More kids are dying of drug overdoses. Could pediatricians do more to help? (2024)

Sam, a 17-year-old boy with shaggy blond hair, stepped onto the scale atTri-RiverFamily Health Center inUxbridge, Massachusetts.

After he was weighed, he headed for an exam room decorated with decals of planets and cartoon characters. A nurse checked his blood pressure. A pediatrician asked about school, home life and friendships.

It seemed like a routine teen checkup, the kind that happens in thousands of pediatric practices across the U.S. every day – until the doctor asked his next question.

“Any cravings for opioids at all?” askedpediatricianSafdarMedina. Sam shook his head.

“None, not at all?” Medina said again, to confirm.

“None,” said Sam, in a quiet but confident voice.

Only Sam’s first name is being used for this article because if his full name were publicized he could face discrimination in housing and job searches based on his prior drug use.

Medina was treating Sam for an addiction to opioids. He prescribed a medication calledbuprenorphine, which curbs cravings for the more dangerous and addictive opioid pillsfor the more dangerous and addictive opioid pills. Sam’s urine tests showed no signs of thePercocetorOxyContinhe used to buy onSnapchat.

“What makes me really proud of you, Sam, is how committed you are to getting better,” said Medina, whose practice is part ofUMassMemorial Health.

Trending in the wrong direction

The American Academy of Pediatricsrecommends offeringbuprenorphineto teensaddicted to opioids. But only 6% of pediatricians report ever doing do, according tosurvey results.

In fact,buprenorphineprescriptions for adolescentsdeclinedas overdose deaths for 10- to 19-year-oldsmore than doubled. These overdoses, combined with accidental opioid poisonings among young children, have become thethird-leading cause of deathfor U.S. children.

“We’re really far from where we need to beand we’re far on a couple of different fronts,” saidScottHadland,chief of adolescent medicine atMass General for Childrenand a co-author of the study that surveyed pediatricians about addiction treatment.

That survey showed that many pediatricians don’t think they have the right training or personnel for this type of care – although Medina and other pediatricians who do manage patients with addiction say they haven’t had to hire.

Some said they didn’t have enough patients to justify learning about this type of care or didn’t think it was a pediatrician’s job.

“A lot of that has to do with training,” saidDeepaCamenga, associate director for pediatric programs at the Yale Program in Addiction Medicine. “It’s seen as something that’s a very specialized area of medicine and, therefore, people are not exposed to it during routine medical training.”

CamengaandHadlandsaid medical schools and pediatric residency programs are working to add information to their curricula about substance use disorders, including how to discuss drug and alcohol use with children and teens.

But the curricula aren’t changingfast enough. In a twisted, deadly development, drug use among adolescents has declined – butdrug-associated deaths are up. The main culprits are fakeXanax,AdderallorPercocetpills laced with the powerful opioid fentanyl. Nearly25% of recent overdosedeaths among 10- to 19-year-oldswere traced to counterfeit pills.

“Many times these kids are overdosing without any awareness of what they’re taking,” saidAndrewTerranella, the Centers for Disease Control and Prevention’s expert on adolescent addiction medicine and overdose prevention.

Terranellasaid pediatricians can help by stepping up screening for – and having conversations about – all types of drug use. He also suggests more pediatricians prescribenaloxone, the nasal spray that can reverse an overdose. It’s available over the counter, butTerranellabelieves a prescription may carry more weight with patients.

Addiction care can take a lot of time for a pediatrician. Sam and Medina text several times a week. Medina stresses that any exchange that Sam asks to be kept confidential is not shared.

Medina said treating substance use disorder is one of the most rewarding things he does.

“If we can take care of it,” he said, “We have produced an adult that will no longer have a lifetime of these challenges to worry about.”

‘It’s really critical that we save lives’

For Sam, finding addiction treatment in a medical office jammed with puzzles, toys and picture books has not been as odd as he thought it would be.

His mom accompanied him to the appointment and said she was grateful the family found a doctor who understands teens and substance use.

Before he started visitingTri-River, Sam had seven months of residential and outpatient treatment without being offeredbuprenorphineto help control cravings and prevent relapse. When Sam’s cravings for opioids returned, a counselor suggested Medina.

Some parents and pediatricians worry about starting a teenager onbuprenorphine, which can produceside effectsincluding long-term dependence. Pediatricians weigh the possible side effects against the threat of a fentanyl overdose.

“In this era, where young people are dying at truly unprecedented rates of opioid overdose, it’s really critical that we save lives,” saidHadland. “And we know thatbuprenorphineis a medication that saves lives.”

In the exam room, Sam was about to get his first shot ofSublocade, an injection form ofbuprenorphinethat lasts 30 days. He switched to the shots because he didn’t like the taste ofSuboxone, oral strips ofbuprenorphinethat dissolve under the tongue. He was spitting them out before he got a full dose.

The injection is painful, and takes 20-30 seconds. A nurse coached him to breathe deeply. When it was over, staffers joked that even adults usually swear when they get the shot. Sam said he didn’t know that was allowed.

His biggest question: “Do you think I can snowboard tonight?” Sam asked the doctor.

“I totally think you can snowboard tonight,” Medina answered.

Sam was going with a new buddy. Making new friends and cutting ties with his former social circle of teens who use drugs has been one of the hardest things, Sam said, since he entered rehab 15 months ago.

“Surrounding yourself with the right people is definitely a big thing you want to focus on,” Sam said. “That would be my biggest piece of advice.”

This article is from a partnership that includesWBUR,NPRandKFFHealth News.KFFHealth Newsis a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs atKFF– an independent source of health policy research, polling and journalism.