On this episode of Raising Joy, we’re joined by Callie Crow, founder of the nonprofit Drew's 27 Chains, in honor of her son who died of an opioid overdose in June 2020.  The organization provides free Narcan and training to law enforcement agencies and other first responders and is credited with saving more than 30 lives to date.

By Ashley Antle

There is a new clear and present danger for children and it’s coming to them through virtual street corners and hidden social media messages. It’s the highly potent synthetic opioid called fentanyl. Similar to morphine but 50 to 100 times more powerful, fentanyl is sometimes prescribed to control severe or chronic pain. Like many opioids, it’s also made and used illegally with deadly consequences.

So far this year at Cook Children’s Medical Center, 15 children have been treated for fentanyl ingestion, some as a result of their own misuse of drugs and some as a result of exposure through someone else’s misuse. That’s up from zero in both 2019 and 2020, and 10 in all of 2021. 

This increase follows national trends. Fentanyl-related overdoses in the U.S. have exploded in recent years. For teens ages 14 to 18, death from fentanyl nearly doubled in 2020 and rose another 20% in 2021, according to researchers at the David Geffen School of Medicine at UCLA. It’s one tragic story after another of a child lost to the drug. A Los Angeles, California, teen dead and six others were hospitalized in September. Three teens from the same school in San Marcos, Texas, dead in August. Thirty-six Georgia teens dead in 2021, and the list goes on and on from coast to coast.

“What we're seeing in the littles is that they sometimes have exposure to fentanyl just because of their environment,” said Elizabeth Peeler, D.O., M.S., M.S.C.S. “They're at the mercy of their caregiver and it's kind of like a wrong place, wrong time situation. They're toddlers or babies, and so they toddle into drugs that are kept in the home. And that can be really scary because they're so small and fentanyl is so potent. It's so strong that just a little bit is enough to make a young child very sick.”

Dr. Peeler is a member of Cook Children’s Child Advocacy Resources and Evaluation (C.A.R.E.) Team. She and her fellow C.A.R.E. Team physicians specialize in examining and treating children who have suffered abuse, including from neglect and drug exposure. This year the team added fentanyl to their regular drug-testing panel due to a sharp increase in the number of fentanyl exposure cases they now encounter.

Drugs in Disguise

The clandestine nature of many fentanyl overdoses is what makes this battle a particularly difficult one.

When it comes to teens — and adults for that matter — it’s not that they are specifically buying fentanyl for a high, it’s that fentanyl is laced into other illicit or counterfeit drugs like Xanax, Percocet and Adderall, to name a few. These drugs don’t come with warning labels from their illegal dealers, so buyers have no idea their purchase may contain hidden fentanyl until it’s too late.

In the most recent fentanyl overdose cases at Cook Children’s, at least two were a result of marijuana laced with fentanyl and two from counterfeit Percocet pills containing fentanyl. The same is true in cases all across the country. According to the U.S. Drug Enforcement Agency (DEA), 42% of pills tested for fentanyl contained a potentially lethal dose of the drug. 

“There’s lots of different reasons why teenagers or adolescents may take a substance, whether it’s to have a good time because of peer pressure, whether it’s because they do suffer from depression or anxiety, whether it’s because they’re curious or because it was in the house and it was an accident,” said Artee Gandhi, M.D., Cook Children’s medical director for pain management and endowed chair for the Center for Pain Management and Integrative Health.

For dealers, adding a synthetic and highly addictive opioid that is cheap, easy to make, and keeps users coming back for more is easy money. However, get the dosage even slightly wrong and it’s deadly. Just two milligrams of fentanyl — the weight of a mosquito — can kill.

“Fentanyl is about 50 times stronger than heroin,” Dr. Peeler said. “Even a small amount can block the brain’s ability to remember to breathe. I want to remind all parents and children that substance misuse can have life-threatening consequences.”

A Mother’s Heartbreak

Callie Crow knows the devastation of fentanyl all too well. For years she watched her son, Drew, spiral into drug addiction, despite raising him in a home where alcohol and drugs were never a factor.

