More children are dying from overdose. Can pediatricians do more? : shot

Dr. Safdar Medina treats opioid use disorder as part of his pediatric practice. During a recent visit at his clinic in Uxbridge, Mass., Medina switched a teenage patient's buprenorphine prescription to an injectable one and took stock of his school and social life.

Martha Bebinger/WBUR

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Martha Bebinger/WBUR

Dr. Safdar Medina treats opioid use disorder as part of his pediatric practice. During a recent visit at his clinic in Uxbridge, Mass., Medina switched a teenage patient's buprenorphine prescription to an injectable one and took stock of his school and social life.

Martha Bebinger/WBUR

A 17-year-old boy with shaggy blonde hair steps on the scale at Tri-River Family Health Center in Uxbridge, Massachusetts.

After weighing in, he heads to an exam room decorated with decals of planets and cartoon characters. A nurse checks his blood pressure. Your pediatrician will ask about your school, home life, and friendships.

This looks like a routine teen checkup, like the one done every day in thousands of pediatric clinics across the United States, until the doctor asks this question.

“Do you have a craving for opioids?” ask Dr.Safdar Medina. The patient shook his head.

“Nothing, nothing at all?” Medina said again for confirmation.

“Nothing,” the boy named Sam said in a quiet but confident voice.

We are using only Sam's first name because he may face discrimination in housing or job applications based on his previous drug use.

Medina is treating Sam for his opioid addiction. I was prescribed a drug called buprenorphine. Suppresses cravings for more dangerous and addictive opioid pills. Sam's urine test showed no trace of Percocet or OxyContin, the pills he had been buying on Snapchat that fueled his addiction.

“Sam, what I'm really proud of is how much you're trying to get better,” Medina says. Massachusetts Memorial Hospital.

Are pediatricians an untapped resource to combat addiction?

American Academy of Pediatrics It is recommended Providing buprenorphine to teens addicted to opioids. However, according to only his 6% of pediatricians, Investigation result.

In fact, the prescription of buprenorphine for adolescents is is in decline Cases of overdose deaths among 10 to 19 year olds more than doubled. These overdoses are coupled with accidental opioid poisoning among young children. 3rd most common cause of death To America's children.

“We're really far from where we should be and far in several different areas,” he says Dr. Scott Hadland, Director of Adolescent Medicine General mass for childrenco-author of a study that surveyed pediatricians about addiction treatment.

The survey showed that many pediatricians do not believe they have the appropriate training or staffing for this type of treatment, but Medina and others managing addicted patients Pediatricians say there was no need to hire additional staff.

Some pediatricians told the survey that they don't have enough patients to justify learning about this type of treatment, or that they don't think it's a pediatrician's job.

“A lot of it has to do with training,” he says. Dr. Deepa KamengaAssociate Director Pediatric Program, Yale University Addiction Medicine Program.

“It's considered a very specialized branch of medicine, so people aren't exposed to it during routine medical training.”

Kamenga and Hadland said medical schools and pediatric training programs are adding information about substance use disorders to their curricula, including how to discuss drug and alcohol use with children and teens.

But the curriculum remains the same. fast enough Needless to say, to help the many young people suffering from addiction. Some people die after taking just one pill..

In an ironic but fatal development, Adolescent drug use is actually decreasing, but drug-related deaths are increasing.

The main culprits are counterfeit Xanax, Adderall, or Percocet pills laced with the powerful opioid fentanyl.almost 25% of recent overdoses The deaths of 10- to 19-year-olds were found to be caused by counterfeit pills.

“Fentanyl and counterfeit pills make our efforts to prevent overdoses extremely difficult,” he says. Dr. Andrew Terranella, a CDC expert on youth addiction medicine and overdose prevention. “In many cases, these children are overdosing without ever realizing what they are ingesting.”

Terranella says pediatricians can help by increasing screening for and discussing drug use of all types.

He also suggests that pediatricians prescribe more naloxone, a nasal spray that can prevent overdoses. Although it is available over-the-counter, Dr. Terranella, who practices in Tucson, Arizona, says a prescription may be more important to patients.

Try different prescribing methods

Back at the doctor's office, Sam is about to receive his first injection of Sublocade, an injectable form of buprenorphine that lasts for 30 days. Sam didn't like the taste of Suboxone, an oral strip of buprenorphine that was supposed to dissolve under her tongue, so she switched to the shot. He was spitting them out before fully ingesting them.

Many doctors also prefer injections because patients don't have to remember to take them every day. But the injection hurts. Sam is surprised to hear that it takes 20 to 30 seconds to inject the stomach.

“Are you almost done?” Sam asked as the nurse instructed him to breathe deeply. After the filming is over, the staff members joke loudly, and it is common for even adults to curse during filming. He says Sam didn't know it was allowed. His biggest worry is that he'll be left with soreness that could interfere with his plans for the night.

“Do you think we can snowboard tonight?” Sam asks Dr. Medina.

“I think you can snowboard tonight,” Dr. Medina said reassuringly.

Sam goes with his new friend. Since entering rehab 15 months ago, Sam says one of the hardest things he's done has been making new friends and cutting ties with his former social circle of drug-using teens. says.

“Surrounding yourself with the right people is definitely a big thing to focus on,” Sam says. “That would be my biggest piece of advice.”

Buprenorphine was not previously offered

For Sam, receiving treatment for addiction in a clinic filled with puzzles, toys, and picture books isn't as strange as he thought.

He came to this appointment with his mother, Julie. She says she's grateful her family found a doctor who understands teens and drug use.

Before coming here, Sam underwent seven months of inpatient and outpatient treatment, but was never offered buprenorphine to control his appetite and prevent relapse. Only 1 in 4 people Youth housing programs provide that. When Sam's opioid cravings returned, the counselor encouraged Julie to call Dr. Medina.

“Oh my god, two or three years ago we would have had Sam here,” Julie says. “I don't know if it would have changed the course, but it would have been a more appropriate level of care for him.”

Some parents and pediatricians are concerned about starting buprenorphine in teenagers. side effects Including long-term dependence. Pediatricians who prescribe the drug weigh the threat of a fentanyl overdose against the potential side effects.

“At a time when young people are dying at unprecedented rates from opioid overdoses, saving lives is critical,” said Hadland, director of adolescent medicine at Mass General for Children. . “And we know that buprenorphine is a lifesaving drug.”

Treating addiction can be time-consuming for pediatricians. Sam and Dr. Medina text several times a week. Medina emphasizes that communications Sam has requested to be kept confidential will not be shared.

Medina says treating substance use disorders is one of the most rewarding parts of her job.

“If we can deal with it, we've created adults who don't have to deal with these challenges for the rest of their lives,” he says.

This article is based on NPR's Health Reporting Partnership. WBUR and KFF Health News.