From the Guidelines
Addiction in pediatric patients requires a comprehensive approach involving early identification, appropriate intervention, and family involvement, with a focus on evidence-based treatments such as buprenorphine for opioid addiction, as recommended by the most recent study 1 and 1. The treatment of addiction in pediatric patients should prioritize a combination of behavioral therapy, such as Cognitive Behavioral Therapy (CBT) or Motivational Enhancement Therapy, and family-based interventions.
- Screening tools like the CRAFFT questionnaire (Car, Relax, Alone, Forget, Friends, Trouble) should be used during routine medical visits to identify substance use disorders in adolescents, as suggested by 1.
- Medication may be appropriate in certain cases, such as buprenorphine (starting at 2-4mg daily, titrated as needed) for opioid addiction in older adolescents, as recommended by 1 and 1.
- For tobacco addiction, nicotine replacement therapy can be considered in adolescents.
- Treatment should be age-appropriate, addressing developmental considerations and co-occurring mental health issues, and should be delivered in a variety of settings, including primary care and mental health offices, emergency rooms, schools, and other community-based programs, as suggested by 1. The developing brain is particularly vulnerable to addiction, as substances can alter neural pathways during critical developmental periods, potentially leading to long-term cognitive and behavioral changes, highlighting the need for early intervention and prevention efforts, as discussed in 1 and 1. Prevention efforts should focus on education, building resilience, and addressing risk factors, and recovery support should include school reintegration plans, peer support, and ongoing monitoring to prevent relapse, as recommended by 1.
From the FDA Drug Label
Drug-seeking tactics include emergency calls or visits near the end of office hours, refusal to undergo appropriate examination, testing, or referral, repeated "loss" of prescriptions, tampering with prescriptions, and reluctance to provide prior medical records or contact information for other treating healthcare provider(s) Dependence Both tolerance and physical dependence can develop during use of opioid therapy Infants born to mothers physically-dependent on opioids will also be physically-dependent and may exhibit respiratory difficulties and withdrawal signs
The risk of addiction in pediatric patients is not directly addressed in the provided drug label. However, it is mentioned that physical dependence can develop during use of opioid therapy, and infants born to mothers physically-dependent on opioids will also be physically-dependent.
- Tolerance and physical dependence can occur with repeated use of opioid therapy.
- Withdrawal signs and symptoms may occur if buprenorphine hydrochloride is abruptly discontinued in a physically-dependent patient. 2
From the Research
Addiction in Pediatric Patients
- The American Academy of Pediatrics Committee on Substance Abuse suggests that pediatricians should be familiar with treatment professionals and facilities in their communities to ensure appropriate treatment for adolescent patients based on their developmental, psychosocial, medical, and mental health needs 3.
- Comorbid psychiatric conditions are common in pediatric patients with substance use disorders and should be evaluated and treated simultaneously by child and adolescent mental health specialists 3.
- A multidisciplinary approach to pain management, incorporating pharmacological and integrative non-pharmacological therapies, can be effective in managing acute and chronic pain in pediatric populations and may reduce reliance on opioids 4.
Treatment Options
- Buprenorphine is a commonly used medication for the treatment of opioid dependence, and its use in office-based treatment has been shown to be effective 5, 6.
- The American Society Of Addiction Medicine Consensus Panel recommends that patients be assessed for a broad array of biopsychosocial needs in addition to opioid use and addiction, and should be treated, referred, or both for help in meeting all their care needs 6.
- Behavioral treatment conditions, such as cognitive behavioral therapy and contingency management, have been studied in combination with buprenorphine, but no clear evidence has been found that they reduce opiate use when added to buprenorphine and medical management in opiate users seeking treatment 7.
Special Considerations
- Pediatric patients with opioid use disorders may require specialized treatment, and further research is needed to demonstrate the effectiveness of buprenorphine for special populations, such as adolescents 6.
- Multidisciplinary pain management treatments can benefit psychological functioning and quality of life, and may have the potential to reduce reliance on opioids in pediatric patients with acute and chronic pain 4.