“He breaks that mold of what we sometimes think of as a stereotypical person that's addicted to drugs,” Crow said. “That's one of my biggest pushes is, you know, it's not even what I thought, because I've never done a drug in my life. I don't drink. I don't smoke. That's not something that my kids were exposed to in any way. And so in my mind, they were exempt and it wasn't going to happen to us.” 

Crow describes her son as having an old soul. He was articulate, even as a very young child, smart, funny and loved to learn. Drew was first offered cocaine by a trusted family friend at the age of 14. That eventually led to other drugs and pills and, by 17, he was addicted to opioids.

“We did detox. We did rehab. We did therapy. We did all of the things that, you know, are supposed to help,” Crow said. “And it just never, ever happened. I don't think he ever turned a corner from the time he was 17 on. It was really difficult watching that struggle.”

But there were moments of light. Drew got married and, at the time of his death at age 27, was studying political journalism at the University of North Texas. By then, his opioid use had morphed into a way to survive withdrawal, not necessarily to get high, Crow said, describing her son as a “functional addict.”

That’s what happened the night he died in June 2020. Crow says Drew purchased pills from someone in the town where he lived and took them to avoid withdrawal symptoms of nausea, vomiting, sweating and pain. The pill he took was unknowingly laced with fentanyl. Ten minutes after ingesting it, he was in cardiac arrest and died.

Four doses of Naloxone, also known as Narcan — the FDA-approved drug used to reverse the effects of fentanyl overdose — were within feet of Drew at the time of his overdose. Two on his bedside table that Drew’s wife did not know about and two on the police officer who initially responded to the 911 call placed by his wife. For reasons unknown to Crow, the officer did not administer the Naloxone he carried. Any one of the four doses in Drew’s presence at the time could have reversed the effects of the fentanyl and saved his life.

Since her son’s death, Crow, an EMT- paramedic, has made giving out Naloxone and teaching others how to administer it her life’s mission. She calls the organization she founded in her son’s honor Drew’s 27 Chains. The name is a reference to Drew’s love for disk golf. So far, 36 people have escaped a fentanyl-related overdose death as a result of Narcan handed out at a Drew’s 27 Chains event, and that’s just the ones Crow can track.

Like Crow, Dr. Gandhi is a proponent of keeping Narcan in your home and on your person.

“I think it is important for parents to know that there is a medication that's a nose spray that's available at any pharmacy and it does not require a prescription,” Dr. Gandhi said. “They can walk up to the counter and say, ‘Can I please have a dose of Naloxone?’”

Parental Interference Strongly Advised

“For the first time we are seeing an increase in overdose deaths in adolescents, and it’s predominantly due to the effect of fentanyl, which was not an intentional effect that the adolescent was going for,” Dr. Gandhi warned. “The number of overdose deaths itself has risen every year, but this is the first time that the adolescent population has actually had an increase.”

There are things parents can do to help protect their kids and teens. Running interference for your child against these dangers starts with a conversation. Not just one, but many.

“First and foremost, these conversations have got to happen all the time,” said Lisa Elliott, Ph.D., licensed psychologist and manager of Cook Children’s Behavioral Health Clinic in Denton. “There needs to be dinner conversations. There needs to be conversations in the car. They need to be constantly talking about it and making their kids very well aware of the reality and risks of drugs.”

Dr. Elliott says one way to talk to teens about these dangers is to frame the conversation as information they may need to help a friend. This takes the attention off your kid, she says, and they’re more likely to listen. These conversations should start early, as young children are at risk of fentanyl poisoning, too. Many dealers are disguising pills as candy, and there is always a risk of children ingesting a pill they’ve found on the ground.

Staying as involved as possible in your child’s life is the key to knowing if they are abusing drugs or participating in behaviors that could lead to addiction or overdose. This includes keeping a close eye on their online habits, social media accounts and text threads. A generation ago, keeping kids safe from drugs meant knowing their friends and steering them away from certain hangouts and street corners. Today, social media sites have brought an entire world of virtual street corners and strangers right into your child’s bedroom.

