A National Institute on Drug Abuse (NIDA) Center for Clinical Trials Network study evaluated the efficacy of continuing buprenorphine-naloxone treatment for 12 weeks versus providing only detoxification to youth ages 15–21 who were opioid dependent. The study found improved outcomes among youth who received continued treatment with buprenorphine-naloxone compared with those in detoxification. However, the authors recommend additional research to assess the efficacy and safety of long-term treatment for adolescents with opioid dependence (Woody et al., 2008).
Insights From a Pediatrician
Deepa Camenga, MD
Pediatrician and Addiction Medicine Specialist
Assistant Professor, Yale School of Medicine, New Haven, Connecticut
Pediatricians already have the skills to treat opioid use disorder (OUD)
"As pediatricians we naturally have unique skills to treat young people with OUD. We practice family-based care, understand developmental stages, and know how to speak with young people. These are critical to engaging them in treatment, and we have these skills."
Getting Started: Key Considerations for Success
Integrating a new treatment protocol into your practice may come with a learning curve. In our discussion with Dr. Camenga, she mentioned several important lessons she learned and key considerations for getting started that can help you be successful.
Outcomes of Success
"When I see young teenagers integrate back into school after treatment, it is one of greatest signs of success. I think any additional amount of education strongly impacts a teenager’s potential trajectory for well-being and is one of the most important outcomes at this stage of a teen’s life. It’s a true outcome of success for young people." – Dr. Camenga
- 1. Setting Yourself Up For Success
Familiarize yourself with the local education system because you may need to advocate for patients who are ready to reintegrate into the school setting after taking time off for treatment
Familiarize yourself with your organization’s reimbursement structure to ensure that, financially, you can take on medication treatment for OUD. Consider whether billing by time is a possibility, because it may take longer to introduce treatment to a teen and his/her family.
Review the science and research to get comfortable with the treatment you are providing and with talking to others about apprehensions they have about medication treatment for OUD. Reviewing the study above, the AAP Policy Statement on MAT, or NIDA’s publication, Effective Treatments for Opioid Addiction, can help get you started.
Build a psychiatric referral base because you may need additional support with young patients who have co-occurring substance use and psychiatric issues.
Establish processes for coverage and support by building support systems with colleagues who can cover you when you’re out of the office and can offer consultation when you have questions or concerns. Find colleagues in your practice or local community who are comfortable treating teens and have the numbers in their waivers to pick up additional patients.
- 2. Getting Started
Review the diagnostic spectrum of OUD from mild to severe as it pertains to your patients’ developmental stages, since you will need to treat patients across the entire spectrum.
Build enough time into your schedule for initial visits. Think about the best time of the day for accommodating this longer type of visit. Get help from your psychiatric referral base (e.g., to obtain input before you meet with your patient, to conduct a full psychosocial assessment).
Follow specific checklists or tools to become accustomed to the components of the treatment regimen. Some useful resources include Clinical Tools from the Provider Clinical Support System and checklists, brochures, and prescriber letters specific to each treatment medication from the Risk Evaluation and Mitigation Strategies database.
Consider starting treatment with only a few patients to see them through the treatment process and to build your confidence as an OUD treatment provider. As your practice with teen patients with OUD grows, you’ll start to see the impact growing as well.
If you’re interested in OBOT, but don’t have your buprenorphine waiver, visit SAMHSA's Buprenorphine Waiver Management page to learn about the training and steps needed to get it. The Provider Clinical Support System (PCSS) provides access to the online 8-hour waiver training for physicians, physician assistants, advanced practice registered nurses, and medical students.
Visit NIDAMED for additional resources for you and your patients.
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