Recognizing and Reducing Risk Factors

Text risk factors from wooden blocks with stethoscope

Risk factors are predictors, not causes, of substance use disorder. According to the CDC (2020), risk factors for substance use among youth may include:

Family history of substance use, including parental substance use
Favorable parental attitudes towards the behavior
Poor parental monitoring
Family rejection of a child’s sexual orientation or gender identity
Associating with peers who use substances or are involved in the juvenile justice system
Lack of school connectedness
Low academic achievement
Being sexually abused as a child
Mental health issues

Mental Health and Overdose Risk

Approximately 41% of decedents [deaths from overdose, the majority of which resulted from illicitly manufactured fentanyl] had evidence of mental health conditions or treatment.
Drug Overdose Deaths Among Persons Aged 10–19 Years, CDC 2022

Providers can help protect their patients by taking a proactive approach to any suspected mental health conditions, in both healthy patients and in those considered at risk for substance use disorders.

See the sections on Screening and Referral to Treatment for more information.

Counseling Families to Reduce Risk of Opioid Poisoning

According to a 2022 American Academy of Pediatrics (AAP) report, pediatricians can do the following to protect children and teens from opioid-related injury and death:

Talking to parents and guardians:

Encourage them to share their concerns about substance use with their children and reinforce messages about the dangers of unknown substances youths may try.
Counsel parents to store prescribed and over-the-counter medications in a locked medicine cabinet or out-of-reach box.
Connect patients and families to harm reduction resources.

Talking to children and youth:

Explain that they should never take medicine their caregiver did not specifically give them. If they find medicine, always give it to their caregiver.
Counsel adolescents about the presence and dangers of fentanyl and novel synthetic opioids in the illicit drug supply.
Use visuals, such as posters and videos from the DEA’s One Pill Can Kill campaign, in the office.
Ask older adolescents and young adults if they know anyone who experienced overdose and offer to prescribe naloxone to help empower them to prevent overdose deaths.

Treating Opioid Poisoning in Children and Youths

Providers should keep naloxone, commonly known by the brand name Narcan, on hand and prescribe it when indicated. Naloxone is an opioid antagonist that reverses opioid overdose. It comes in forms such as intranasal and auto-injector, making it easy to administer. It also is safe, with minimal side effects.

**Narcan nasal spray.** Source: Texas Targeted Opioid Response (2023)

Texas law permits a standing order for Naloxone

Any Texas pharmacy or other health organization can apply for a standing order to distribute naloxone without a prescription. Since standing orders are granted based on the licensure of a specific physician, it is critically important that applicants provide accurate and reliable contact information as requested in the standing order application.

The order allows the recipient to administer naloxone for a suspected opioid overdose. Under Texas law, once you are covered under this standing order, you are protected legally to distribute naloxone to people who want or need it (Tx HHS, 2023).

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