Paul: Hello and welcome to our webinar. My name is Paul Toriello and I’m a proud member of the Empowering Youth and Families Program. Today’s webinar is on opioid use by youth and today we have a special guest. Dr. Celeste Crawford, who’s going to talk to us about opioid use by youth as well as alternatives to pain management. Dr. Crawford, thank you for joining us today
Celeste: Thank you for having me.
P: Tell us a little bit about your path that led you where you are today professionally
C: Okay, well I’ve been very fortunate to have a variety of experiences in my career as a counselor. I started working in community mental health. I worked primarily with youth and families after that. I had a chance to become a middle school counselor, again same population but just a broader approach to counseling, and in that work I became more interested in the educating side of counseling and came back to school got my PhD in rehabilitation counseling, and now I teach in the department of addictions and rehabilitation studies here at ECU. And I’m also the director of the Navigate Counseling Clinic
P: So let’s jump right into the topic of opioid use by youth. What are some of the myths about youth and opioid use?
C: That’s a good question I think when people think about opioids often we think of street drugs, we think of heroin, shooting heroin, snorting heroin, but actually when we talk to youth we find most of their first experience using opioids is with pain medication, prescription medication, and there’s a perception that heroin is actually more harmful than pain medication when really they’re all the same family of drug and what we found is that opioid pain relievers are actually responsible for more overdose deaths than cocaine and heroin combined
P: Wow, so pain management is the typical road to opioid use for youth. Tell us more about that. Is it through athletics, is it through maybe getting to the medicine cabinet and experimenting, or both?
C: Yes, actually a lot of teens report that their first you know use of an opioid-based medication, you know a lot of times it’s like cough medicine for bronchitis or pain medication after a dental surgery or you know getting your wisdom teeth out. Something that’s like a prolonged pain and then off you know or a surgery where you’re given a prescription to come home so sometimes it’s their pain medicine that they’re taking and then other times it’s you know someone else in the family has a prescription for that medication who that they may share with the youth
P: So through injury, doctors visits, or medical issues like dental issues are some typical routes of exposure. Other exposures that youth may have to opioids in opioid use?
C: Other routes of exposure? Well an interesting statistic that came up when I was kind of researching this topic was that 22% of youth report that they were given a prescription paid medication by a family member that was not prescribed for them so a parent shares their pain medication, leftover pain medication with their child if you know the child has an injury and but it’s not under doctor care or under doctor supervision
P: Wow, that’s a bit scary when the caregiver steps in and plays the role of the doctor in terms of opioid prescriptions.
C: Yeah, you know and I wonder if some of that has to do with just access to medical care, fear of not getting what they want from the doctor, or a parent just really seeing their child in pain and the caregiver seeing their child in pain and wanting to give them some relief not realizing the ramifications of using an opioid
P: That makes sense. So let’s go in the direction of when opioid use becomes problematic in terms of addiction, withdrawal. What does that look like in a youth? Help us identify that, again what does it look like, what are some of the signs, symptoms of addiction, or when there’s a problem?
C: You know and that is a tricky question for anyone who spends time with youth. From recognizing that adolescence in particular, is a time where moods are up and down and a lot of changes going on. So trying to differentiate can be a little tricky but really you know trying to pay attention to how often moods are shifting, physical appearance, you know if you are seeing that your, you know, your child has flushed face, flushed skin, there’s big change in appetite, a lot of extra you know opioids are a sedative so being drowsy, sleeping a lot, complaining of being constipated can be a sign because you know opioids definitely can affect your digestive tract you know, and really just noticing when it goes beyond what you’d sort of consider a normal sort of moody teenager, more moody. Think about what goes beyond what you consider normal for your child
P: So those are some behaviors and changes that the caregivers can look for. Before we switch into pain management or alternatives to pain management should a caregiver see those changes, what do you recommend that they do? What are some steps they can take to intervene?
C: It’s a good question. Again wanting to make sure you’re getting good medical care and supervision because withdrawal from opioids can be, although it’s not life-threatening, it’s very uncomfortable and very distressing for the person going through the withdrawal. One interesting thing to think about is you know a lot of times when a young person is not feeling well, offering to taking them to the doctor you know is not a problem, you know usually they’re willing to go, but if we’re looking at withdrawal, sometimes that becomes more, there could be more resistance to that out of fear of being discovered, being you know that they might have their addiction discovered, so making sure you find a medical professional who’s familiar with substance use issues and is also good working with the youth population so that it’s not a shaming experience or not a punitive experience and that the youth is given some relief from their distress and also some recommendations for follow-up care.
P: Those are excellent suggestions, Dr. Crawford. Let’s transition into alternatives to pain management and the phrase you use is relief from distress, relief from pain. Pain is real. Even for youth, teens, preteens, athletic injuries, getting their wisdom teeth pulled, pain is real. For caregivers who want to look at alternatives to opioids for pain management, where would you suggest starting? What was a good starting point in thinking about alternatives, considering alternatives?
