Identifying and Treating Opioid Misuse in Pediatric Patients

Opioid use disorder (OUD) is a chronic illness that often has its roots in the adolescent period. The risk of adolescent death from opioid overdose has surpassed the risk of death from motor vehicle accidents and gun violence. Most adolescents who meet criteria for OUD do not receive treatment for this problem, and many pediatricians do not adequately screen for substance use. Though room for improvement exists, useful prevention methods, validated screening tools, and affective treatment modalities have been developed. In this chapter, we discuss risk factors for opioid misuse; consider primary, secondary, and tertiary prevention of OUD; explain the utility of the SBIRT (screening, brief intervention, and referral to treatment) technique, and briefly summarize medical management of OUD including buprenorphine, methadone and naltrexone. In addition we review management of opioid overdose and management of severe, acute pain in the setting of OUD on maintenance medication.