“Being vigilant about your kid’s social media use I think is important,” Dr. Gandhi said. “Your kids can have freedom on those devices but they still need monitoring.”

And for good reason. The prefrontal cortex of kids and adolescents is not fully developed until they are in their 20s. That’s the part of the brain that controls impulse, and that’s why young people have poor reasoning skills when it comes to risky behaviors.

“Kids and adolescents are basically a high-speed car going down a highway at a hundred miles an hour without any brakes,” Dr. Gandhi said. “They have no breaks. They have no self-regulation. They don't know the difference between what's real, what's not real, and what’s just something that you would think is a fluke. They don't understand the long-term implications or consequences of their actions. So don't fool yourself into thinking that your 15-year-old does. They don't. You've got to be involved in screening and monitoring and knowing what your children are having access to.”

Know their friends, Dr. Gandhi says, and communicate with their friends’ parents. She also encourages parents to find activities that kids enjoy but also make them feel like they’re a part of a community.

If you suspect your child is using opioids or other substances, reach out to their school counselor, drug counselor, a mental health professional or their pediatrician for help. If you suspect your child has overdosed on fentanyl or any other drug, call 911.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

Event leaders will be collecting unused and expired medications in a drive-thru in the building’s parking lot, and distributing free medication lockboxes.

Stacey Vanvliet, M.D., an inpatient pediatric hospitalist at Cook Children’s, stresses the importance of locking medications up, even if they seem harmless. She said suicide attempts “have become part of my daily practice” and most are overdoses on a substance that’s “convenient for the children and teens to grab.” While most patients are in their teens, children as young as 8 or 9 are routinely admitted to Cook Children’s for attempting suicide with medication.

“Commonly, we see Tylenol, Motrin, aspirin, Benadryl—things that people just stock in their cabinets to have on hand,” she said. “We see teenagers take huge handfuls of them.”

Each year, Cook Children’s treats hundreds of children and teens for medication poisonings and overdoses. Sadly, the number of these patients continues to reach record levels year after year.

"It is a huge problem right now. We’re seeing more kids in the hospital for opioid overdoses than ever before," said Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s. 

Dr. Gandhi also points out that a recent letter published in the American Medical Association reported a 20% increase in drug overdose deaths among 14 to 18 year olds from 2020. The 1,150 deaths is double the number reported in 2019.

“While teen drug use has remained relatively stable, the biggest problem is kids trying to get their hands on prescription opioids such as oxycodone or other medications such as Xanax and Adderall,” Dr. Gandhi said. “So often, counterfeit versions of these drugs are laced with deadly amounts of fentanyl. Therefore, it is paramount that parents, educators and health care providers argue against medication misuse or drug experimentation at all.”

**Dr. Artee Gandhi and DEA agents will be available for interviews at this event.

“One thing to keep in mind is that while the stewardship focuses on our opioid utilization and prescribing habits and aiming to keep children safe, we can’t ignore the fact that kids will have pain—either acute or chronic. So, it has to be addressed,” says Artee Gandhi, M.D., medical director of Pain Management at Cook Children’s, who also oversees the stewardship program. “It’s not a matter of getting rid of one thing and not replacing it with anything else, or not using it sparingly in conjunction with other ways to treat pain. We recognize both sides of the coin.”

The goal of Safe and Sound is to use other methods of managing pain, she says. It aims “to improve patient safety, reduce the risk for potential child addiction, ingestion, misuse, overdose and death, while promoting best practices through the safe and sound management of pain,” according to its mission statement.

From 1999 to 2019, overdose deaths involving prescription opioids more than quadrupled in the United States—leaving about 247,000 dead, according to the Center for Disease Control and Prevention.

The trend has hit locally, as well. As of May, Cook Children’s admitted 17 patients for opioid-related overdoses, representing a significant jump from 2020 when 16 patients were admitted for the same condition for the entire year. In March, at least four area teens died from overdosing on fentanyl, a synthetic opioid that is 100 times stronger than morphine and 50 times stronger than heroin. The teens purchased the pills thinking they were Percocet, but they were laced with fentanyl, according to reports. Drug dealers often package and sell fentanyl on the streets disguised in forms of other popular medications, such as OxyContin, Percocet or Xanax.

