Pain Makes Young Adults More Likely to Mix Cannabis with Alcohol

By Crystal Lindell

A new study reveals that being in pain as a young adult makes you more likely to mix cannabis and alcohol. 

The research, published in the journal Alcohol, looked at 18 to 24 year olds. They found that those with moderate to severe pain were 1.4 times more likely to engage in the co-use of alcohol and cannabis over the next four years, compared to those with no pain. 

The Binghamton University researchers say this is the first study to examine pain as a predictor for co-using alcohol and cannabis. 

Previous research has shown that young adults who mix alcohol and cannabis are more likely to engage in impaired driving, risky sexual behavior, and/or experience mental health problems. 

But that begs the question, which causes which? 

I don’t think we should assume that using cannabis and alcohol together causes mental health issues. Perhaps it is the stress and anxiety of young adulthood – and poorly treated pain – that cause people to seek relief with things like alcohol and cannabis.

Previous studies have shown that about two-thirds (67%) of young adults in the U.S. reported pain in the past six-months, and more than 2 million of them had chronic pain. 

Physical pain in young adulthood can have long-lasting consequences. 

"Pain is of particular concern during emerging adulthood because it directly impacts developmental milestones across multiple domains, and emerging adults with chronic pain report greater isolation from their peers, fewer educational and occupational opportunities, greater anxiety and depression, and a poorer overall quality of life," the authors write. 

All of this really highlights why it’s so important that we fully treat pain in young adults – and really, in everyone who suffers from it. 

Unfortunately, that’s not the framing the authors chose to go with in their paper. Instead, they write that “pain is a unique risk factor for substance use.”

The choice to use “risk factor” in that sentence speaks volumes, although I am glad that they then used “substance use” as opposed to the more judgemental “substance abuse.”

Because that’s the thing, using a substance to treat something is not inherently bad. People use ibuprofen to treat headaches. But we don’t have research papers claiming that “headaches are a risk factor for Advil use.” Or even “having diabetes is a risk factor for insulin use.” 

Like yeah, you think? People use medications that treat their ailment in order to treat their ailment. 

Pain is definitely an aliment – and cannabis and alcohol are substances that do indeed relieve pain. The only reason anyone believes otherwise is because of government framing. 

We have drastically reduced the amount of opioids prescribed, but that doesn’t mean we have drastically reduced the amount of pain that people endure. It’s only natural that people will seek out alternatives. Younger people tend to have a more difficult time convincing doctors to treat their pain, meaning they are more likely to be left to fend for themselves. 

Alcohol and cannabis may not be the best choices for pain relief, but they may be the only ones available.

People in pain — at any age — will always look for ways to alleviate that pain. And the more options people in pain have, the more likely it is that they’ll find what works best for their body and their circumstances, while causing the least amount of negative side effects. 

If their only effective option is alcohol mixed with cannabis, then that’s what they’ll use. If the government and medical community don’t like that, then they should give them more options. 

Study Finds Low Risk of Rx Opioid Abuse Among Young People

By Pat Anson, PNN Editor

The stories are heartbreaking. A young man gets a prescription for opioid pain medication and quickly becomes addicted.

“I lost everything. I had to leave school, and stop playing sports in college. I started to watch my life slip away. These drugs are addictive. One prescription can be all it takes to lose everything,” says Mike.

A mother loses her son to an overdose.

“My son… was 20 years old when he was prescribed opioids,” says Ann Marie. “It took him five days to get addicted.”

These are some of the real-life stories being told in a CDC awareness campaign that warns against the use of prescription opioids. “It only takes a little to lose a lot,” is the theme in a series of CDC videos, billboards and online ads.

The stories are sad, but the widespread belief that adolescents and young adults can quickly become addicted to prescription opioids is not accurate for the vast majority of young people, according to a large new study published in JAMA Pediatrics.

Researchers at Indiana University looked at a database of over 77,000 young people in Sweden between the ages of 13 and 29 who were prescribed opioids for the first time. They were compared to a control group that was given non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. Both groups had no previous signs of substance abuse.

Only 4.6% of those prescribed an opioid developed a substance use disorder or other substance-related issue, such as an overdose or criminal conviction within five years of being prescribed.  That compared to 2.4% of those in the control group.

"By using several rigorous research designs, we found that there was not a huge difference -- in fact, the difference was smaller than some previous research has found,” said Patrick Quinn, PhD, an assistant professor at the IU School of Public Health-Bloomington. “But the study still shows that even a first opioid prescription may lead to some risk."

Interestingly, young people given oxycodone were at no greater risk of developing a substance abuse problem than those given “weaker” opioids such as codeine or tramadol.

Quinn says further research is needed to determine how much substance abuse risk is caused by opioid medication alone and how much is related to other issues, such as mental health, genetics and environmental factors.

"We need to have a good understanding of what those risks might be in order for patients and doctors to make informed decisions," said Quinn. "Our findings highlight the importance of screening for substance use disorders and other mental health conditions among patients with pain, including those receiving opioid therapy."

A 2018 study of young people given opioids after their wisdom teeth were removed also found the risk of long-term use low. The study of over 70,000 teens and young adults found that only 1.3% were still being prescribed opioids months after their initial prescription by a dentist.  

High Number of Youths Using Rx Opioids

By Pat Anson, PNN Editor

A large new analysis of drug use by teenagers and young adults in the U.S. has found a surprisingly high level of prescription opioid use. In a survey of over 56,000 youths, researchers found that 21% of teens and 32% of young adults said they had used opioid medication in the past year.

"The percentages were higher than we expected," said first author Joel Hudgins, MD, of Boston Children's Hospital's Division of Emergency Medicine. "They really highlight how common use of prescription opioids is in this vulnerable population."

The data from the 2015-2016 National Survey on Drug Use and Health doesn’t necessarily reflect the environment that exists today. Opioid prescriptions have fallen by 43% since their peak and last year alone declined by a record 17 percent. Many pain patients — of all ages — now have trouble getting opioids prescribed and filled.

During the study period, nearly 4% of teens and 8% of young adults reported misusing prescription opioids or having an opioid use disorder.

Misuse was defined as using opioids “in any way that a doctor did not direct you to use them,” while a use disorder was classified as recurrent use that causes significant impairment and failure to meet major responsibilities at home, work or school.

Researchers were surprised by some of the findings, which are published in the online journal PLOS One. Among youths who reported misusing prescription opioids, 57% said they obtained them from friends or relatives and only 25% percent came from healthcare providers.

"In previous studies in adults, opioids were more commonly obtained from a physician," Hudgins says. "Our findings show that the focus of prevention and treatment should include close friends and family members of adolescents and young adults, not simply prescribers."

Youths who misused opioids, particularly the young adults, often reported using other substances, including cocaine (36%), hallucinogens (49%), heroin (9%) and inhalants (30%). At least half had used tobacco, alcohol, or cannabis in the past month.

In a previous study, the same researchers found relatively high rates of opioid prescribing to youths visiting emergency rooms and outpatient clinics. About fifteen percent of youths were given opioids during ER visits from 2005 to 2015.

"Given these rates of opioid use and misuse, strong consideration should be given to screening adolescents and young adults for opioid use when they receive care," says Hudgins.

More recent surveys have found a steady decline in the misuse of prescription opioids by young people. The most recent Monitoring the Future Survey found that only 3.4% of high school seniors misused opioid medication in 2018.

Misuse of Vicodin and OxyContin among 12th graders has fallen dramatically over the past 15 years, from 10.5% in 2003 to 1.7% in 2018 for Vicodin, and from 4.5% in 2003 to 2.3% in 2018 for OxyContin.