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Population of interest

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In a retrospective analysis by National Survey on Drug Use and Health it was observed that opioid use was seen significantly more in females than males, with non-hispanic whites and blacks reporting more likely use of opioids compared to hispanics. (Volkow & Boyle, 2018) Opioid addiction in teenagers would range from age twelve to eighteen years old. Those above the age of sixteen with a drivers license are likely more prone to dangerous activities due to rise of independence with a recent accomplishment of achieving a license.

Factors leading to Clinical Concern

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Training Gap - Only one percent of all United States Medicine Board diplomats are pediatricians (Wakeman & Rich, 2017). Not only does this create a lack of specialty of opioid use disorder, but the dire need, yet absence of pediatric provider knowledge in treatment and prevention of addiction is concerning.

Family History - Pediatric patients who are experiencing family issues at home or have a parental history of substance abuse are more likely to suffer from opioid use disorder (Centers for Disease Control and Prevention [CDC], 2022).

Lack of guidelines - The Center of Disease control (CDC) guidelines regarding opioid prescription only included the adult population, leaving out pediatric patients (Hudgins, Porter, Monuteaux, & Bourgeois, 2019).

Increase in Opioid prescribing - In the last twenty years, the prescription of opioids for adolescents has nearly doubled from 1994 to 2007. The rate increased from 3% of all ambulatory care or emergency department to 5.5% (Hudgins, Porter, Monuteaux, & Bourgeois, 2019).

Epidemiologic Evidence of the Problem

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Race/Ethnicity - In a study of High School Students, it was discovered whites (5.5%) had a lower prevalence of misusing prescription opioid drugs compared to blacks (8.7%) or hispanic students (9.8%) (Centers for Disease Control and Prevention [CDC], 2022).

Sexual Identity - Lesbian , gay or bisexual students had a higher rate of substance use disorders compared to heterosexual students. (Centers for Disease Control and Prevention [CDC], 2022).

Sexual risk Behaviors - Those engaging in sexual risk behaviors (Not wearing a condom, multiple sexual partners) have been shown to be associated with substance use. (Centers for Disease Control and Prevention [CDC], 2022)

Other risk factors include a family history of substance abuse, family management problems and family conflict. (Centers for Disease Control and Prevention [CDC], 2022)

Pathophysiology

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Teen addiction happens because the brain is still developing. The reward system, which releases dopamine, is very active in teens, while the judgment control system and self-control mechanism is not fully mature yet. This makes teenagers more drawn to things that feel good, like drugs. Repeated drug use changes brain signaling, strengthening reward pathways yet weakening self control. Over time, the brain becomes used to the drug, making it hard to stop even when they want to (Kalivas & O’Brien, 2005).

Population interventions

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Telehealth Appointments - Telehealth appointments help to provide a resource for those living in rural areas. This also resolves the issue of lack of transportation, which especially effects the teenagers population due to possible lack of license or vehicle (Wakeman & Rich, 2017).

Opioid Use Disorder Management with Primary Care Provider - Since many opioid use disorder clinics hold a stigma, using the primary care provider for treatment of opioid addiction would help relieve anxiety associated with stigmas. It will also provide integrated care, as the client may already be visiting their primary care doctor for other metal health issues such as anxiety or depressio (Wakeman & Rich, 2017).

Telemedicine Training - Pediatric addiction medicine subspecialists communicate with rural pediatric doctors to support them in this unfamiliar topic. They can offer mentorship for the pediatric providers who lack experience in this specialty. This can lead to an increase in training and comfortability, eventually reaching mastery in the subject and therefore independence for future opioid addiction cases (Wakeman & Rich, 2017).

Decrease in opioid Prescription - While it is necessary to address pain among patients, opioids should only be prescribed when other pain medications such as non-steroidal ant-inflammatory medications are trailed with lack of improvement. A survey revealed 21–40% of adolescents with headache, musculoskeletal, back, and abdominal pain diagnoses received opioids. (Hudgins, Porter, Monuteaux, & Bourgeois, 2019)

Pharmacologic Treatments

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Opioid Partial Agonist Antagonist (Buprenorphine) - Synthetic low potency opioid used to replace opioids with higher potency. Suppresses and decreases desires for opioids. Use of this medication is done under strict monitoring and regulatory measures due to federal regulations. This medication has anti-cholinergic effects which may cause hypotension, dry mouth or urinary retention (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023).

Opioid Analgesic (Methadone) - Similar to Buprenorphine, methadone is also an opioid. It works to reduce opioid cravings and withdrawal symptoms. Since it is a controlled substance, the medication requires close monitoring. This medication may cause addiction, constipation, sexual dysfunction or weight gain. (SAMHSA, 2023)

Opioid Antagonist (Naltrexone) - Used to treat opioid use disorder and alcohol use disorder. Compared to the medications listed prior, naltrexone is not an opioid nor is it addictive. The medication binds and blocks opioid receptors to decrease opioid cravings. This may cause dizziness, vomiting, or sleepiness. (SAMHSA, 2023)

References

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Wakeman, S. E., & Rich, J. D. (2017). Barriers to medications for addiction treatment: How stigma kills. Substance Use & Misuse, 52(2), 213–215. https://doi.org/10.1080/10826084.2016.1245742

Kalivas, P. W., & O’Brien, C. (2005). Drug addiction as a pathology of staged neuroplasticity. The American Journal of Psychiatry, 162(8), 1403–1413. https://doi.org/10.1176/appi.ajp.162.8.1403

Volkow, N. D., & Boyle, M. (2018). Neuroscience of addiction: Relevance to prevention and treatment. The American Journal of Psychiatry, 175(8), 729–740. https://pmc.ncbi.nlm.nih.gov/articles/PMC6830740/

Substance Abuse and Mental Health Services Administration. (2023, December 20). Medications for substance use disorders. https://www.samhsa.gov/substance-use/treatment/options/medications

Koob, G. F., & Volkow, N. D. (2010). Neurocircuitry of addiction. Neuropsychopharmacology, 35(1), 217–238. https://pmc.ncbi.nlm.nih.gov/articles/PMC3767185/

Centers for Disease Control and Prevention. (2022, July). Teens and opioids: What educators and students need to know. CDC Museum Public Health Academy Newsletter. https://www.cdc.gov/museum/education/newsletter/2022/july/index.html

Hudgins, J. D., Porter, J. J., Monuteaux, M. C., & Bourgeois, F. T. (2019). Trends in opioid prescribing for adolescents and young adults in ambulatory care settings. Pediatrics, 143(6), e20181578. https://doi.org/10.1542/peds.2018-1578