Opioids, which “bind to or activate opioid receptors on cells located in the brain, spinal cord and other organs in the body,” block pain signals and release large amounts of dopamine throughout the body, according to the National Institute on Drug Abuse (NIDA), the leading federal agency supporting scientific research on drug use and its consequences. That flooding of dopamine can reinforce using the drug and make users want to repeat the experience, the agency reports. NIDA lists the most common drugs containing opioids as hydrocone (Vicodin), oxycodone (OxyContin, Percocet), oxymorphone (Opana), morphine (Kadian, Avinza), codeine and fentanyl.

In the late 1990s, the medical community was given the green light to prescribe opioid pain relievers after pharmaceutical companies assured them patients wouldn’t become addicted, according to the U.S. Department of Health and Human Services. Increased prescriptions of opioid meds led to widespread misuse of both prescription and nonprescription opioids before their highly addictive nature became clear. The department declared a public health emergency in 2017 and announced a 5-Point Strategy to Combat the Opioid Crisis.

Despite these efforts, 10.1 million Americans reportedly misused prescribed opioids last year, according to department data released in December.

At first, physicians and prescribers thought opioid medications were a safe, long-term way to manage acute pain and chronic pain—“not recognizing the effects opioids have on the pleasure-seeking parts of our brain,” Dr. Gandhi says. “Opioids not only helped control pain, but they also helped reduce anxiety and depression. By stimulating endorphins, one would feel more outgoing, confident and increase motivation. This property, along with the chemical changes in the brain, alters our biological or physiological set point. Now we need more to achieve the same effect. And if we don’t get the drug, we have withdrawal, which is a horrible feeling. So, now one becomes addicted and seeks ways to get the medication that may not be safe or legal.”

In the 2000s, opioid substance misuse, abuse and overdose deaths continue to climb, she says, adding, “Physician prescriptions have definitely decreased, but unfortunately substance abuse, opioid use and overdose has not. Those numbers are still increasing and are still in the hundreds of thousands of people who die each year from an overdose.”

The increase in opioid overdoses and deaths has trickled over into the younger population, bringing attention to what opioids can do to children and adolescents brains. Research studies show that the earlier children are exposed to opioid substances, the higher the risk of long-term addiction, Dr. Gandhi says.

“What we’re recognizing in the pediatric population is the adolescent brain is set up for risk-taking behaviors. The brain is changing in a way that the prefrontal cortex is the last to develop—it’s developing from the back to the front,” she says. “The front is the part that regulates. But the back is the part that’s about risk-taking, asking questions, wanting to rebel, wanting to find answers for themselves, not wanting to listen to what other people say.

“It’s kind of like they’re a high-speed car without any brakes,” Dr. Gandhi says. “We can prescribe opioids in a safe way to kids, but we really need to be conscientious of how many doses we’re giving them, whether there are other ways to control their pain, making sure parents are the ones giving them their medications and that the medication is locked and secured in a safe place.”

Educating physicians, parents and patients on alternative ways to manage pain is one of the most important goals of Safe and Sound. For instance, under the program, guidelines to manage acute pain have been created, using a multimodal analgesia regimen of acetaminophen and ibuprofen as the primary medications for post-surgical pain management.

“There are studies that show when those medications are used together and scheduled for the first 72 hours after surgery, you need less narcotics, if any at all,” she says. “And that they’re more effective than even an oxycodone.”

During surgeries, physicians may use local anesthetics or nerve blocks as a proactive way to minimize postoperative pain. Families also are educated ahead of time on what to expect during post-op and what the plan will be for medications.

“Every patient goes home with a handout and discharge instructions on how to manage pain, including things like ice and heat, rest, utilizing relaxation and breathing apps, ways to help cope with distraction,” she says. “We tell parents that it’s OK for them to have a little bit of pain after surgery. As long as they can function, they can eat, do the things they need to do to recover, that’s the focus, as opposed to saying, we’re just going to give you these pills and this will be it.”

