Medication Treatment of Adolescent Opioid Use Disorder in Primary Care.

1. Brittany L. Carney, MS* 2. Scott E. Hadland, MD, MPH, MS*,† 3. Sarah M. Bagley, MD, MSc*,† 1. *Department of General Internal Medicine/Pediatrics, Boston Medical Center, Boston, MA 2. †Department of Pediatrics, Boston University School of Medicine, Boston, MA 1. Medication-Assisted Treatment of Adolescents With Opioid Use Disorders. Committee on Substance Use and Prevention. Pediatrics. 2016;138(3). Available at: https://doi.org/10.1542/peds.2016-1893 2. Electronic Code of Federal Regulations, 42 CFR 8.12 - Federal Opioid Treatment Standards. § Part 8—Medication Assisted Treatment for Opioid Use Disorders. Available at: https://www.ecfr.gov/cgi-bin/text-idx?SID=25e311ab0b3ac62d80439ad2c1ba7bb2&mc=true&node=pt42.1.8&rgn=div5 3. 1. Gaither JR, 2. Leventhal JM, 3. Ryan SA, 4. Camenga DR National Trends in Hospitalizations for Opioid Poisonings Among Children and Adolescents, 1997 to 2012. Gaither JR, Leventhal JM, Ryan SA, Camenga DR. JAMA Pediatrics. 2016;170(12):1195–1201. Available at: https://doi.org/10.1001/jamapediatrics.2016.2154 [OpenUrl][1] 4. 1. Johnston LD, 2. O’Malley PM, 3. Miech RA, 4. Bachman JG, 5. Schulenberg JE Monitoring the Future National Survey Results on Drug Use, 1975-2016: Overview, Key Findings on Adolescent Drug Use. Johnston LD, O’Malley PM, Miech RA, Bachman JG, Schulenberg JE. Ann Arbor, MI: Institute for Social Research, The University of Michigan; 2017. 5. 1. Kampman K, 2. Jarvis M American Society of Addiction Medicine (ASAM) National Practice Guideline for the Use of Medications in the Treatment of Addiction Involving Opioid Use. Kampman K, Jarvis M. J Addict Med. 2015;9(5):358–367 [OpenUrl][2][CrossRef][3][PubMed][4] 6. 1. Han B, 2. Hedden SL, 3. Lipari R, 4. Copello EAP, 5. Kroutil LK Receipt of Services for Behavioral Health Problems: Results from the 2014 National Survey on Drug Use and Health (National Survey on Drug Use and Health [NSDUH] Data Review). Han B, Hedden SL, Lipari R, Copello EAP, Kroutil LK. Available at: https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014/NSDUH-DR-FRR3-2014.pdf. Published September 2015 Since 2000, a threefold increase in unintentional opioid poisonings among adolescents has followed a dramatic increase in adult opioid-related deaths. In 2016, 1 in 13 high school seniors reported past-year nonprescription use of opioids. Despite these increases, only 8.5% of adolescents received addiction treatment. In September 2016, the American Academy of Pediatrics (AAP) released a policy statement recommending that pediatricians offer medication for the treatment of severe opioid use disorder (OUD). There are 3 medications approved for OUD treatment: buprenorphine, naltrexone, and methadone. Buprenorphine and methadone are opioid agonists that decrease cravings for opioids and treat withdrawal symptoms. In addition, both provide opioid blockade, which means that if an individual uses another opioid after taking their medication, euphoric effects are blocked. Naltrexone, an opioid antagonist, blocks the opioid receptor, preventing the effects of opioid use. It may also reduce cravings for opioids. Head-to-head clinical trials of these medications in adolescents are lacking; observational data from adults suggest that of these medications, methadone may be the most effective for retention in treatment. Buprenorphine is taken daily via sublingual tablets or films and can be prescribed in pediatric primary care. The film is a dissolving strip absorbed through the buccal mucosa or tongue. Buprenorphine has 2 formulations: 1) combined with naloxone (buprenorphine/naloxone) … [1]: {openurl}?query=rft.jtitle%253DJAMA%2BPediatrics%26rft.volume%253D170%26rft.spage%253D1195%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: {openurl}?query=rft.jtitle%253DJ%2BAddict%2BMed%26rft.volume%253D9%26rft.spage%253D358%26rft_id%253Dinfo%253Adoi%252F10.1097%252FADM.0000000000000166%26rft_id%253Dinfo%253Apmid%252F26406300%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [3]: /lookup/external-ref?access_num=10.1097/ADM.0000000000000166&link_type=DOI [4]: /lookup/external-ref?access_num=26406300&link_type=MED&atom=%2Fpedsinreview%2F39%2F1%2F43.atom