Sulman Aziz Mirza, MD, addresses concerns parents have about the prescription pain drug

As communities across the U.S. confront the epidemic of opioid addiction, Inova staff psychiatrist, Sulman Aziz Mirza, MD, works with teens and families to provide psychiatric evaluations, medication management, therapy and partial hospitalization services at the Inova Keller Center.

“Often I hear from patients that they have tremendous guilt or that they’ve done something wrong,” Dr. Mirza says. “We need to look at addiction as a medical disorder, and families need to be supportive of recovery. There’s a scientifically, medically recommended way of working through this, and it works. There is help out there.”

Dr. Mirza explains how parents and guardians can approach their teens about opioids in light of the current opioid crisis and deaths related to opioid misuse in the U.S., and what to consider if they believe their teen could be misusing opioids.

Q: Given that opioid addiction has affected so many people in the U.S., are doctors changing the way they treat pain to reduce or eliminate opioids?

Dr. Mirza: Doctors are limiting the length and number of opioid prescriptions. There’s a re-education effort in medical schools, and Inova offers its own training on alternatives to opiates. Doctors are prescribing over-the-counter medicine or some stronger nonsteroidal anti-inflammatory drugs, and people are open to trying alternatives, such as local nerve blocks, trigger point injections, ultrasound-guided regional anesthesia, ketamine, nitrous oxide, acupuncture, yoga or physical therapy.

Q: What are some of the most common ways adolescents come in contact with legal opioids?

Dr. Mirza: The most common reason a doctor would prescribe opioids is for management of severe, breakthrough pain from an event, such as an injury or surgery, that’s not relieved by over-the-counter painkillers such as Tylenol or Advil. Some data show that 31 percent of adolescents’ first exposure to opioids is through their dentist, usually after a tooth removal procedure.

Q: How can adults spot opioid misuse in adolescents, and how can they approach a child if opioid use is suspected?

Dr. Mirza: Adults should certainly make sure any opioids that are in the home are accounted for and locked up. Look for behavior like sleeping for unusual lengths of time, not being present, experiencing symptoms of withdrawal, such as excessive sweating, diarrhea or nodding off unexpectedly. If you suspect opioid misuse, look at their eyes. If they’re intoxicated, their pupils will be small. But if they’re experiencing withdrawal from a substance, their pupils will be big. I always advocate for bringing up the topic of opioids in a gentle, nonconfrontational way by expressing concern. If we confront aggressively, teens — and anyone — will dig in and become defensive. Tell them, “I’m concerned that you’re using opioids. I really don’t want you to get hurt. I want you to get help. What can we do to help?”

Q: How do you treat opioid addiction or dependence in an adolescent?

Dr. Mirza: In treating opioid addiction, long-term studies show that while the physical process of detoxing can take just a week or two, and the associated psychological cravings can last months to years. Opioid addiction can change the brain. Medication-assisted treatment is the gold standard. It has a success rate of over 90 percent, allowing people to be functional, productive and retain a quality of life.

Q: Do we know anything about the effects of parental opioid abuse on children?

Dr. Mirza: The best predictors of opioid misuse are a person’s environment and genetics. People from families with substance use in the home have a 50 percent higher risk of having a substance use disorder themselves. And the majority of people who illegally use opioids get them from friends or family — whether they are shared by or stolen from the person for whom they were prescribed.

Q: How can adults prevent opioid misuse in the children or adolescents they are responsible for?

Dr. Mirza: In trying to prevent opioid misuse in your kids, be proactive with early education. This is most effective. Have a frank discussion about it. The more you avoid talking about it, the more kids may try to do “forbidden” things in secret. Part of being a teenager is experimenting with things, but we really want them to understand the risk and serious dangers of misusing opioids.

Q: How is Inova taking steps to address teenage opioid misuse?

Dr. Mirza: Here at the Inova Kellar Center, we recently held an addiction summit for Fairfax County, Virginia, on October 5, called “Act on Addiction,” thanks to a grant from the Hitt Family. The community attendance was incredibly high with more than several hundred attendees, including county public school officials. We also have an intensive outpatient program for adolescents ages 13–18 with substance-related disorders, including a track with an opioid-specific curriculum.

The Inova Kellar Center was founded in 1991 thanks to a donation by visionaries Art and Betty Kellar, who experienced death by overdose in their family and felt a strong commitment to serve children and families in the multicultural Northern Virginia region. The Inova Kellar Center is part of the comprehensive offerings of Inova Behavioral Health Services.

Parents need to educate their children about opioids. If you suspect your child is misusing opioids, seek help immediately, whether at the Inova Kellar Center or elsewhere.


Learn more about Inova Behavioral Health Services, and find a list of locations. If in need of child and adolescent behavioral health outpatient services, call 703-218-8500. For inpatient adolescent behavioral health inpatient services, or inpatient and outpatient adult mental health and substance use services, call 703-289-7560.  

The Inova Kellar Center provides a full continuum of outpatient services and programs, including individual, family and group therapy, medication management, psychiatric evaluations, psychological testing, intensive outpatient programs, intensive home base services and partial hospitalization programs.

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