There’s a natural course for acute pain, Dr. Gandhi says, and if a patient is not healing accordingly, the individual needs to be reevaluated. “If someone’s not following that natural course, we want to assess why that is the case. It’s important because pain can always be a sign of something else. We want to be able to address it before blankly prescribing a pill,” she says.

The Safe and Sound approach appears to be working, says Lorrainea Williams, Cook Children’s Patient/Medication Safety Officer. In the past, surgical patients were usually sent home with a medication that contained both an opioid and acetaminophen. Now, they’re sent home with a medication plan that uses alternating acetaminophen and ibuprofen doses as the primary method to control pain. Patients also may receive a small amount of low-dosage medication that contains only an opioid to be used as a “rescue” in case their pain intensifies, she says.

In 2018, patients who needed pain relief were sent home with an average of 25 doses of medication that contained an opioid. That number has steadily decreased since the program began, and now the average is 12 doses for patients who need additional pain relief, she says.

The number of post-surgical patients who returned to the emergency room or had to be readmitted because of severe pain also has lowered since the hospital decreased the amount of opioids prescribed, Williams says, adding the number of return patients from 2018 to present dropped by 34 percent.

“Based on the numbers, we can determine that we are effectively managing our patients’ pain with less opioids,” Williams says.

The Safe and Sound program also established guidelines on prescribing opioids, and all opioids are prescribed electronically through our system, which tracks them, Williams says. Under the law, physicians can still write paper prescriptions for opioids if special circumstances exist.

But there are exceptions for prescribing opioids under the guidelines developed for Safe and Sound. Opioid therapy is to be considered only if the physician expects the benefit for pain and function to outweigh the risks and is reserved for moderate to severe pain in patients with conditions such as post-operative pain, trauma, sickle cell disease, palliative or end-of-life care.

As for patients dealing with chronic pain, the preferred first-line treatments under the Safe and Sound program include using more beneficial non-opioid medications, making positive lifestyle changes (such as getting enough sleep) and trying complementary therapies, depending on each individual’s condition. The non-pharmacological therapies include acupuncture, aromatherapy, biofeedback, cognitive behavioral therapy, massage, positioning, and Transcutaneous Electrical Nerve Stimulation (TENS).

It all comes back to an evidence-based approach.

“For example, there are some wonderful studies that show the benefits of acupuncture for chronic headaches and the benefits of massage for chronic back pain,” Dr. Gandhi says. “There also are studies that show the benefits of Tai-Chi for insomnia, fatigue and other chronic conditions.”

When it comes to treating chronic pain conditions, physicians must rely heavily on functional ability, such as how difficult is it for patients to walk to the bathroom, meet with friends, sit in a car or go to school, she says. The goal is to improve functional ability because that improves patients’ lifestyles, relationships and healthy routines.

“Trying to keep that routine is what we talk about when it comes to chronic pain, and then maximizing the appropriate types of medications,” Dr. Gandhi says. “All pain medicines are not the same. I would not throw opioids on top of opioids for chronic pain because that would be like trying to treat an ear infection with an antibiotic that treats urinary tract infections. Opioids have a limited role in chronic pain. They can actually induce a hyperalgesia response, where the sensitivity of those pain receptors increases. So, you actually could experience more pain with longer exposure to those opiates.”

For patients who are prescribed opioid medications for acute pain, it’s important to return unused pills once the pain has been managed, she says. The pharmacy at Cook Children’s has become a take-back location, where families can drop off unused meds. Other area pharmacies also have been designated as take-back locations.

“They don’t have to talk to anyone. There’s a little slot, you put your bag in there and walk away,” Dr. Gandhi says. Patients sent home with opioid prescriptions get a text message within a week reminding them to dispose of their unused medications and providing a website link that shows them the nearest take-back pharmacy location.

The program’s success hinges on physicians and parents working together and, so far, they have responded favorably, Dr. Gandhi says, adding the evidence-based approach is much more proactive than in the past. It focuses on pain management for each individual rather than a generalized approach, she says.

