Opioid Use in Adolescents
Laura M. Blinkhorn, MD
Posted on October 23, 2023
A recent visit with a regular patient quickly changed direction. Instead of discussing his medical problems, he shared his concern for his stepson's illicit fentanyl use. It was impossible for my patient to focus on his own health when his family was in crisis. This story is not anomalous; with adolescent opioid use and overdose on the rise, many families and communities struggle to respond. Experts agree that the treatment plan for youth with addiction must consider and include their families. A leading risk factor for a child to develop a substance use disorder is having a parent with the same problem. Addiction is a chronic, relapsing disorder and requires a team for ongoing support and treatment. Family physicians care for entire families and are particularly well suited to address the opioid epidemic in adolescents in the following ways.
Counseling: "One pill can kill." Overall, teen alcohol and drug use is declining, but many still experiment. Fentanyl, a synthetic opioid, is the present in about three of four fatal overdoses. The U.S. Drug Enforcement Agency lauched the "one pill can kill" campaign to raise awareness of the fact that fentanyl is widely present in counterfeit pills and powders, including those purporting to be cocaine, amphetamines, or benzodiazepines. Adolescents and their families must be warned of this. During teen well-child visits, physicals, and with the parents of adolescents, we must be clear: Any illicit pills or powders are potentially contaminated with fentanyl and could therefore lead to a fatal overdose.
Overdose prevention. Fortunately, medications are available to reverse opioid overdoses, including those caused by fentanyl. Naloxone and nalmefene are opioid antagoinists that can be given intranasally to reverse an overdose. In the Morbidity and Mortality Weekly Report of youth overdose deaths from 2019–2020, 90% involved opioids, and two-thirds had a potential bystander available who could have, but didn't provide, an overdose response. Although barriers to getting these medications to those who need it have been lowered—naloxone (brand name Narcan) is now available over the counter—family physicians can educate, promote, and help families obtain this life-saving medication.
Treatment options. Strong evidence supports that medication for opioid use disorder (MOUD; e.g., methadone, buprenorphine, naltrexone) increase retention in care and reduces death, including in adolescents. Unfortunately, medication treatment for adolescents and adults with opioid use disorder is severely underused. Although barriers have been lifted for prescribing suboxone, it still remains underprescribed. Family physicians should be comfortable prescribing MOUD, or at least discussing it as the standard of care.
More help for the very sick. In my region and many others, it is exceedingly difficult to find more intensive treatment options for adolescents with severe substance use disorder. One study found that only one-quarter of addiction treatment centers offer services to adolescents and that those were less likely to offer medication treatment. Family physicians must advocate for more research and resources to help younger patients.
At the end of the visit, my patient left with naloxone, information for Nar-Anon, and a number for intake at our integrated recovery program. I am hoping to see both my patient and his stepson in the office soon.
Resources
AFP article: Opioid Use Disorder: Medical Treatment Options
Previous AFP Community Blog posts on substance use disorders