Nine in 10 adults with a substance use disorder began using substances before age 18. Among youth, opioid and polysubstance overdose deaths have increased by 384% and 760%, respectively, since the late 1990s. Pediatricians need training in screening, brief intervention, and referral to treatment (SBIRT) for substance use disorders and in medication treatment of opioid use disorder (OUD), all of which are recommended as best practice by the American Academy of Pediatrics (AAP).3–5 

Pediatric residency training on substance use and opioid misuse is poorly described. The extent to which training relates to regional needs, perhaps most importantly, local overdose death rates, is also insufficiently characterized. We conducted a survey of US pediatric residency programs to assess training in youth substance use and compared findings with regional overdose mortality. We hypothesized that programs located in counties with elevated mortality would be more likely to offer substance...

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