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POV: More Help Needed for Youngest Victims of Opioid Epidemic

“The time is now for pediatricians to step up” to address the crisis

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Opioids and the harm they cause have received a lot of attention recently. Drug overdoses are now the leading cause of unintentional death in the United States, with the number of annual overdoses exceeding deaths from motor vehicle crashes. Fortunately, there is increasing focus on treatment for opioid addiction and on making sure that those who need it can access it.

Yet voices urging evidence-based addiction treatment are quieter when it comes to one highly vulnerable group: adolescents and young adults. Youth tend to receive less attention because as a group, they represent a smaller proportion of overdose deaths in the United States than older individuals. Additionally, youth often use opioids privately, and their early struggles with addiction may not yet have resulted in serious life problems (such as relationship difficulties, loss of a job, dropping out of school, or homelessness). As a result, their drug use and the problems it causes may go unnoticed.

Why should we care about whether youth have access to treatment? Halting the opioid crisis in the United States will require upstream public health and clinical interventions that target the pipeline of young people who use opioids. Put simply, we need to prevent today’s opioid-using youth from becoming tomorrow’s overdose statistics. One in three individuals in treatment for opioid addiction reports that the first time they used was before age 18; two in three report that it was before age 25.

The problem with the current treatment system for youth is that it often piggybacks onto treatment for adults. Many treatment centers treat teenagers alongside adults in their 50s and 60s, requiring young people to follow the same rules as older people and expecting the same results. It is no surprise, then, that younger people—who have unique developmental considerations that need to be taken into account—tend to have the lowest rates of treatment retention. Also, many youth come to treatment with a parent or other caregiver, which offers a special opportunity to bolster support, and yet many treatment centers do not allow family members to participate in the recovery process.

To address these problems will take experts who can drive better clinical care and research for addiction. Last year, addiction medicine became a medical subspecialty (just like cardiology or gastroenterology), allowing doctors to become experts in preventing and treating addiction. This has made it possible for pediatricians and family doctors (who are experts in providing developmentally appropriate and family-centered care) to become addiction subspecialists. Pediatric addiction subspecialists will be poised to not only provide treatment for young people struggling with opioids, but to lead clinical research and education that move the field forward.

Pediatric addiction subspecialists, however, represent only a small portion of the workforce needed to address the large number of youth with opioid addiction. (Indeed, the field already faces a critical shortage; only one percent of all addiction medicine subspecialists are pediatricians.) Health care providers who work with youth in primary care settings, including general pediatricians, family doctors, nurse practitioners, and physician assistants, will need to gain competency in addiction. This includes screening for drug use, providing basic treatment, and understanding when to refer more complicated cases to subspecialty treatment.

The idea that primary care doctors should provide addiction treatment may sound radical, but it isn’t. The American Academy of Pediatrics, the leading pediatric professional society in the United States, recognizes that youth have insufficient treatment options and has explicitly called on pediatricians to provide opioid addiction treatment in primary care. A policy statement released last month encourages pediatricians to provide youth with access to evidence-based medications, such as buprenorphine or injectable naltrexone, both of which can be offered in primary care. Combined with behavioral therapy, these medications offer the greatest likelihood of recovery from addiction.

This marks the first time that a major pediatric professional organization has called on pediatricians to prescribe these medications, which until now had been the province of addiction subspecialists. Making these medications available in pediatric primary care is an enormous opportunity to greatly expand the number of treatment options for youth. Furthermore, this approach gives youth the opportunity to receive treatment from a trusted provider in the same familiar setting where they receive the rest of their medical care. It also helps youth and families avoid the stigma they sometimes experience when they go to specialized drug treatment programs in the community.

The School of Medicine and Boston Medical Center are new leaders in this area, having started one of the country’s first primary care–based treatment programs, CATALYST, led by Sarah Bagley, a MED assistant professor of medicine and pediatrics. Elsewhere, many pediatricians have been hesitant to treat addiction in primary care; managing substance use just isn’t why most pediatricians chose to enter pediatrics. The first time I provided care to an adolescent with opioid addiction in primary care, he sat on my exam table reading a Harry Potter book. It was in this moment that I knew addiction and pediatrics were truly intersecting. Pediatricians already manage many conditions that have both medical and psychosocial underpinnings, such as obesity, diabetes, or ADHD. The time is now for pediatricians to step up, gain competency in addiction, and do their part to address a crisis that is killing Americans at an unprecedented rate.

Scott Hadland, a School of Medicine assistant professor of pediatrics, is an adolescent medicine and addiction specialist. He can be reached at Scott.Hadland@bmc.org.

“POV” is an opinion page that provides timely commentaries from students, faculty, and staff on a variety of issues: on-campus, local, state, national, or international. Anyone interested in submitting a piece, which should be about 700 words long, should contact Rich Barlow at barlowr@bu.eduBU Today reserves the right to reject or edit submissions. The views expressed are solely those of the author and are not intended to represent the views of Boston University.

2 Comments

2 Comments on POV: More Help Needed for Youngest Victims of Opioid Epidemic

  • N. Paul Rosman, M.D. on 02.21.2017 at 9:14 am

    Scott, when you were at BMC several years ago, as a Chief Resident in Pediatrics, you were a star. And now, as a staff member, your star shines ever more brightly. Perhaps your Canadian lineage is making an egenetic contribution to your wonderful work with opioid addiction in our youth, though I doubt it….it’s all Scott Havilland, whose intelligence, foresight and drive are combining to lead this fight. You bring much honor to our field and much healing to our youth with your important work.
    N. Paul Rosman, M.D.
    Professor of Pediatrics and Neurology
    BUSM, BMC

  • Jay on 02.21.2017 at 11:19 pm

    I tend to stop and read most articles I see about substance abuse because it’s something that’s effected too many of my closest family members. But this is the first article I’ve read that specifically talks about the a pediatrician’s responsibilities. “The time is now for pediatricians to step up, gain competency in addiction, and do their part to address a crisis that is killing Americans at an unprecedented rate.” Thank you for that statement and for this article. I think what you’ve written about here is so so important.

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