Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Current Addiction Reports
Erschienen in: Current Addiction Reports 4/2019

01.12.2019 | Opioids (J Donroe and D Fiellin, Section Editors)

Treatment of Opioid Use Disorder in Pediatric Medical Settings

verfasst von: Sharon Levy, Deepa Camenga

Erschienen in: Current Addiction Reports | Ausgabe 4/2019

Einloggen, um Zugang zu erhalten

Abstract

Purpose of Review

The purpose of this review is to examine the impact of the opioid epidemic in adolescents and young adults and recent findings regarding the treatment of opioid use disorder (OUD) in pediatric medical settings.

Recent Findings

Existing guidelines for the treatment of chronic pain in adults are not intended to be applied to adolescents, who arguably may need different interventions that balance the need to mitigate the long-term impact of chronic pain with the need to limit opioid misuse. Screening, brief intervention, and referral to treatment is an important upstream strategy to prevent opioid misuse in youth. Medications such as buprenorphine, naltrexone, and methadone are important treatment options for youth with OUD but remain underutilized in this population.

Summary

More research is needed to better understand how to best prevent opioid misuse and treat OUD in adolescents and young adults.
Literatur
1.
Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: results from the 2017 National Survey on Drug Use and Health. Rockville, MD.
2.
Saha TD, Kerridge BT, Goldstein RB, et al. Nonmedical prescription opioid use and DSM-5 nonmedical prescription opioid use disorder in the United States. J Clin Psychiatry. 2016;77:772–80.PubMedPubMedCentralCrossRef
3.
• McCabe SE, Kloska DD, Veliz P, Jager J, Schulenberg JE. Developmental course of non-medical use of prescription drugs from adolescence to adulthood in the United States: national longitudinal data. Addiction. 2016;111:2166–76 This study examines 30 cohorts of high school seniors participating in the Monitoring the Future study and demonstrates that late adolescence is a life stage wherein misuse of prescription opioids peaks. PubMedPubMedCentralCrossRef
4.
5.
Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite-Powell A, et al. Vital signs: trends in emergency department visits for suspected opioid overdoses — United States, July 2016–September 2017. MMWR Morb Mortal Wkly Rep. 2018;67:279–85.PubMedPubMedCentralCrossRef
6.
Gaither JR, Leventhal JM, Ryan SA, Camenga DR. National trends in hospitalizations for opioid poisonings among children and adolescents, 1997 to 2012. JAMA Pediatr. 2016;170:1195–201.PubMedCrossRefPubMedCentral
7.
8.
• Gaither JR, Shabanova V, Leventhal JM. US national trends in pediatric deaths from prescription and illicit opioids, 1999–2016. JAMA Netw Open. 2018;1:e186558 This study demonstrates that nearly 9000 children and adolescents died from opioid poisonings between 199 and 2016, and the mortality rate increased nearly 3-fold. PubMedPubMedCentralCrossRef
9.
10.
Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154–63.CrossRefPubMed
11.
McCabe SE, West BT, Morales M, Cranford JA, Boyd CJ. Does early onset of non-medical use of prescription drugs predict subsequent prescription drug abuse and dependence? Results from a national study. Addiction. 2007;102:1920–30.PubMedPubMedCentralCrossRef
12.
Guarino H, Mateu-Gelabert P, Teubl J, Goodbody E. Young adults’ opioid use trajectories: from nonmedical prescription opioid use to heroin, drug injection, drug treatment and overdose. Addict Behav. 2018;86:118–23.PubMedPubMedCentralCrossRef
13.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep. 2016;65:1–49.CrossRefPubMed
14.
• Schechter NL, Walco GA. The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: above all, do no harm. JAMA Pediatr. 2016;170:425–6 This is an editorial which succinctly outlines why the CDC opioid prescribing guideline is not intended for children < 18 years of age, and the future research needs in the area of pediatric pain management. PubMedCrossRef
15.
Groenewald CB, Law EF, Fisher E, Beals-Erickson SE, Palermo TM. Associations between adolescent chronic pain and prescription opioid misuse in adulthood. J Pain. 2019;20:28–37.PubMedCrossRef
