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

Sam, a 17-year-old boy with shaggy blond hair, stepped onto the scale at Tri-River Family Health Center in Uxbridge, 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?” asked pediatrician Safdar Medina. 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 called buprenorphine, which curbs cravings for the more dangerous and addictive opioid pills for the more dangerous and addictive opioid pills. Sam’s urine tests showed no signs of the Percocet or OxyContin he used to buy on Snapchat.

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

Trending in the wrong direction

The American Academy of Pediatrics recommends offering buprenorphine to teens addicted to opioids. But only 6% of pediatricians report ever doing do, according to survey results.

In fact, buprenorphine prescriptions for adolescents declined as overdose deaths for 10- to 19-year-olds more than doubled. These overdoses, combined with accidental opioid poisonings among young children, have become the third-leading cause of death for U.S. children.

“We’re really far from where we need to be and we’re far on a couple of different fronts,” said Scott Hadland, chief of adolescent medicine at Mass General for Children and 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,” said Deepa Camenga, 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.”

Camenga and Hadland said 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 changing fast enough. In a twisted, deadly development, drug use among adolescents has declined – but drug-associated deaths are up. The main culprits are fake Xanax, Adderall or Percocet pills laced with the powerful opioid fentanyl. Nearly 25% of recent overdose deaths among 10- to 19-year-olds were traced to counterfeit pills.

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

Terranella said pediatricians can help by stepping up screening for – and having conversations about – all types of drug use. He also suggests more pediatricians prescribe naloxone, the nasal spray that can reverse an overdose. It’s available over the counter, but Terranella believes 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 visiting Tri-River, Sam had seven months of residential and outpatient treatment without being offered buprenorphine to 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 on buprenorphine, which can produce side effects including 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,” said Hadland. “And we know that buprenorphine is a medication that saves lives.”

In the exam room, Sam was about to get his first shot of Sublocade, an injection form of buprenorphine that lasts 30 days. He switched to the shots because he didn’t like the taste of Suboxone, oral strips of buprenorphine that 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 includes WBUR, NPR and KFF Health News. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF – an independent source of health policy research, polling and journalism.

This article originally appeared on USA TODAY: Could pediatricians do more to help as more kids die of drug overdoses