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Pediatricians As First Responders in the Opioid Battle

Can screen and refer their young patients

Growth charts, hormones, risky behaviors … pediatricians have a lot to cover in the 20 minutes they spend with their patients, and yet a simple conversation can help redirect a potentially dangerous youthful trajectory. The most recent Emerging Drug Trends report from the Hazelden Betty Ford Foundation and the University of Maryland School of Public Health distinguishes pediatricians as the central figures in early detection and prevention of substance use in adolescents.

"Standing at the front line of where the neurodevelopmental disease of addiction starts, pediatricians are in the unique position of being able to practice primary prevention of a disease that begins in adolescence," said Stephen Delisi, MD, medical director of Hazelden Publishing's Professional Education Services.

In addition to screening their patients for risk factors, the report says, pediatricians can encourage youth who have not initiated substance use to not start; conduct brief interventions with those who have started; and facilitate access to treatment for those who may develop a substance use disorder.

Ten or 20 years from now, says Joseph Lee, MD, medical director of the Hazelden Betty Ford Foundation Youth Continuum, “there may be another epidemic involving other chemicals, coupled with more heartache, loss, and anguish…. [W]e must not forget that there are generations of youth incubating right now in our school systems and we are not doing nearly enough to prevent the same mistakes that have so dearly cost us in the present. Without aggressive and strategic investment in our youth, we are bound to suffer again."

The report looks in detail at the following:

  • Research showing that substance use screening, intervention and referral-to-treatment strategies are not being implemented routinely in "well child" visits, acute illness visits or any other pediatric settings, despite the American Academy of Pediatrics' recommendations;
  • The need for more training and education due to barriers frequently cited by physicians, such as time constraints and insufficient knowledge and skills; and
  • Areas where more research is needed to further establish the importance of having early dialogues to delay or prevent initiation of substance use.

Starting conversations about substance use at a young age helps normalize the topic and sets the stage for better patient-physician dialogue throughout the lifetime, said Alaina Steck, MD, assistant professor of emergency medicine at the Emory University School of Medicine.

"If substance use is addressed regularly and nonjudgmentally, this topic becomes less stigmatized, and discussions regarding use come to be an expected part of the health maintenance conversation, like seatbelt use and safer sex practices," Dr. Steck said. "Hopefully with time and repetition, adolescents and young adults may become more able to discuss and seek treatment for themselves and for others when problematic substance use arises, rather than living in shame with a disorder that not even their doctors would address."

Source: Hazelden Betty Ford Foundation, Dec. 12, 2019

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