16.
Cooper TE, Fisher E, Gray AL, Krane E, Sethna N, van Tilburg MAL, et al. Opioids for chronic non-cancer pain in children and adolescents. Cochrane Database Syst Rev. 2017;2017:1–23.
17.
Harbaugh CM, Gadepalli SK. Pediatric postoperative opioid prescribing and the opioid crisis. Curr Opin Pediatr. 2019;1.
18.
• Harbaugh CM, Lee JS, Hu HM, McCabe SE, Voepel-Lewis T, Englesbe MJ, et al. Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018;141:e20172439 This study demonstrates that about 5% of pediatric patients filled an opioid prescription 90 to 180 days after surgery. These findings highlight the importance of the post-surgical period as an opportune time to reduce opioid misuse. PubMedCrossRef
19.
20.
Monitto CL, Hsu A, Gao S, et al. Opioid prescribing for the treatment of acute pain in children on hospital discharge. Anesth Analg. 2017;125:2113–22.PubMedPubMedCentralCrossRef
21.
Brown R, Deyo B, Riley C, Quanbeck A, Glass JE, Turpin R, et al. Screening in trauma for opioid misuse prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury. Addict Sci Clin Pract. 2017;12:28.PubMedPubMedCentralCrossRef
22.
Fiellin LE, Tetrault JM, Becker WC, Fiellin DA, Hoff RA. Previous use of alcohol, cigarettes, and marijuana and subsequent abuse of prescription opioids in young adults. J Adolesc Health. 2013;52:158–63.PubMedCrossRef
23.
(2014) A drug policy for the 21st century | The White House.
24.
Levy S, Mountain-Ray S, Reynolds J, Mendes SJ, Bromberg J. A novel approach to treating adolescents with opioid use disorder in pediatric primary care. Subst Abus. 2018:1–9.
25.
Curry SJ, Krist AH, Owens DK, et al. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults. JAMA. 2018;320:1899.PubMedCrossRef
26.
Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G. Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Arch Pediatr Adolesc Med. 2002;156:607–14.PubMedCrossRef
27.
Levy S, Sherritt L, Harris SK, Gates EC, Holder DW, Kulig JW, et al. Test-retest reliability of adolescents’ self-report of substance use. Alcohol Clin Exp Res. 2004;28:1236–41.PubMedCrossRef
28.
Bernstein E, Edwards E, Dorfman D, Heeren T, Bliss C, Bernstein J. Screening and brief intervention to reduce marijuana use among youth and young adults in a pediatric emergency department. Acad Emerg Med. 2009;16:1174–85.PubMedPubMedCentralCrossRef
29.
D’Amico EJ, Miles JNV, Stern SA, Meredith LS. Brief motivational interviewing for teens at risk of substance use consequences: a randomized pilot study in a primary care clinic. J Subst Abus Treat. 2008;35:53–61.CrossRef
30.
D’Amico EJ, Parast L, Meredith LS, Shadel WG, Seelam R. Brief motivational interviewing intervention to reduce alcohol and marijuana use for at-risk adolescents in primary care. J Consult Clin Psychol. 2018;86:775–86.PubMedPubMedCentralCrossRef
31.
Newton AS, Mushquash C, Krank M, Wild TC, Dyson MP, Hartling L, et al. When and how do brief alcohol interventions in primary care reduce alcohol use and alcohol-related consequences among adolescents? Artic J Pediatr. 2018;197:221–32.CrossRef
32.
• Levy SJL, Williams JF, COMMITTEE ON SUBSTANCE USE AND PREVENTION. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016. https://​doi.​org/​10.​1542/​peds.​2016-1210This paper provides a comprehensive overview of how to clinically implement SBIRT for adolescents in primary care.
33.
Harris SK, Herr-Zaya K, Weinstein Z, Whelton K, Perfas F Jr, Castro-Donlan C, et al. Results of a statewide survey of adolescent substance use screening rates and practices in primary care. Subst Abus. 2012;33:321–6.PubMedCrossRef
34.
Levy S, Ziemnik RE, Harris SK, Rabinow L, Breen L, Fluet C, et al. Screening adolescents for alcohol use: tracking practice trends of Massachusetts pediatricians. J Addict Med. 2017;11:427–34.PubMedCrossRef
35.
36.
Ford C, English A, Sigman G, Center for Adolescent Health & the Law (2004) Confidential health care for adolescents: Position paper of the society for adolescent medicine. J Adolesc Heal 35:160–167
37.
Hassan A, Harris SK, Sherritt L, Van Hook S, Brooks T, Carey P, Kossack R, Kulig J, Knight JR. Primary care follow-up plans for adolescents with substance use problems. Pediatrics. 2009;124:144–150.
