hispanic adolescents. Health Education & Behavior, 36(1), 45–61.

135.

Rabbitts

J. A.

Fisher

Rosenbloom

B. N.

Palermo

T. M.

(2017). Prevalence and predictors of chronic postsurgical pain in children: A systematic review and meta-analysis. The Journal of Pain, 18(6), 605–614.

136.

Rabbitts

J. A.

Zhou

Groenewald

C. B.

Durkin

Palermo

T. M.

(2015). Trajectories of postsurgical pain in children: Risk factors and impact of late pain recovery on long-term health outcomes after major surgery. Pain, 156(11), 2383–2389.

137.

Ramirez-Maestre

Esteve

Ruiz-Parraga

Gomez-Perez

Lopez-Martinez

A. E.

(2017). The key role of pain catastrophizing in the disability of patients with acute back pain. International Journal of Behavioral Medicine, 24(2), 239–248. doi:10.1007/s12529-016-9600-9

138.

Repetti

R. L.

Taylor

S. E.

Seeman

T. E.

(2002). Risky families: Family social environments and the mental and physical health of offspring. Psychological Bulletin, 128(2), 330–366.

139.

Richardson

L. P.

Russo

J. E.

Katon

McCarty

C. A.

DeVries

Edlund

M. J.

. . . Sullivan

(2012). Mental health disorders and long-term opioid use among adolescents and young adults with chronic pain. Journal of Adolescent Health, 50(6), 553–558. doi:10.1016/j.jadohealth.2011.11.011

140.

Roeckel

L.- A.

Le Coz

G.- M.

Gavériaux-Ruff

Simonin

(2016). Opioid-induced hyperalgesia: Cellular and molecular mechanisms. Neuroscience, 338, 160–182.

141.

Rony

R. Y.

Fortier

M. A.

Chorney

J. M.

Perret

Kain

Z. N.

(2010). Parental postoperative pain management: Attitudes, assessment, and management. Pediatrics, 125(6), e1372–e1378. doi:10.1542/peds.2009-2632

142.

Ross-Durow

P. L.

McCabe

S. E.

Boyd

C. J.

(2013). Adolescents’ access to their own prescription medications in the home. Journal of Adolescent Health, 53(2), 260–264. doi:10.1016/j.jadohealth.2013.02.012

143.

Russell

B. S.

Trudeau

J. J.

Leland

A. J.

(2015). Social influence on adolescent polysubstance use: The escalation to opioid use. Substance Use and Misuse, 50(10), 1325–1331. doi:10.3109/10826084.2015.1013128

144.

Sadhasivam

Chidambaran

Ngamprasertwong

Esslinger

H. R.

Prows

Zhang

. . . McAuliffe

(2012). Race and unequal burden of perioperative pain and opioid related adverse effects in children. Pediatrics, 129(5), 832–838. doi:10.1542/peds.2011-2607

145.

Sandborgh

Johansson

A. C.

Soderlund

(2016). The relation between the fear-avoidance model and constructs from the social cognitive theory in acute WAD. Pain Research and Management, 2016, 8281926. doi:10.1155/2016/8281926

146.

Sanders

Stogner

Seibert

Miller

B. L.

(2014). Misperceptions of peer pill-popping: The prevalence, correlates, and effects of inaccurate assumptions about peer pharmaceutical misuse. Substance Use and Misuse, 49(7), 813–823.

147.

Schechter

N. L.

Walco

G. A.

(2016). The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: Above all, do no harm. JAMA Pediatrics, 170, 425–426. doi:10.1001/jamapediatrics.2016.0504

148.

Sebastian

Burnett

Blakemore

S. J.

(2008). Development of the self-concept during adolescence. Trends in Cognitive Science, 12(11), 441–446. doi:10.1016/j.tics.2008.07.008

149.

Sehgal

Manchikanti

Smith

H. S.

(2012). Prescription opioid abuse in chronic pain: A review of opioid abuse predictors and strategies to curb opioid abuse. Pain Physician, 15(3), ES67–ES92.

150.