“Where it comes back to is all of us working together and being really consistent in our messaging,” she says. “We’ve done a lot of education for our staff as well, learning modules, training modules, continuing education opportunities. Parents are hearing the same message from the beginning, and not just when their children are in the throes of a situation.”

Dr. Kirk Pinto, M.D., a Cook Children’s urologist, says he has found the stewardship program to be helpful for his patients.

“I was skeptical at first, but I learned from my colleagues, who do essentially the same things I do, that these patients could be adequately managed with fewer or less opioids,” Dr. Pinto says. “I have always promoted the use of Motrin and Tylenol as first-line therapies. With all the bad publicity that opioids have gotten lately, parents are much more receptive to nonnarcotic pain management after surgery.”

Dr. Gandhi says she has been pleased by the overall response to the stewardship program.

“I have to say our surgeons and providers have been very open and receptive to this information because everything that we’ve brought forward has been evidenced-based,” she says. “Once we’re able to give them factual information, they’re very willing to change their culture or their prescribing habits, knowing that there’s literature that supports this change.

“We also monitor readmissions for pain or emergency room visits for pain. So we’re able to give them the data that shows kids are not coming back in with more pain, even though we’re prescribing less opioids,” Dr. Gandhi says.

Overall, families also have been on board with the Safe and Sound approach. They get a lot of education through media and commercials, she says, so they’re more aware of concerns surrounding opioid medications.

“They don’t necessarily want their kids to be on them long-term or to get high doses or go home with a lot of medications,” Dr. Gandhi says. “Obviously, you still get into situations where maybe there’s a little bit more stress around it, but I think everyone’s done a great job rallying around parents and supporting them. We’re not letting their kids suffer—they’re still getting the relief they need, just in different ways.”

The announcement is not a surprise by any means for caregivers at Cook Children’s who see opioid abuse and misuse among children ranging from babies to teens. Neonates are exposed in utero and experience neonatal abstinence syndrome as a result.

In 2016, 21 children were seen by Cook Children’s Emergency Department as a result of poisonings by opioids (10 accidentally, 11 intentionally). Nearly twice a month, children between the ages of 1 and 19 were arriving at Cook Children’s because of these dangerous drugs.

Much of the national focus has been on adults addicted to opioids. In fact, most programs and position statements refer to adults and fail to address the issues our children are combatting. Until now.

Artee Gandhi, M.D., is among Cook Children’s caregivers who are leading efforts to make changes in opioid distribution.

She is working on new guidelines to create patient information handouts on safe opioid prescribing within Cook Children’s. A plan is also in place to establish safe monitoring and risk assessment through electronic records. Dr. Gandhi is also on the Fort Worth Safe Communities Coalition Drug Overdose and Poisoning Prevention Task Force.

Dr. Gandhi says the problem for many children is that health care has focused its attention on treating children with medications.

“These are kids that were prescribed opioids for some reason, most of the time for some pain-related condition by dentists, emergency room doctors or primary care physicians,” said Dr. Gandhi, who is the medical director of Pain Management at Cook Children’s. “These kids are going back and taking these medications at a later time. They are using these left overs for non-medical use. We now know that the risk of death from overdose has increased. We also know that the use of opioid prescriptions leads to a higher incidence of anxiety and depression. Interestingly enough, even those kids that are given opioids for a legitimate reason will tend to misuse and abuse drugs.”

Another danger is when younger children find grownups’ prescription drugs and pop them in their mouth. Jamye Coffman, M.D., a pediatrician who specializes in child abuse, says that leaving these prescriptions where young children can access them usually falls under neglectful supervision from the perspective of the Texas Department of Family and Protective Services.

“However, there is also potential for a criminal charge for child endangerment,” Dr. Coffman said. “We see the criminal charge for the most part with illegal drugs which would include opioids obtained illegally. If you have followed the usual precautions of keeping them out of reach of the child, but they somehow manage to get it then it is an unfortunate accident.”