38.
Wilson CR, Sherritt L, Gates E, Knight JR. Are clinical impressions of adolescent substance use accurate? Pediatrics. 2004;114:e536–40.PubMedCrossRef
39.
40.
National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: a practitioner’s guide. Natl Institutes Heal. 2012:1–41.
41.
Levy S, Weiss R, Sherritt L, Ziemnik R, Spalding A, Van Hook S, et al. An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatr. 2014;168:822–8.PubMedPubMedCentralCrossRef
42.
Kelly SM, Gryczynski J, Mitchell SG, Kirk A, O’Grady KE, Schwartz RP. Validity of brief screening instrument for adolescent tobacco, alcohol, and drug use. Pediatrics peds. 2014:2013–346.
43.
Knight JR, Harris SK, Sherritt L, Van Hook S, Lawrence N, Brooks T, et al. Adolescents’ preference for substance abuse screening in primary care practice. Subst Abus. 2007;28:107–17.PubMedCrossRef
44.
Jasik CB, Berna M, Martin M, Ozer EM. Teen preferences for clinic-based behavior screens: who, where, when, and how? J Adolesc Health. 2016;59:722–4.PubMedCrossRef
45.
Lunstead J, Weitzman E, Harstad E, et al. Screening and counseling for alcohol use in adolescents with chronic medical conditions in the ambulatory setting. J Adolesc Health.
46.
47.
Friedman JL, Lyna P, Sendak MD, Viera AJ, Silberberg M, Pollak KI. Use of the 5 As for teen alcohol use. Clin Pediatr (Phila). 2017;56:419–26.CrossRef
48.
Lord SE, Trudeau KJ, Black RA, Lorin L, Cooney E, Villapiano A, et al. CHAT: development and validation of a computer-delivered, self-report, substance use assessment for adolescents. Subst Use Misuse. 2011;46:781–94.PubMedCrossRef
49.
Levy S, Shrier LA (2015) Adolescent SBIRT toolkit for providers. Massachusetts Department of Public Health
50.
Levy S, Wiseblatt A, Straus J, Strother H, Fluet C, Harris S. Adolescent SBIRT practices among pediatricians in Massachusetts. J Addict Med. (in press).
51.
Mitchell SG, Schwartz RP, Kirk AS, et al. SBIRT implementation for adolescents in urban federally qualified health centers. J Subst Abus Treat. 2016;60:81–90.CrossRef
52.
Mitchell SG, Gryczynski J, O’Grady KE. Schwartz RP SBIRT for adolescent drug and alcohol use: current status and future directions. J Subst Abus Treat. 44:463–72.
53.
Ozechowski TJ, Becker SJ, Hogue A. SBIRT-A: adapting SBIRT to maximize developmental fit for adolescents in primary care. J Subst Abus Treat. 2016;62:28–37.
54.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.CrossRef
55.
Sterling S, Kline-Simon AH, Jones A, Hartman L, Saba K, Weisner C, Parthasarathy S (2019) Health Care Use Over 3 Years After Adolescent SBIRT. Pediatrics 143:e20182803
56.
57.
•• Committe on Substance Use and Prevention; American Academy of Pediatrics. Medication-assisted treatment of adolescents with opioid use disorders. Pediatrics. https://​doi.​org/​10.​1542/​peds.​2016-1893This is the American Academy of Pediatrics' policy statement that recommends pediatricians Offer Medications for opioid use disorder in adolescents
58.
Bisaga A, Mannelli P, Sullivan MA, Vosburg SK, Compton P, Woody GE, et al. Antagonists in the medical management of opioid use disorders: historical and existing treatment strategies. Am J Addict. 2018;27:177–87.PubMedPubMedCentralCrossRef
59.
60.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2014):CD002207.
61.
Connery HS. Medication-assisted treatment of opioid use disorder. Harv Rev Psychiatry. 2015;23:63–75.PubMedCrossRef
62.
•• Borodovsky JT, Levy S, Fishman M, Marsch LA. Buprenorphine treatment for adolescents and young adults with opioid use disorders: a narrative review. J Addict Med. 2018;12:170–83 This review article provides a comprehensive overview of the evidence base surroudning burpenrophine use in adolescents. PubMedPubMedCentralCrossRef
63.
64.
Sofuoglu M, DeVito EE, Carroll KM (2018) Pharmacological and behavioral treatment of opioid use disorder. Psychiatr Res Clin Pract appiprcp 20180.
65.
Mccormick C (2002) Suboxone and subutex approval letter. Rockville, M.D.
66.
Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA. 2008;300:2003–11.PubMedPubMedCentralCrossRef
67.
