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.
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.
More research is needed to better understand how to best prevent opioid misuse and treat OUD in adolescents and young adults.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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.
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.
• 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.
Consequences of the Non-Medical Use of Prescription Drugs (NMUPD). In: Subst. Abus. Ment. Heal. Serv. Adm. http://masstapp.edc.org/sites/masstapp.edc.org/files/NMUPD_Conseq_v_2_12_12_(2).pdf. Accessed 4 Mar 2019.
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.
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.
Scholl L, Seth P, Kariisa M, Wilson N, Baldwin G. Drug and opioid-involved overdose deaths — United States, 2013–2017. MMWR Morb Mortal Wkly Rep. 2018. https://doi.org/10.15585/mmwr.mm6751521e1.
• 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.
Spear LP. Adolescent neurodevelopment. J Adolesc Health. 2013. https://doi.org/10.1016/j.jadohealth.2012.05.006.
Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154–63.
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.
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.
Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain — United States, 2016. MMWR Recomm Rep. 2016;65:1–49.
• 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.
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.
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.
Harbaugh CM, Gadepalli SK. Pediatric postoperative opioid prescribing and the opioid crisis. Curr Opin Pediatr. 2019;1.
• 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.
Bell TM, Raymond J, Vetor A, Mongalo A, Adams Z, Rouse T, et al. Long-term prescription opioid utilization, substance use disorders, and opioid overdoses after adolescent trauma. J Trauma Acute Care Surg. 2019. https://doi.org/10.1097/TA.0000000000002261.
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.
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.
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.
(2014) A drug policy for the 21st century | The White House.
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.
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.
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.
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.
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.
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.
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.
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.
• 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.
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.
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.
American Academy of Family Physicians (2018) Adolescent Health Care, Confidentiality. In: Am. Acad. Fam. Physicians. https://www.aafp.org/about/policies/all/adolescent-confidentiality.html. Accessed 23 Jul 2019
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
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.
Wilson CR, Sherritt L, Gates E, Knight JR. Are clinical impressions of adolescent substance use accurate? Pediatrics. 2004;114:e536–40.
NIDA launches drug use screening tools for physicians. In: Natl. Institutes Heal. https://www.nih.gov/news-events/news-releases/nida-launches-drug-use-screening-tools-physicians. Accessed 24 Apr 2019.
National Institute on Alcohol Abuse and Alcoholism. Alcohol screening and brief intervention for youth: a practitioner’s guide. Natl Institutes Heal. 2012:1–41.
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.
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.
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.
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.
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.
Bernstein E, Bernstein J, Feldman J, et al. The impact of screening, brief intervention, and referral for treatment on emergency department patients’ alcohol use. Ann Emerg Med. 2007. https://doi.org/10.1016/j.annemergmed.2007.06.486.
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.
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.
Levy S, Shrier LA (2015) Adolescent SBIRT toolkit for providers. Massachusetts Department of Public Health
Levy S, Wiseblatt A, Straus J, Strother H, Fluet C, Harris S. Adolescent SBIRT practices among pediatricians in Massachusetts. J Addict Med. (in press).
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.
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.
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.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
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
Sterling S, Kline-Simon AH, Weisner C, Jones A, Satre DD. Pediatrician and behavioral clinician-delivered screening, brief intervention and referral to treatment: substance use and depression outcomes. J Adolesc Health. 2018. https://doi.org/10.1016/j.jadohealth.2017.10.016.
•• 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
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.
Leshner AI, Mancher M (eds) (2019) Medications for opioid use disorders save lives: consensus study report. doi: https://doi.org/10.17226/25310
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.
Connery HS. Medication-assisted treatment of opioid use disorder. Harv Rev Psychiatry. 2015;23:63–75.
•• 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.
Levy S. Youth and the opioid epidemic. Pediatrics. 2019;143:e20182752.
Sofuoglu M, DeVito EE, Carroll KM (2018) Pharmacological and behavioral treatment of opioid use disorder. Psychiatr Res Clin Pract appiprcp 20180.
Mccormick C (2002) Suboxone and subutex approval letter. Rockville, M.D.
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.
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.
• 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.
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.
Massachusetts Bureau of Substance Addiction Services Adolescent Prescriber Toolkit. In press
Carney BL, Hadland SE, Bagley SM. Medication treatment of adolescent opioid use disorder in primary care. Pediatr Rev. 2018;39:43–5.
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.
•• 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.
• 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.
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.
• 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.
Muvvala SB, Edens EL, Petrakis IL. What role should psychiatrists have in responding to the opioid epidemic? JAMA Psychiat. 2019;76:107–8.
Van Winkle PJ, Ghobadi A, Chen Q, Menchine M, Sharp AL. Association of age and opioid use for adolescents and young adults in community emergency departments. Am J Emerg Med. 2018. https://doi.org/10.1016/j.ajem.2018.10.021.
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.
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.
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.
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.
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.
About PCSS. https://pcssnow.org/about/. Accessed 2 Apr 2019.
Opioid Response Network STR-TA Project Overview. https://www.getstr-ta.org/ProjectOverview.aspx. Accessed 2 Apr 2019.
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Opioids
About this article
Cite this article
Levy, S., Camenga, D. Treatment of Opioid Use Disorder in Pediatric Medical Settings. Curr Addict Rep 6, 374–382 (2019). https://doi.org/10.1007/s40429-019-00272-0
- Opioid use disorder
- Young adults