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 his friendships.
This seemed like a routine teen checkup, the kind that happens in thousands of pediatric practices across the U.S. every day 鈥� until the doctor popped his next question.
鈥淎ny cravings for opioids at all?鈥� asked . The patient shook his head.
鈥淣one, not at all?鈥� Medina said again, to confirm.
鈥淣one,鈥� said the boy named Sam, in a quiet but confident voice.
Only Sam鈥檚 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. Sam鈥檚 urine tests showed no signs of the Percocet or OxyContin pills he had been buying on Snapchat, the pills that fueled Sam鈥檚 addiction.
鈥淲hat makes me really proud of you, Sam, is how committed you are to getting better,鈥� said Medina, whose practice is part of .
The American Academy of Pediatrics addicted to opioids. But only 6% of pediatricians report ever doing do, according to .
In fact, buprenorphine prescriptions for adolescents as overdose deaths for 10- to 19-year-olds . These overdoses, combined with accidental opioid poisonings among young children, have become the for U.S. children.
鈥淲e鈥檙e really far from where we need to be and we鈥檙e far on a couple of different fronts,鈥� said the chief of adolescent medicine at and a co-author of the study that surveyed pediatricians about addiction treatment.
That survey showed that many pediatricians don鈥檛 think they have the right training or personnel for this type of care 鈥� although Medina and other pediatricians who do manage patients with addiction say they haven鈥檛 had to hire any additional staff.
Some pediatricians responded to the survey by saying they don鈥檛 have enough patients to justify learning about this type of care, or don鈥檛 think it鈥檚 a pediatrician鈥檚 job.
鈥淎 lot of that has to do with training,鈥� said , associate director for pediatric programs for the Yale Program in Addiction Medicine. 鈥淚t鈥檚 seen as something that鈥檚 a very specialized area of medicine and, therefore, people are not exposed to it during routine medical training.鈥�
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鈥檛 changing to help the number of young people struggling with an addiction, not to mention .
In a twisted, deadly development, drug use among adolescents has declined 鈥� but .
The main culprits are fake Xanax, Adderall, or Percocet pills laced with the powerful opioid fentanyl. Nearly deaths among 10- to 19-year-olds were traced to counterfeit pills.
鈥淔entanyl and counterfeit pills is really complicating our efforts to stop these overdoses,鈥� said , the Centers for Disease Control and Prevention鈥檚 expert on adolescent addiction medicine and overdose prevention. 鈥淢any times these kids are overdosing without any awareness of what they鈥檙e taking.鈥�
Terranella said pediatricians can help by stepping up screening for 鈥� and having conversations about 鈥� all types of drug use.
He also suggests pediatricians prescribe more naloxone, the nasal spray that can reverse an overdose. It鈥檚 available over the counter, but Terranella, who practices in Tucson, Arizona, believes a prescription may carry more weight with patients.
Back in the exam room, Sam was about to get his first shot of Sublocade, an injection form of buprenorphine that lasts 30 days. Sam is switching to the shots because he didn鈥檛 like the taste of Suboxone, oral strips of buprenorphine that he was supposed to dissolve under his tongue. He was spitting them out before he got a full dose.
Many doctors also prefer to prescribe the shots because patients don鈥檛 have to remember to take them every day. But the injection is painful. Sam was surprised when he learned that it would be injected into his belly over the course of 20-30 seconds.
鈥淚s it almost done?鈥� Sam asked, while a nurse coaches him to breathe deeply. When it was over, staffers joked out loud that even adults usually swear when they get the shot. Sam said he didn鈥檛 know that was allowed. He鈥檚 mostly worried about any residual soreness that might interfere with his evening plans.
鈥淒o you think I can snowboard tonight?鈥� Sam asked the doctor.
鈥淚 totally think you can snowboard tonight,鈥� Medina answered reassuringly.
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.
鈥淪urrounding yourself with the right people is definitely a big thing you want to focus on,鈥� Sam said. 鈥淭hat would be my biggest piece of advice.鈥�
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.
He mom, Julie, had accompanied him to this appointment. She said she鈥檚 grateful the family found a doctor who understands teens and substance use.
Before he started visiting the Tri-River Family Health Center, Sam had seven months of residential and outpatient treatment 鈥� without ever being offered buprenorphine to help control cravings and prevent relapse. residential programs for youth offer it. When Sam鈥檚 cravings for opioids returned, a counselor suggested Julie call Medina.
鈥淥h my gosh, I would have been having Sam here, like, two or three years ago,鈥� Julie said. 鈥淲ould it have changed the path? I don鈥檛 know, but it would have been a more appropriate level of care for him.鈥�
Some parents and pediatricians worry about starting a teenager on buprenorphine, which can produce including long-term dependence. Pediatricians who prescribe the medication weigh the possible side effects against the threat of a fentanyl overdose.
鈥淚n this era, where young people are dying at truly unprecedented rates of opioid overdose, it鈥檚 really critical that we save lives,鈥� said Hadland. 鈥淎nd we know that buprenorphine is a medication that saves lives.鈥�
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.
鈥淚f we can take care of it,鈥� he said, 鈥淲e have produced an adult that will no longer have a lifetime of these challenges to worry about.鈥�
This article is from a partnership that includes , , and 杨贵妃传媒視頻 Health News.