Rachel Alinsky was aware of the previous studies. She knew adolescents with opioid addictions often didn't get the treatment they needed. But in researching further, she was surprised to find the figures weren't any better for youths coming off an opioid overdose.
"I was shocked by how bad it was," says Alinsky, M.D., M.P.H., an adolescent medicine fellow at Johns Hopkins University School of Medicine in Baltimore, Maryland. "I expected the numbers to be lower for adolescents than they were for adults, but I was shocked that the numbers were so low."
The study, co-authored by Alinsky and published earlier this year, reveals some disturbing trends. The researchers analyzed data from more than 4 million Medicaid-enrolled youths aged 13 to 22 years, finding that among the nearly 4,000 youths who experienced an opioid-related overdose:
- Fewer than a third of patients received timely addiction treatment of any kind.
- Less than 2% received pharmacotherapy addiction treatment, even though it is recommended by the American Academy of Pediatrics.
"Those numbers are not acceptable and not what we'd accept for any other pediatric disease," Alinsky says. "If only 1 in 50 kids with asthma got the right medication after coming into the hospital with an asthma attack, we just wouldn't accept that. Unfortunately, this is what our current medical system is doing for these adolescents with an opioid overdose."
Several factors behind opioid treatment gap
Alinsky says a combination of factors contribute to these numbers:
- Education. People don't generally think of opioid addiction as a pediatric disease. Much of the conversation around the opioid crisis focuses on treating adults and prevention in youth, according to Alinsky. As a result, pediatric health care providers aren't typically as familiar with the proper diagnosis and treatment of opioid addiction in adolescents.
- Stigma. Some may have concerns about using medications to treat an opioid overdose in youths except as a last resort. "They should be a first-line treatment for youth with severe opioid use disorder," Alinsky says. "That's supported by the American Academy of Pediatrics, but there's a fear and stigma against the medication."
- Access. Even when the medical provider, patient and family are all in agreement on a treatment plan, it can often be difficult to find addiction treatment providers in the community. Alinsky says there's a lack of providers who are set up to treat youth and very few pediatric providers have the waiver necessary to prescribe buprenorphine and naltrexone—medications used to treat opioid addiction.
ED is logical starting point to establish opioid treatment protocol
Alinsky says this study led to further research on the lack of addiction treatment providers for adolescents in the U.S.—she expects that study to be published this spring. Meanwhile, she says children's hospitals can address the issue in their own institutions by evaluating the numbers of patients they're seeing for opioid addiction and how they're being treated.
"Whether it's a small quality improvement project or applying for a larger grant, they can look at setting a protocol in place to evaluate anyone coming in with an overdose," Alinsky says. "Then they can think about either starting treatment there or getting familiar with the resources out in the community so they can directly link patients and facilitate that handoff, so patients can get timely treatment."
And because overdose patients typically arrive in the emergency department, Alinsky adds that providing specialized training to emergency department staff is a good place to start. "A lot of these programs that are focused on linking people with overdose into care on the adult side are really focused in the emergency room," Alinsky says. "Some places are having all of their emergency department doctors get their buprenorphine waiver, so they're able to prescribe that medication."