Survey: Pediatricians feel unprepared to address opioid use disorder
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Key takeaways:
- In a survey, pediatricians felt more prepared to address alcohol and cannabis use than opioids.
- Just 5.5% of pediatricians surveyed reported ever prescribing buprenorphine.
Less than half of pediatricians in the United States who responded to a survey said they felt prepared to counsel patients on opioid use disorder, researchers reported.
Overdose deaths among high school-aged adolescents in the U.S. more than doubled between 2019 and 2020, driven by counterfeit pills containing illicit fentanyl.
In a national survey of 474 pediatricians, 93.9% said they “strongly agreed” it is their responsibility to identify substance use disorders in patients, but only 48% felt prepared or very prepared to counsel them regarding opioids, according to results published in JAMA Pediatrics. Far more respondents reported feeling prepared to address alcohol (87.1%), cannabis (81.7%) or e-cigarette use (80.1%).
Fewer respondents agreed that it is their responsibility to treat substance use disorders (20.3%) or prescribe medications for addiction treatments (12.4%).
“Our survey suggests that a wide gap exists between adolescents in need of treatment for an opioid use disorder and the ability of families to turn to their pediatrician for that care,” Scott E. Hadland, MD, MPH, MS, chief of adolescent and young adult medicine at Mass General for Children and co-author of the study, said in a press release. “These findings underscore the need for greatly expanded workforce training aimed at treating opioid use disorder in the pediatric primary care setting, just like other physical and mental health conditions.”
Additionally, although 23.7% of respondents had diagnosed an adolescent with an opioid use disorder, only 5.5% had ever prescribed a medication for treating the disorder such as buprenorphine or naltrexone, and 86.8% reported lack of personnel as a reason for this. (Price has also been shown to be a barrier to buprenorphine use.)
Most respondents also reported being more likely to refer patients offsite for care (71.8%) for opioid use than for alcohol (87.7%), cannabis (88.9%) or e-cigarette use (91.6%), whereas a smaller percentage (63%) were likely to counsel themselves.
“The most common barrier to managing [opioid use disorder] was a lack of appropriately trained personnel and behavioral health support services within pediatric practices,” Deepa Camenga, MD, MHS, associate professor of emergency medicine, pediatrics and public health at Yale School of Medicine and co-author of the study, said in a release.
“As a result, many pediatricians refer their patients to outside treatment programs.” Camenga said. “Our goal is to help these pediatricians understand that prescribing medications is one part of treatment that is truly lifesaving, and that they can start this therapy immediately while linking patients and families to appropriate care.”
According to the authors, the results indicate that physicians need better training in counseling for opioid use. They cited another survey led by Hadland, which found that fewer than one in three U.S. pediatric residency programs included education on prescribing medications for opioid use disorder.
“We will continue our advocacy with the American Academy of Pediatrics, government agencies and medical schools to increase pediatric training opportunities that can pave the way for greater evidence-based care of opioid addiction in young patients,” Hadland said. “We will also push for greater financial incentives for pediatricians to treat patients with addiction problems. Youth with an opioid use disorder benefit from dedicated time and care from a clinician, and this critical work should be adequately compensated.”
References:
Allen EB, et al. Pediatrics. 2024;doi:10.1542/peds.2021-053423.
Hadland SE, et al. JAMA Pediatr. 2024;doi:10.1001/jamapediatrics.2023.6493.
Mass General for Children research survey finds most pediatricians unprepared to treat teens with opioid use disorder. https://www.massgeneral.org/news/press-release/research-survey-finds-most-pediatricians-unprepared-to-treat-teens-with-opioid-use-disorder. Published Mar. 4, 2024. Accessed Mar. 18, 2024.
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