Marsch LA, Bickel WK, Badger GJ, Stothart ME, Quesnel KJ, Stanger C, et al. Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial. Arch Gen Psychiatry. 2005;62:1157–64.PubMedCrossRef
68.
• Marsch LA, Moore SK, Borodovsky JT, et al. A randomized controlled trial of buprenorphine taper duration among opioid-dependent adolescents and young adults. Addiction. 2016;111:1406–15 This is one of three published randomized controlled trials evaluating the efficacy of buprenorphine for the treatment of OUD in adolescents. PubMedPubMedCentralCrossRef
69.
Lee JD, Nunes EV, Novo P, et al. Comparative effectiveness of extended-release naltrexone versus buprenorphine-naloxone for opioid relapse prevention (X:BOT): a multicentre, open-label, randomized controlled trial. Lancet. 2018;391:309–18.PubMedCrossRef
70.
Massachusetts Bureau of Substance Addiction Services Adolescent Prescriber Toolkit. In press
71.
Carney BL, Hadland SE, Bagley SM. Medication treatment of adolescent opioid use disorder in primary care. Pediatr Rev. 2018;39:43–5.PubMedCrossRef
72.
Feder KA, Krawczyk N, Saloner B. Medication-assisted treatment for adolescents in specialty treatment for opioid use disorder. J Adolesc Health. 2017;60:747–50.PubMedPubMedCentralCrossRef
73.
•• Hadland SE, Bagley SM, Rodean J, Silverstein M, Levy S, Larochelle MR, et al. Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA Pediatr. 2018;172:1029–37 This study demonstrates that use of medications within 3 months of diagnosis of opioid use disorder is associated with increased treatment retention in adolescents and young adults. PubMedPubMedCentralCrossRef
74.
• Hadland SE, Wharam JF, Schuster MA, Zhang F, Samet JH, Larochelle MR. Trends in receipt of buprenorphine and naltrexone for opioid use disorder among adolescents and young adults, 2001–2014. JAMA Pediatr. 2017;171:747–55 This study demonstrates the low prevalence of using medications for the treatment opioid use disorder in adolescents and young adults. PubMedPubMedCentralCrossRef
75.
Liebling EJ, Yedinak JL, Green TC, Hadland SE, Clark MA, Marshall BDL. Access to substance use treatment among young adults who use prescription opioids non-medically. Subst Abus Treat Prev Policy. 2016;11:38.CrossRef
76.
• Alinsky R, Zima B, Bagley S, Rodean J, Matson P, Adger H, et al. 32. Receipt of addiction treatment following opioid-related overdose among Medicaid-enrolled youth. J Adolesc Health. 2019;64:S17 This study outlines low treatment engagement rates for youth with a recent history of opioid overdose. CrossRef
77.
Muvvala SB, Edens EL, Petrakis IL. What role should psychiatrists have in responding to the opioid epidemic? JAMA Psychiat. 2019;76:107–8.CrossRef
78.
79.
Whiteside LK, Walton MA, Bohnert ASB, Blow FC, Bonar EE, Ehrlich P, et al. Nonmedical prescription opioid and sedative use among adolescents in the emergency department. Pediatrics. 2013;132:825–32.PubMedPubMedCentralCrossRef
80.
Bohnert ASB, Bonar EE, Cunningham R, Greenwald MK, Thomas L, Chermack S, et al. A pilot randomized clinical trial of an intervention to reduce overdose risk behaviors among emergency department patients at risk for prescription opioid overdose. Drug Alcohol Depend. 2016;163:40–7.PubMedCrossRef
81.
D’Onofrio G, O’Connor PG, Pantalon M V, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA (2015) Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA 313:1636–44.
82.
Linakis JG, Bromberg J, Baird J, Nirenberg TD, Chun TH, Mello MJ, et al. Feasibility and acceptability of a pediatric emergency department alcohol prevention intervention for young adolescents. Pediatr Emerg Care. 2013;29:1180–8.PubMedPubMedCentralCrossRef
83.
Ballesteros MF, Williams DD, Mack KA, Simon TR, Sleet DA. The epidemiology of unintentional and violence-related injury morbidity and mortality among children and adolescents in the United States. Int J Environ Res Public Health. 2018;15:616.PubMedCentralCrossRef
84.
85.
Metadaten
Titel
Treatment of Opioid Use Disorder in Pediatric Medical Settings
verfasst von
Sharon Levy
Deepa Camenga
Publikationsdatum
01.12.2019
Verlag
Springer International Publishing
Erschienen in
Current Addiction Reports / Ausgabe 4/2019
Elektronische ISSN: 2196-2952
DOI
https://doi.org/10.1007/s40429-019-00272-0

