Teens and adolescents suffering from severe opioid disorders should have access to medication-assisted treatment, the American Academy of Pediatrics (AAP) said in a policy statement released in August 2016.
The AAP pointed out that pediatricians rarely used medication-assisted treatments (MATs) to treat adolescent opioid use disorders despite the availability of effective medications. In fact, a 2011 University of Kentucky study revealed that only 34.4 percent of all patients in the United States received medication-assisted treatment for opioid dependence.
Opioid misuse among teenagers and young adults more than doubled from 1991 to 2012. The National Institute on Drug Abuse reported in 2014 that 6 percent of adolescents had misused prescription opioids in the past year. These alarming numbers reinforce the need for MATs among teenagers suffering from severe opioid addiction.
“The time to act is now to take advantage of these medications that can have a profound impact on the lives of adolescents and young adults struggling with opioid addiction,” Dr. Michael Weaver, a professor and medical director at McGovern Medical School, told MedPage Today.
To address the lack of MAT availability among teenagers, the AAP made three recommendations:
- Increase resources to improve access to MATs for adolescents and young adults. Pediatricians should facilitate MAT access at a primary care level to young adults suffering from severe opioid use disorders. They should also make sure that the community provides a developmentally appropriate substance abuse counseling program for adolescents.
- Pediatricians should consider using MATs to treat teenage and young adult patients with severe opioid use disorders or refer them to other health care providers offering MATs.
- There needs to be further research on developmentally appropriate treatment of teenage substance use disorders, notably on substance use prevention, behavioral interventions and medication treatment.
“Policies, attitudes and messages that serve to prevent patients from accessing a medication that can effectively treat a life-threatening condition may be harmful to adolescent health,” the authors wrote in the policy statement.
Medications for Adolescent Substance Use Disorders
One barrier preventing wider access to MATs is the lack of evidence proving the effectiveness and safety of the medications to treat opioid use disorders in people under 18 years of age. In addition, federal regulations do not permit most methadone treatment centers to admit children under 18.
Currently, physicians use buprenorphine, naltrexone and methadone to treat opioid use disorders. After two randomized studies revealed that buprenorphine encouraged teenagers and young adults to stay in treatment and decreased their opioid use, the FDA approved the medication to treat teenagers 16 years and older. Buprenorphine blocks opioid receptors in the brain to decrease opioid withdrawal symptoms and cravings.
Similar to buprenorphine, methadone reduces cravings and deters withdrawal symptoms. In special cases, teenagers 16 to 18 years of age can access methadone treatment if they have two previously failed attempts of opioid detoxification and their parents sign off on the treatment.
In its policy statement, the AAP mentioned a lack of substantial evidence regarding the effectiveness of naltrexone in treating teenage opioid addiction. However, it highlighted that naltrexone proved effective in the reduction of alcohol cravings, which may be helpful to teenagers suffering from alcohol addiction.
One of the measures the AAP recommended in its policy statement was additional research on behavioral interventions. These approaches are beneficial because they teach teenagers how to recognize and avoid the unhealthy practices that lead to substance use disorders.
Cognitive behavioral therapy (CBT) teaches adolescents to recognize the negative drug-related influences in their lives and adopt coping strategies to steer away from substances. Through CBT, adolescents learn to identify cravings and triggers and develop a number of coping skills to handle high-risk situations. CBT helps patients remain abstinent.
Contingency management uses a positive reinforcement technique that rewards patients when they make good drug-related choices. The approach aims to dissociate the link between drugs and reward by rewarding healthy behaviors that do not involve substances. Parents can learn how to use contingency management to help teens who are recovering from addiction.
Medications work best when coupled with counseling and behavioral therapies. In fact, federal law requires MAT patients to receive counseling while being treated with medications. According to the Substance Abuse and Mental Health Services Administration, MATs have proven to reduce the need for inpatient detoxification services for individuals suffering from an opioid use disorder.