Shah

(2017). Characteristics of initial prescription episodes and likelihood of long-term opioid use—United States, 2006–2015. Morbidity and Mortality Weekly Report, 66(10), 265–269.

151.

Shulman

E. P.

Smith

A. R.

Silva

Icenogle

Duell

Chein

Steinberg

(2016). The dual systems model: Review, reappraisal, and reaffirmation. Developmental Cognitive Neuroscience, 17, 103–117. doi:10.1016/j.dcn.2015.12.010

152.

Skarstein

Lagerlov

Kvarme

L. G.

Helseth

(2016). High use of over-the-counter analgesic; possible warnings of reduced quality of life in adolescents—A qualitative study. BMC Nursing, 15, 16. doi:10.1186/s12912-016-0135-9

153.

Spandorfer

J. M.

Karras

D. J.

Hughes

L. A.

Caputo

(1995). Comprehension of discharge instructions by patients in an urban emergency department. Annals of Emergency Medicine, 25(1), 71–74.

154.

Stanford

E. A.

Chambers

C. T.

Biesanz

J. C.

Chen

(2008). The frequency, trajectories and predictors of adolescent recurrent pain: A population-based approach. Pain, 138(1), 11–21. doi:10.1016/j.pain.2007.10.032

155.

Steers

M.- L. N.

Moreno

M. A.

Neighbors

(2016). The influence of social media on addictive behaviors in college students. Current Addiction Reports, 3(4), 343–348.

156.

Steinberg

Fletcher

Darling

(1994). Parental monitoring and peer influences on adolescent substance use. Pediatrics, 93(6), 1060–1064.

157.

Stone

A. L.

Wilson

A. C.

(2016). Transmission of risk from parents with chronic pain to offspring: An integrative conceptual model. Pain, 157(12), 2628–2639. doi:10.1097/j.pain.0000000000000637

158.

Sullivan

M. D.

Von Korff

Banta-Green

Merrill

J. O.

Saunders

(2010). Problems and concerns of patients receiving chronic opioid therapy for chronic non-cancer pain. Pain, 149(2), 345–353. doi:10.1016/j.pain.2010.02.037

159.

Sung

H. E.

Richter

Vaughan

Johnson

P. B.

Thom

(2005). Nonmedical use of prescription opioids among teenagers in the United States: Trends and correlates. Journal of Adolescent Health, 37(1), 44–51. doi:10.1016/j.jadohealth.2005.02.013

160.

Swendsen

Conway

K. P.

Degenhardt

Glantz

Jin

Merikangas

K. R.

. . . Kessler

R. C.

(2010). Mental disorders as risk factors for substance use, abuse and dependence: Results from the 10-year follow-up of the National Comorbidity Survey. Addiction, 105(6), 1117–1128. doi:10.1111/j.1360-0443.2010.02902.x

161.

Tepper

S. J.

(2012). Opioids should not be used in migraine. Headache: The Journal of Head and Face Pain, 52(s1), 30–34.

162.

Tietjen

G. E.

Brandes

J. L.

Peterlin

B. L.

Eloff

Dafer

R. M.

Stein

M. R.

. . . Khuder

S. A.

(2010). Childhood maltreatment and migraine (part III). Association with comorbid pain conditions. Headache, 50(1), 42–51. doi:10.1111/j.1526-4610.2009.01558.x

163.

Toliver-Sokol

Murray

C. B.

Wilson

A. C.

Lewandowski

Palermo

T. M.

(2011). Patterns and predictors of health service utilization in adolescents with pain: Comparison between a community and a clinical pain sample. Journal of Pain, 12(7), 747–755. doi:10.1016/j.jpain.2010.12.011

164.

Tsao

J. C.

Meldrum

Kim

S. C.

Jacob

M. C.

Zeltzer

L. K.

(2007). Treatment preferences for CAM in children with chronic pain. Evidence Based Complementary and Alternative Medicine, 4(3), 367–374. doi:10.1093/ecam/nel084

165.

Turner

J. A.

Shortreed

S. M.

Saunders

K. W.

LeResche

Thielke

Von Korff

(2016). Does association of opioid use with pain and function differ by fibromyalgia or widespread pain status? Pain, 157(10), 2208–2216. doi:10.1097/j.pain.0000000000000631

166.

