How to screen and treat opioid use disorder among youth

The nonmedical use of prescription opioids and heroin/fentanyl has decreased among adolescents in recent years (Jones et al., 2020). This is consistent with the recent overall decrease in substance use in youth (with the exception of marijuana use, which is increasing). However, hospitalizations and emergency department visits for opioid poisoning among adolescents have significantly increased. For example, opioid-related overdose deaths among 15–19-year-olds increased 19% from 2014 to 2015 (Kounang, 2017). An increasing proportion of those deaths were attributed to synthetic opioids, including fentanyl.

Misusing prescription opioids is a risk factor for transition to heroin use. Youth who start to misuse prescription opioids early appear to have the highest risk of transitioning to heroin use (Bonar et al., 2020). Although some teens will receive a prescription for an opioid from a doctor, many adolescents report first taking an opioid from a friend or family member. Safe medication storage and removal are essential practices in homes with teens.

There are screening tools for the detection of opioid and other substance use specifically designed for adolescents. The National Institute on Drug Abuse provides a free, brief, easy-to-use screening toolopens in new window for providers.

In 2016, the American Academy of Pediatrics recommended that all youth with a severe opioid use disorder should be offered medication treatment in addition to behavioral therapy. Little research is available on the effectiveness of medication in youth; however, there are a few randomized controlled trials suggesting that buprenorphine is effective for opioid abstinence and treatment retention among youth.

Other modalities such as cognitive behavioral therapy, adolescent community reinforcement approach, and contingency management should be part of treatment plans for youth based on individual needs.

For youth with opioid use disorder, redefining social networks and finding new ways to have fun without substances can be a challenging task. Additional recovery support services such as youth-focused mutual help groups, recovery high schools, or collegiate recovery programs can be important components of optimizing treatment goals. Helping to facilitate reconnecting to sober friends or identifying sober activities should also be part of an overall treatment plan, especially in communities with limited formal recovery support services.

Family

Ideally, families are included in the treatment plan for youth with opioid use disorder. This can range from psychoeducation visits about opioids and treatment options to family therapy. All families should be trained in how to reduce risk for opioid overdose and have access to naloxone.

Harm reduction

Although abstinence is the goal, some youth may exhibit ambivalence about completely stopping. Harm reduction services such as access to clean needles, overdose education, naloxone, and sexually transmitted infection screening and prevention should be part of any treatment plan.

Protective concerns

Maintaining confidentiality is a critical part of the therapeutic relationship. There will be times, however, when it is not possible to maintain confidentiality because of protective concerns and high-risk behavior. Adolescents under the age of 18 should be aware that clinicians may have to break confidentiality by notifying parents/guardians.