The Centers for Disease Control and Prevention (CDC) reports that nearly 2 million Americans, 12 years of age or older, either abused or were dependent on opioid painkillers in 2013.

“No part of our society — not young or old, rich or poor, urban or rural — has been spared this plague of drug addiction and this horrible, horrible situation that’s taken place with opioids,” President Trump said. “This epidemic is a national health emergency.”

In one study of illicit drug use among teens, opioids accounted for 100 percent of the deaths.

The Pain Management Program at Cook Children’s treats kids with pain ranging from fibromyalgia to migraine headaches to end-of-life patients to kids with life- limiting conditions such as neuromuscular disorders, and pain related diseases such as arthritis, cerebral palsy, etc.

The specially trained physicians at Cook Children’s create a treatment plan that is focused on each particular child and opioids aren’t often the first or only pain medicine used to treat children.

“The danger comes when physicians think the only way they can treat pain is through a narcotic and that’s not the case,” Dr. Gandhi says. “We need to know what type of pain the patient is having and take into account the child’s experience of pain. We are all individuals and no two people react the same way."

Dr. Gandhi says that between 15 to 20 percent of the kids seen at her clinic are on chronic opioids, but they are kids that have life-limiting medical conditions or end- of-life conditions.

The other 80 percent of the pain management patients work with physical and occupational therapists and receive therapies such as massage, biofeedback, cognitive behavioral therapy and acupuncture. Music, art and animal assisted therapies are also available for children. They look at all factors that contribute to the pain experience such as diet, nutrition, sleep habits, stress management and coping mechanisms. They create an environment of integrative health where practitioners and patients work together.

“We need to be much more vigilant on how we treat kids’ pain and how we create centers that address that pain,” Dr. Gandhi says. “If you look in Fort Worth or Tarrant County, there are probably 60 adult pain centers in this area, but for kids there are 35 in the entire country. That’s a huge difference. That perspective is crazy.”

If you want proof, read this diverse list of our most popular stories of 2016. We hope you enjoy our look back:

10. 7 Ear Infection Myths Every Parent Should Know. Parents flocked to this blog from Doc Smitty. Can your child go swimming with an ear infection? Do all ear infections need antibiotics? If your child gets ear tubes, will the infections stop?  All this and more was answered in this blog.

9. 7 Online Challenges This ER Doctor Warns Could Be Deadly Oh the Internet. Where kids do all kinds of things to get noticed and maybe go to hospital in the process. We asked our medical director of the Emergency Department to look at seven really silly, really dangerous dares that kids (or grownups for that matter) shouldn't try at home. 

8. Almond Milk: A Nutty Fad or Healthy Alternative. Almond milk sales have gone through the roof over the past decade. But is it the right drink for your child? Doc Smitty gave the answer in this informative piece. 

7. The Death of Ethan: A Life of Chronic Pain Ends in Tragedy. This is the most recent entrant in our list of top 10 stories. Only the fact that it was published in December kept this story out of the top five. We were so honored that Ethan's parents shared their son's story of a life filled with chronic pain. They want you to read it to learn about their son and hopefully help other children who may be suffering as well.

6. New Hope In Fight Against Deadly Brain-Eating Amoeba. The Lewis family holds a special place in the hearts of everyone involed in the Checkup Newsroom. Following the tragic death of their son Kyle to a brain infection caused by a water-born amoeba, Jeremy and Julie Lewis created Kyle Cares. Read their inspiring story as they fought to bring a drug to Cook Children's and other hospitals around the nation that may save children's lives.

5. 11 Tips That Could Save Your Daughter's Life.  In Janaury 2016, Rylie Whitten made national headlines after suffering one of the worst cases of toxic shock syndrome (TSS)  that her doctors had ever seen. Rylie's story moved us to run this informative piece on TSS that we hope every parent of a daughter reads.

4. A Sign From Heaven: Family Travels Across U.S. For Care at Cook Children's. A family's desperate search for answers on Google led them to Cook Children's. Read the fascinating story of what led this family to travel from Detroit, Mich. to Fort Worth, Texas, to be treated for a rare condition called hyperinsulinism.

