Some finding opioid addiction help in an unlikely place
Pediatricians working to keep teen patients on track
Sam, a 17-year-old boy with shaggy blond hair, stepped onto the scale at TriRiver Family Health Center in Uxbridge, Massachusetts.
After he was weighed, he headed for an exam room decorated with decals of planets and cartoon characters. A nurse checked his blood pressure. A pediatrician asked about school, home life and friendships.
It seemed like a routine teen checkup, the kind that happens in thousands of pediatric practices across the U.S. every day – until the doctor asked his next question.
“Any cravings for opioids at all?” asked pediatrician Safdar Medina. Sam shook his head.
“None, not at all?” Medina said again, to confirm.
“None,” said Sam, in a quiet but confident voice.
Only Sam’s first name is being used for this article because if his full name were publicized he could face discrimination in housing and job searches based on his prior drug use.
Medina was treating Sam for an addiction to opioids. He prescribed a medication called buprenorphine, which curbs cravings for the more dangerous and addictive opioid pills. Sam’s urine tests showed no signs of the Percocet or OxyContin he used to buy on Snapchat.
“What makes me really proud of you, Sam, is how committed you are to getting better,” said Medina.
Trending in the wrong direction
The American Academy of Pediatrics recommends offering buprenorphine to teens addicted to opioids. But only 6% of pediatricians report ever doing do, according to survey results.
In fact, buprenorphine prescriptions for adolescents declined as overdose deaths for 10- to 19-year-olds more than doubled. These overdoses, combined with accidental opioid poisonings among young children, have become the thirdleading cause of death for U.S. children.
“We’re really far from where we need to be,” said Scott Hadland, chief of adolescent medicine at Mass General for Children and a co-author of the study that surveyed pediatricians about addiction treatment.
That survey showed that many pediatricians don’t think they have the right training or personnel for this type of care – although Medina and other pediatricians who do manage patients with addiction say they haven’t had to hire.
Some said they didn’t have enough patients to justify learning about this type of care or didn’t think it was a pediatrician’s job.
“A lot of that has to do with training,” said Deepa Camenga, associate director for pediatric programs at the Yale Program in Addiction Medicine. “It’s seen as something that’s a very specialized area of medicine and, therefore, people are not exposed to it during routine medical training.”
Camenga and Hadland said medical schools and pediatric residency programs are working to add information to their curricula about substance use disorders, including how to discuss drug and alcohol use with children and teens.
But the curricula aren’t changing fast enough. In a twisted, deadly development, drug use among adolescents has declined – but drug-associated deaths are up. The main culprits are fake Xanax, Adderall or Percocet pills laced with the powerful opioid fentanyl. Nearly 25% of recent overdose deaths among 10- to 19year-olds were traced to counterfeit pills.
“Many times these kids are overdosing without any awareness of what they’re taking,” said Andrew Terranella, the Centers for Disease Control and Prevention’s expert on adolescent addiction medicine and overdose prevention.
Terranella said pediatricians can help by stepping up screening for – and having conversations about – all types of drug use. He also suggests more pediatricians prescribe naloxone, the nasal spray that can reverse an overdose. It’s available over the counter, but Terranella believes a prescription may carry more weight with patients.
Addiction care can take a lot of time for a pediatrician. Sam and Medina text several times a week. Medina stresses that any exchange that Sam asks to be kept confidential is not shared.
Medina said treating substance use disorder is one of the most rewarding things he does.
“If we can take care of it,” he said, “We have produced an adult that will no longer have a lifetime of these challenges to worry about.”