Dr. LevyThe rising rate of opioid addiction and overdose deaths in the U.S. is a prominent topic of discussion in many sectors of society — from local communities to presidential politics. Strategies for managing this crisis center on treatment of substance use disorders like never before. The Affordable Care Act has called on primary care physicians to expand prevention, counseling, case finding and linkage with treatment.
Pediatricians may have the best vantage point to identify patients with substance use disorders relatively early in the course of this disease and ensure that treatment is initiated. A new AAP policy statement advocates for increased access to effective treatments for adolescents and young adults with opioid use disorders, including developmentally appropriate counseling and medication.
The policy, Medication-Assisted Treatment of Adolescents With Opioid Use Disorders from the Committee on Substance Use and Prevention, is available at http://pediatrics.aappublications.org/content/early/2016/08/18/peds.2016-1893 and will be published in the September issue of Pediatrics.
Opioid addiction is a chronic condition in which neurological changes in the brain’s reward center are responsible for compulsive substance use. While the rate of spontaneous remission is low, patients can recover.
Three medications are indicated for treating severe opioid use disorder: methadone, naltrexone and buprenorphine.
Methadone has been used as a treatment for opioid addiction for more than 40 years, though it can be prescribed only by specialized methadone treatment programs, few of which are able to accept patients younger than 18 years of age. Naltrexone, an opioid antagonist, and buprenorphine, a partial opioid agonist, both can be prescribed in primary care for outpatient treatment of patients with opioid use disorders. To prescribe buprenorphine, physicians first must complete eight hours of training and apply for a waiver. In partnership with the Academy, the Prescribers’ Clinical Support System for Opioid Therapies offers an eight-hour waiver training course designed specifically for pediatricians that covers use of these medications (see resource).
Despite the established efficacy of medication treatment and potentially devastating consequences of untreated opioid addiction, utilization of medications for opioid use disorders remains low, particularly in youths. Current policies, stigma and attitudes may present barriers to accessing medication for adolescents with opioid use disorders. The Academy addresses these barriers through the policy’s three key recommendations:
- Advocate for increasing resources to improve access to medication-assisted treatment of adolescents and young adults addicted to opioids.
- Consider offering medication-assisted treatment to adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service.
- Support further research focusing on developmentally appropriate treatment of substance use disorders in adolescents and young adults, including primary and secondary prevention, behavioral interventions and medication treatment.
Dr. Levy, the lead author of the policy statement, is a former member of the AAP Committee on Substance Use and Prevention.