3. The Most Common Rash You Never Knew About. Ever heard of molluscum contagiosum? We hadn't when Dr. Diane Arnaout wrote this blog for the newsroom. Dr. Diane's informative blog "that will save you and your child pain, money, time and anxiety" went viral quickly and became our third most read story of the year.

2. RSV On The Rise: 6 Things Every Parent Should Know. Here we are at the beginning of 2017 and we have been lucky in that we haven't seen much flu yet at Cook Children's. But we have seen plenty of RSV (respiratory syncytial virus), which explains the popularity of this great blog from Dr. Lizy Varughese.

1. Let's Learn Something: Bouncers, Jumpers and Walkers. Dr. Diane Arnaout's "Let's Learn Something" series was a big hit this year and none were bigger than this tale of caution. Dr. Diane's blog on how baby bumpers, bouncers and activity centers could play a role in your baby's motor delays is our most read new story of 2017. You've probably read this blog. But if you aren't one of the more than 117,000 readers who took a look, now's the time. And if you have read it, feel free to click again.

Well, that's it for 2016. Thank you all for reading. We'll be back with plenty more stories to tell in 2017.

Recent studies show that the use of prescription opioids doubled for adolescents, 15 to 19 years of age, between 1994 and 2007. The Centers for Disease Control and Prevention (CDC) reports that nearly 2 million Americans 12 years of age or older either abused or were dependent on opioid painkillers in 2013.

In one study of illicit drug use among teens, opioids accounted for 100 percent of the deaths.

“These are kids that were prescribed opioids for some reason, most of the time for some pain-related condition by dentists, emergency room doctors or primary care physicians,” Dr. Gandhi says. “These kids are going back and taking these medications at a later time. They are using these left overs for non-medical use. We now know that the risk of death from overdose has increased. We also know that the use of opioid prescriptions leads to a higher incidence of anxiety and depression. Interestingly enough, even those kids that are given opioids for a legitimate reason will tend to misuse and abuse drugs.”

The CDC, the U.S. Surgeon General, and President Obama have all taken strong stances on addressing the epidemic of opioid misuse and related deaths.

However, most programs and position statements refer to adults and do not address the issues our children are combatting.

The Pain Management Program at Cook Children’s treats kids with pain ranging from fibromyalgia to migraine headaches to end-of-life patients to kids with life- limiting conditions such as neuromuscular disorders, and pain related diseases such as arthritis, cerebral palsy, etc.

The specially trained physicians at Cook Children’s create a treatment plan that is focused on each particular child and opioids aren’t often the first or only pain medicine used to treat children.

“The danger comes when physicians think the only way they can treat pain is through a narcotic and that’s not the case,” Dr. Gandhi says. We need to know what type of pain the patient is having and take into account the child’s experience of pain. We are all individuals and no two people react the same way."

Dr. Gandhi says that between 15 to 20 percent of the kids seen at her clinic are on chronic opioids, but they are kids that have life-limiting medical conditions or end- of-life conditions.

The other 80 percent of the pain management patients work with physical and occupational therapists and receive therapies such as massage, biofeedback, cognitive behavioral therapy and acupuncture. Music, art and animal assisted therapies are also available for children. They look at all factors that contribute to the pain experience such as diet, nutrition, sleep habits, stress management and coping mechanisms. They create an environment of integrative health where practitioners and patients work together.

“We need to be much more vigilant on how we treat kids’ pain and how we create centers that address that pain,” Dr. Gandhi says. “If you look in Fort Worth or Tarrant County, there are probably 60 adult pain centers in this area, but for kids there are 35 in the entire country. That’s a huge difference. That perspective is crazy.”

About the source

Artee Gandhi, M.D., is a pediatric pain management specialist and anesthesiologist. She has trained across the country including residency at the University of Missouri and fellowship at Stanford Univeristy. Cook Children's Pain Management program cares for infants, children and adolescents with chronic and acute pain. C​ook Children's is one of a few children's hospitals in the U.S. providing a comprehensive pediatric pain management program.