As the opioid abuse epidemic continues unabated in the U.S., experts say there simply aren’t enough resources to provide adequate treatment to those in the grips of addiction. That includes a dearth of medications being prescribed to assist in breaking the hold of powerful prescription painkillers and heroin.
As it turns out, teens, whose brains are still developing, are particularly vulnerable to becoming addicted to alcohol and drugs including opioids, and are also less likely than adults to have access to treatment programs and medications. The majority of drug treatment centers are geared toward adults, and far fewer providers prescribe medications recommended for treatment of opioid addiction, like buprenorphine, to youth.
For people of all ages in the U.S. struggling with opioid addiction, the services available — including the total number of treatment programs and clinicians treating this issue — aren’t adequate to meet the needs of the population, says Dr. Sheryl Ryan, chairwoman of the American Academy of Pediatrics Committee on Substance Use and Prevention and professor of pediatrics at the Yale School of Medicine. The problem is even more pronounced for adolescents, she says.
“Developmentally their needs are different,” she says. For instance, successful substance use treatment programs geared toward teens — and even some young adults — are often family-based, incorporating parents, siblings and others close to the child in treatment. The programs address issues that go beyond substance abuse, from family conflict to mental health concerns that may contribute to drug abuse.
[See: 4 Opioid Drugs Parents Should Have on Their Radar.]
However, while counseling can be a critical component to recovery, Ryan says medication that has also been shown to be effective in tackling addiction is commonly not given to teens and young adults who are addicted to opioids.
In fact, recent research evaluating claims data between 2001 and 2014 for 20,822 privately insured individuals aged 13 to 25 who were diagnosed with opioid use disorder found that only about 1 in 4 received medication therapy to treat the disorder. OUD is marked by a range of factors such as craving of opioids and use of the drugs in excessive amounts or for longer than intended as well as social impairment — like interpersonal problems or not being able to meet obligations at school or home.
The study, published in JAMA Pediatrics in June, found that prescribing of these drugs had increased through 2009 — but it declined thereafter, even as opioid addiction in youth and adults has continued to increase. “That treatment gap was even worse for females and for black and Hispanic youth,” says Dr. Scott Hadland, a pediatrician and adolescent addiction specialist at the Grayken Center for Addiction Medicine at Boston Medical Center.
“Medication-assisted treatment for adolescents with an opioid use disorder is very uncommon,” echoes Kenny Feder, a Ph.D. student pursuing a doctorate degree in public health, with a focus in mental health, at Johns Hopkins Bloomberg School of Public Health in Baltimore. Feder led research first published online in March in the Journal of Adolescent Health that found low rates of prescribing these medications in treatment programs that specialize in substance abuse.
Though all the reasons for the treatment gap aren’t clear, there are some obvious barriers to medication-assisted treatment for opioid addiction. Among them, despite a push to expand addiction treatment into primary care to make it more widely available to patients, very few pediatricians prescribe medication to treat OUD. Doctors must complete an eight-hour training course and apply for a waiver to be able to properly prescribe buprenorphine — which itself has abuse potential — that’s approved by the Food and Drug Administration for patients 16 years and older. Suboxone — which includes buprenorphine in combination with another drug, naloxone — has much lower abuse potential than the Subutex which is just buprenorphine, and is more commonly prescribed to adolescents, Ryan says.
Naltrexone, another medication recommended to treat opioid addiction, is approved for individuals 18 years and up, while methadone prescribing is highly restricted for individuals under 18, and most methadone treatment programs serve individuals 18 and older. The drugs aren’t without risk either; though naltrexone has very limited potential for misuse, methadone can create dependence and be addictive. All medications used to treat addiction must be prescribed properly and patients must be monitored.
In a policy statement last year, the American Academy of Pediatrics emphasized that all three medications are effective treatments, based on research, and underused — just as with non-pharmacologic treatment of opioid treatment. It noted that the rate of opioid overdose in the U.S. has climbed and that severe opioid use disorder is a chronic condition, though patients can recover with treatment. “The AAP recommends that pediatricians consider offering medication-assisted treatment to their adolescent and young adult patients with severe opioid use disorders or discuss referrals to other providers for this service,” the statement noted.
[See: 10 Concerns Parents Have About Their Kids’ Health.]
In the meantime, experts say, parents or other caregivers of adolescents battling addiction should be persistent if encountering roadblocks to treatment for their children. Besides practical obstacles that may limit prescribing to treat opioid addiction, Ryan says the stigma still surrounding drug addiction may also preclude some providers from getting involved in treating substance abuse or parents from taking their kids in for addiction treatment.
If unable to get help or a referral through your child’s doctor, check out resources online like the Substance Abuse and Mental Health Service’s Administration website which has a behavioral health services treatment locator for issues including substance abuse. Look for providers or programs specializing in addiction that accept adolescents. Doctors may also become certified in addiction medicine, which the American Board of Medical Specialties now also recognizes as a subspecialty.
For parents who suspect their child might be experimenting with drugs — but don’t yet know if they are abusing drugs — the first step is to keep the lines of communication open. The best approach is to begin the conversation well before a child is a teen. Talk openly about the subject, the potential harm of drugs and alcohol, and try to understand what kids — and peers, who influence them — might be exposed to, Hadland says.
Forget about worries you’re being a hypocrite. If you did things you wish your kids wouldn’t, such as abusing alcohol or drugs as a teen — and you feel you must come clean about it — turn it into a teachable moment; at the very least advise your children to take a different path that’s less trepidatious, experts say.
By the same token, fast forwarding to present day, parents should try to serve as a model for their children. “Do their parents drink heavily? Are they smokers? Do they just take pills for the least little thing that bothers them?” Ryan says. Being moderate about substance use — like having a glass of wine now and again rather than binge-drinking — can give kids a road map when they’re of age.
Keep prescription opioids locked away in a medicine cabinet or another safe place that your kids can’t access, and make sure your kids aren’t given an overly abundant supply either. As efforts continue to reduce unnecessary prescribing of opioids by medical and dental providers, experts say, it’s important to be discerning about what you and your kids take. “Don’t let your teenager who’s getting his wisdom teeth out get four weeks’ worth or Vicodin or Oxycontin,” Ryan says. “All they need is maybe two to three days.”
[See: 7 Health Risks of Binge Drinking You Can’t Ignore.]
Finally, though quitting opioids cold turkey — without any treatment assistance — may not be a particularly effective option, never using drugs or alcohol as a teen to start with is an option. National survey data, like that from the University of Michigan, suggests that’s a choice many teens are making, Hadland notes. So irrespective of what parents might have chosen to do when they were children, it’s important to encourage teens to consider this option, he says. “A majority of young people are actually postponing substance use until their adult years, and the science shows that’s probably the healthiest choice.”
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Battling Opioid Addiction in Adolescents originally appeared on usnews.com