C: Well this is actually one of my favorite areas to talk about and to research. In the last 10 years or so I’d say we’ve seen more acceptance in the medical profession for what we might consider alternative and complementary approaches to pain management. The ones that come to mind that I think are more commonly known would but we don’t necessarily associate with pain management would be acupuncture. Acupuncture can really do a nice job of relieving inflammation and taking away nerve pain to try to lessen the pain, calm the pain down. It also can help regulate your mood a little bit and when we think about pain a lot of times what we don’t consider is pain can be aggravated by anxiety, fear of the pain, worrying about what’s happening to your body, so if we can calm down your mood and your nerves and inflammation a lot of times it can sort of lower the pain level to a more acceptable tolerable condition. Another area that I would consider and I might like think about types of pain, whether it’s just situational or maybe more chronic, but I think if you’re you know you have an athlete who maybe has you know the tendency to aggravate a certain you know injury or part of their body, getting into some meditation or guided imagery can help. Focusing on again lessening that anxiety, a lot of times there’s that anxiety of, “oh if I get back in the game and I pull my Achilles tendon again, I’m going to be out,” you know so it kind of like ups your stress over that injury or that area of your body so practicing ahead of time lowering that stress, lowering that sort of visualizing a healthy body, a strong body can, it lowers the pain in the sense that it kind of helps manage your thoughts around your pain which lowers your anxiety and lowers your body, your cortisol levels, and all the pain hormones that kind of kick in when you’re nervous
P: Fascinating, so one follow-up question I have is the connection between pain and mental health or our emotional states. Can you talk more about that? It seems like our understanding of that connection is growing more, more research is coming out or doctors are more open to that connection, certainly counselors might be more open to it, but talk more about that if you can
C: Sure, I mean I think what we are seeing is our bodies and minds are you know are one and although injuries are real, pain is real in the area you’ve injured it. It’s all attached to how your brain processes that information so the level of pain you experience may be able to be mitigated by your ability to manage your internal systems. Another intervention that we find very helpful is biofeedback. Biofeedback helps you use your brain to regulate the way your body responds to certain situations and even to the point to be able to manage your heart rate, your blood pressure, how your body responds to nerve pain, focusing your body’s energy to certain areas, to your brain’s energy to certain areas of your body to regulate sort of the electrical impulses that affect the healing process, so the more a person can become aware of their body and the pain response that they are having, a lot of times it can offset that level of pain
P: You mentioned religious practice, that implies some of the angst against using alternative approaches, complementary approaches while they’re becoming more accepted in medical practice there are probably still a lot of caregivers out there that are unsure of these alternative, complementary medicines. What suggestions, mind frames would you offer to caregivers who are thinking about an alternative to pain management but are still skeptical that this is not a good fit for my family. What would you say to them?
C: I’d really suggest talking to your primary care physician. I think you’ll find it’s a lot easier to access these type of services through a traditional medical setting. A lot of physical therapists are trained in acupuncture so it’s not like you have to go to a special clinic to get this type of treatment. Oftentimes this can be combined with your primary care
P: So, Dr. Crawford, you mentioned acupuncture, biofeedback techniques, also mentioned deep breathing and meditation types of alternatives to pain. What are some other alternatives to pain management that you would recommend to caregivers?
C: One technique that is becoming more popular particularly amongst athletes is cryotherapy and cryotherapy is the use of extreme cold to heal an injury or heal an area of the body that’s experiencing illness or discomfort. Now this is done under medical supervision for a very short period of time but it’s using just air temperature to drop down the body temperature in that particular area that needs attention, to lower inflammation. if you have a nerve injury that is activated, the cold can settle that down, calm that down, but again it’s for a very short period of time, it’s under medical supervision and it’s something that can be done quickly and you feel immediate relief from the pain which is one of the benefits of that type of treatment and it’s non-invasive
P: So, Dr. Crawford, wrapping up the webinar, our mission with Empowering Youth and Families Program is to do just that, to empower the families, the youth, to make healthy decisions to not misuse substances, to not misuse opioids even when there is a pain condition. What’s your big message or your take-home message in addition to these alternatives? What would you say to families and youth who are trying to live healthy lives without misusing substances?
C: Be a good advocate for your family and for your children. If there’s a pain issue, if you’re being prescribed an opioid, ask questions, ask what side effects to be looking for what’s a reasonable time frame to be using it, and also just from a more holistic view, encourage healthy recovery for the person who’s injured. If they’re an athlete, take the pressure off of them for having to return to play too quickly, give them time to heal, support them in their recovery program, whether it’s exercises, going to physical therapy, rest whatever the regiment is, offer support and encouragement through the process, and remind them that by following that regiment they’re going to be ready to get back in action quicker.
P: Thank you, Dr. Crawford for your expertise as well as message about advocacy. Thank you for watching the Empowering Youth and Families Webinar. As always there’ll be links at the end of this for you to get more information on alternatives to pain management. Thanks again!