AAP: Offer Teens Medication-Assisted Tx for Opioid Addiction

Medication-assisted treatment should be offered to adolescents with severe opioid use disorders, said the American Academy of Pediatrics in a new policy statement.

Characterizing medication-assisted treatment in adolescents as "underused" and "severely restricted," the AAP called upon pediatricians to offer this type of care to their patients with opioid use disorders or to refer patients to other health professionals who may provide this service, reported the AAP Committee on Substance Use and Prevention in Pediatrics.

Buprenorphine, naltrexone and methadone are the three medications currently indicated to treat opioid use disorder, though the authors noted there is limited research on their effect on adolescents. Buprenorphine was approved for use in patients ages 16 years and older, and two randomized trials found that adolescents and young adults taking the medication were more likely to continue medical care and had lower rates of illicit opioid use.

Despite "promising" anecdotal reports, the authors wrote that naltrexone lacks "rigorous research support" that it is effective in adolescents. They added that the medication also reduces alcohol cravings, making it a potentially good option for young people who also have an alcohol use disorder.

While methadone is indicated for treating opioid use disorder, federal regulations prohibit most methadone treatment programs from admitting children under 18 years old.

The authors also encouraged improved access to medication-assisted treatment, such as community-based substance disorder counseling, for these adolescents. Further research into other "developmentally appropriate treatment" was recommended for this population, including primary and secondary prevention and behavioral interventions.

"The time to act is now to take advantage of these medications that can have a profound impact of the lives of adolescents and young adults struggling with opioid addiction," said Michael Weaver, MD, of McGovern Medical School at UTHealth in Houston, who was not involved with the statement. "The epidemic of opioid addiction in the U.S. has disproportionately affected adolescents and young adults, and multiple medications are available that can save lives."

"These medications are not being used in a majority of programs, even though they are evidence-based and standard of care," said Weaver. "Pediatricians can take the initiative and prescribe naltrexone to appropriate patients right away with no need for specialized training, or prescribe buprenorphine after completing an 8-hour training program available through AAP."

In fact, one study found that less than half of addiction treatment programs for both adolescents and adults offer medication treatment programs, and only about a third of opioid-dependent patients receive medication treatment (compared with 70% of patients with mental health disorders).

"Policies, attitudes, and messages that serve to prevent patients from accessing a medication that can effectively treat a life-threatening condition may be harmful to adolescent health," the authors wrote.

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