Opioid Overdose Prevention in Practice

Overview

Pediatricians play a critical role in reducing opioid overdose and overdose deaths among adolescents and young adults. Changes in the drug supply, particularly the proliferation of fentanyl and polysubstance use, have disproportionately impacted youth. A multifaceted approach encompassing education, policy reform, strategic strategies, and healthcare integration is necessary to prevent overdose and overdose deaths among adolescents and young adults.

Screening and Early Identification

Incorporate routine screening for substance use, including prescription and nonmedical use of controlled medications, as part of regular check-ups using validated tools. Familiarize yourself with federal and state guidelines as well as professional guidelines for confidentiality in care of adolescents. Engage adolescents using non-judgmental communication styles to identify and screen for risk factors that may predispose adolescents to opioid misuse. Monitor for physical, emotional, or behavioral changes in adolescents that may suggest opioid misuse.

Ask: Access resources to screen for use, recognize symptoms and risk factors.

• Substance Use Screening as part of an annual health supervision visit
• Getting Candid: framing the conversation around youth substance use prevention
• Why is one-on-one time with the pediatrician important for adolescents – a patient and family resource

Education and Anticipatory Guidance for Patients and Families

Adolescents consider pediatricians to be a trusted authoritative source of information about drugs and are receptive to having this conversation if they believe it will remain confidential. Pediatricians are in a prime position to educate adolescents and their families about the dangers of opioids, the risk of addiction, and safe use of any prescribed medications.

Counsel: Access resources to counsel adolescents and young adults on substance use based on risks (not using, moderate use, high risk).

• Tip Sheet to promote safe storage and disposal of opioids and all medications; to accompany counseling for patients and parents about the importance of securely storing and properly disposing of prescription opioids.
• Partner with schools to educate students about drugs and overdose prevention.
• Build your peer-to-peer relationships with oral surgeons, orthopaedic doctors, and other physicians who often prescribe narcotics in your community; build a shared understanding of opioid prescribing for pain management and how you can coordinate and co-manage care.
• Consider peer-to-peer support such as Partnership to End Addiction, songforcharlie.org. SMART Recovery, or Young People in Recovery to empower adolescents and their friends.
• Encourage non-opioid treatments for managing pain, such as acetaminophen, ibuprofen, physical therapy, or cognitive behavioral therapy (CBT) for chronic pain.

Routinely discuss naloxone and other strategies as part of an open and non-judgmental discussion around substance use with all patients and families. Prescribe and/or dispense naloxone (a life-saving opioid overdose reversal drug) to at-risk adolescents and young adults, particularly those with opioid use disorder (OUD) or those prescribed opioids. Educate patients and families on how to recognize opioid overdose and administer naloxone effectively, and when and how to seek emergency medical help.

• AMA Tip Sheet: Help save lives: Co-prescribe naloxone to patients at risk of overdose
• Participate in and share National Fentanyl Prevention and Awareness Day (August 22) messages
• Stanford's Safety First curriculum to improve self-efficacy for pediatricians regarding patient education and interventions
• What to know about fentanyl and using naloxone for opioid overdose (a patient and family resource) 

Treatment and Referral

Follow safe opioid prescribing clinical practice guidelines, using a multimodal approach that includes the appropriate use of nonpharmacologic therapies, nonopioid medications, and, when needed, opioid medications.

Initiate treatment for adolescents with opioid use disorder or refer for treatment. Medication for opioid use disorder is safe and effective in adolescents, and is recommended for treatment of opioid use disorder. Coordinate care with behavioral health services, community-based organizations, and peer support groups for ongoing mental health and social support.  

Treat Access resources to connect patients to support, prescribe overdose prevention, and refer for treatment.

• Substance Use / Abuse Coding Fact Sheet for Primary Care Pediatrics
• Online Course: Managing Acute and Chronic Pain and Substance Use Disorders in Pediatrics Update (10 hours of CME and MOC Part 2)
• Providers Clinical Support System for Medications for Opioid Use Disorders training and mentoring to promote effective evidence-based clinical practices in the prevention of OUD through proper opioid prescribing practices, identifying patients with OUD, and the treatment of opioid use disorder.
• Consider utilizing your state’s prescription drug monitoring program (PDMP) to monitor patients’ opioid prescription history to detect possible misuse. Access additional considerations for clinicians using PDMPs.
• Opioid Pain Management Instructions: A customizable template to include with patient discharge instructions. May also be incorporated into the EHR
• Pediatrics On Call Podcast: The Opioid Epidemic: Compassionate Treatment for Patients with Substance Use Disorders – Episode 165
• SAMHSA’s National Helpline at 1-800-662-HELP (4357) is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. Home - FindTreatment.gov offers additional resources.
• Consider peer-to-peer support such as Partnership to End Addiction, songforcharlie.org. SMART Recovery, or Young People in Recovery to empower adolescents and their friends.