Tyler

D. C.

Woodham

Stocks

Leary

Lloyd-Thomas

(1995). Oxygen saturation in children in the postoperative period. Anesthesia & Analgesia, 80(1), 14–19.

167.

Van Tilburg

M. A.

Levy

R. L.

Walker

L. S.

Von Korff

Feld

L. D.

Garner

. . . Whitehead

W. E

. (2015). Psychosocial mechanisms for the transmission of somatic symptoms from parents to children. World Journal of Gastroenterology: WJG, 21(18), 5532–5541.

168.

van Tulder

M. W.

Ostelo

Vlaeyen

J. W.

Linton

S. J.

Morley

S. J.

Assendelft

W. J

. (2000). Behavioral treatment for chronic low back pain: A systematic review within the framework of the Cochrane Back Review Group. Spine, 25(20), 2688–2699.

169.

Veehof

M. M.

Oskam

M.- J.

Schreurs

K. M.

Bohlmeijer

E. T.

(2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533–542.

170.

Veehof

Trompetter

Bohlmeijer

E. T.

Schreurs

K. M. G.

(2016). Acceptance- and mindfulness-based interventions for the treatment of chronic pain: A meta-analytic review. Cognitive Behaviour Therapy, 45(1), 5–31.

171.

Voepel-Lewis

Zikmund-Fisher

Smith

E. L.

Zyzanski

Tait

A. R.

(2015). Opioid-related adverse drug events: Do parents recognize the signals? Clinical Journal of Pain, 31(3), 198–205. doi:10.1097/AJP.0000000000000111

172.

Volkow

N. D.

Koroshetz

(2017). Lack of evidence for benefit from long-term use of opioid analgesics for patients with neuropathy. JAMA Neurology, 74(7), 761–762.

173.

Wasan

A. D.

Butler

S. F.

Budman

S. H.

Benoit

Fernandez

Jamison

R. N.

(2007). Psychiatric history and psychologic adjustment as risk factors for aberrant drug-related behavior among patients with chronic pain. The Clinical Journal of Pain, 23(4), 307–315.

174.

Whiteside

L. K.

Russo

Wang

Ranney

M. L.

Neam

Zatzick

D. F.

(2016). Predictors of sustained prescription opioid use after admission for trauma in adolescents. Journal of Adolescent Health, 58(1), 92–97. doi:10.1016/j.jadohealth.2015.08.011

175.

Wilkerson

R. G.

Kim

H. K.

Windsor

T. A.

Mareiniss

D. P.

(2016). The opioid epidemic in the United States. Emergency Medicine Clinics of North America, 34(2), e1–e23. doi:10.1016/j.emc.2015.11.002

176.

Wilson

A. C.

Fales

J. L.

(2015). Parenting in the context of chronic pain: A controlled study of parents with chronic pain. Clinical Journal of Pain, 31(8), 689–698. doi:10.1097/AJP.0000000000000157

177.

Wilson

A. C.

Moss

Palermo

T. M.

Fales

J. L.

(2014). Parent pain and catastrophizing are associated with pain, somatic symptoms, and pain-related disability among early adolescents. Journal of Pediatric Psychology, 39(4), 418–426. doi:10.1093/jpepsy/jst094

178.

Windle

Spear

L. P.

Fuligni

A. J.

Angold

Brown

J. D.

Pine

. . . Dahl

R. E.

(2008). Transitions into underage and problem drinking: Developmental processes and mechanisms between 10 and 15 years of age. Pediatrics, 121(Suppl. 4), S273–S289. doi:10.1542/peds.2007-2243C

179.

Yaster

Gao

Vozzo

P. T.

Hsu

Roter

White

Monitto

C. L.

(2015). Physicians dispense more opioid than needed to treat pediatric pain: A prospective cohort study. Paper presented at the Annual Meeting of the American Society of Anesthesiologists, San Francisco.

180.

Pryzbylkowski

(2015). Opioid induced hyperalgesia. Pain Medicine, 16(Suppl. 1), S32–S36.

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