Weitere Artikel der Ausgabe 4/2019

Current Addiction Reports 4/2019 Zur Ausgabe

Opioids (J Donroe and D Fiellin, Section Editors)

Models of Resident Physician Training in Opioid Use Disorders

Gambling (L Clark, Section Editor)

Gambling and Social Cognition: a Systematic Review

Technology Addiction (J Billieux, Section Editor)

A Systematic Review of the Co-occurrence of Gaming Disorder and Other Potentially Addictive Behaviors

Adolescent / Young Adult Addiction (M Heitzeg, Section Editor)

Sex Differences in Adolescent Neurobiological Risk for Substance Use and Substance Use Disorders

Cannabis (A McRae-Clark and B Sherman, Section Editors)

Behavioral Treatments for Adolescent Cannabis Use Disorder: a Rationale for Cognitive Retraining

Adolescent/Young Adult Addiction (M Heitzeg, Section Editor)

The Impact of Genes on Adolescent Substance Use: a Developmental Perspective

Neu im Fachgebiet Psychiatrie

Demenzkranke durch Antipsychotika vielfach gefährdet

23.04.2024 Demenz Nachrichten

Wenn Demenzkranke aufgrund von Symptomen wie Agitation oder Aggressivität mit Antipsychotika behandelt werden, sind damit offenbar noch mehr Risiken verbunden als bislang angenommen.

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

23.04.2024 Depression antepartal oder postpartal Nachrichten

Bislang gibt es kein Medikament zur Prävention von Wochenbettdepressionen. Das Injektionsanästhetikum Esketamin könnte womöglich diese Lücke füllen.

„Psychotherapie ist auch bei sehr alten Menschen hochwirksam!“

22.04.2024 DGIM 2024 Kongressbericht

Die Kombination aus Medikamenten und Psychotherapie gilt als effektivster Ansatz bei Depressionen. Das ist bei betagten Menschen nicht anders, trotz Besonderheiten.

Auf diese Krankheiten bei Geflüchteten sollten Sie vorbereitet sein

22.04.2024 DGIM 2024 Nachrichten

Um Menschen nach der Flucht aus einem Krisengebiet bestmöglich medizinisch betreuen zu können, ist es gut zu wissen, welche Erkrankungen im jeweiligen Herkunftsland häufig sind. Dabei hilft eine Internetseite der CDC (Centers for Disease Control and Prevention).

Update Psychiatrie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise