Q&A: How pediatricians can counsel patients and parents on overdose prevention
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Key takeaways:
- Pediatricians routinely counsel patients and families about firearm injuries and motor vehicle crashes.
- A new article offers anticipatory guidance on another top cause of death in children: overdose.
Two pediatric addiction medical specialists and a mother who lost her daughter to fentanyl poisoning collaborated to write anticipatory guidance that may help pediatricians counsel patients and families on overdose prevention strategies.
“Pediatricians routinely provide anticipatory guidance to patients and families regarding the top two causes of death in children — firearm injuries and motor vehicle crashes,” Scott E. Hadland, MD, MPH, MS; Deb M. Schmill, BS, and Sarah M. Bagley, MD, MS, wrote in Pediatrics. “[W]e believe there is now an urgent need for pediatricians to counsel adolescents and families on potentially lifesaving overdose prevention strategies.”
We spoke with Bagley, an associate professor of medicine and pediatrics at the Boston University Chobanian & Avedisian School of Medicine, and Hadland, who is division chief of adolescent and young adult medicine at Massachusetts General for Children and Harvard Medical School, about the recommendations, which they hope will become formal guidance.
Healio: What is the need for anticipatory guidance on counseling adolescents and families about overdose prevention, and why now?
Bagley: Teen overdoses have significantly increased in recent years, and we have not had a standardized way to ensure that they have access to information about overdose prevention. Pediatric providers regularly provide guidance to patients and families about injury prevention. Given that overdose is a leading cause of teen death and is preventable, it makes sense to have this guidance now.
Hadland: Overdose deaths in teens have reached an all-time high and are now the third leading cause of death in children under age 19 in the United States. Pediatricians already provide anticipatory guidance for the top two causes of death — firearms and motor vehicle crashes. Fentanyl poisonings and overdoses now need this same attention.
Healio: How should a pediatrician initiate the conversation with patients and parents?
Bagley: Pediatricians can start by saying something like, “In recent years, there have been changes in the risk of overdose in teens. Because of that, I like to talk to all my patients and their families about how to protect themselves against having an overdose and how to recognize and respond to an overdose they might see.” In the paper, there is a table with suggested language: “It’s important that we talk about safety. As you might know, the number of teen drug overdoses has been increasing. I now talk all my teen patients and their families about how to prevent and respond to an overdose.”
Healio: What steps come after that?
Bagley: An important first step is to find out what people already know. Many families have been impacted and we don’t want to make assumptions about their prior experiences. Based on the response, the pediatric provider can then provide information about the presence of fentanyl in pressed pills and drugs such as cocaine.
Here are some of the key points to cover: It’s important to emphasize that someone might not know that there is fentanyl in the substance they might be taking — or their friend might be taking. Providers can review risks for overdose, such as using alone and taking pills that are not prescribed to them. Then we want to teach the signs of an overdose and what to do in case they suspect someone might be experiencing an overdose, including calling 911. The next step is making sure patients and families know where to get naloxone — it’s available over the counter, or the provider can write a prescription if that is preferred. Part of the conversation should happen confidentially with the teen. It’s good to end with giving the teen and family an opportunity to ask questions, “what questions do you have”?
Hadland: We see important steps as:
- confidentially assessing the teen’s prior fentanyl use or exposure;
- providing education about fentanyl;
- reviewing signs of overdose;
- reviewing how to respond to an overdose; and
- discussing naloxone and how to find it.
Healio: Your perspective does not mention stigma, which is an important part of the conversation about addiction and harm reduction. Should addressing stigma be a part of formal guidance?
Bagley: That’s an important question. Stigma continues to play an important role in prevention, treatment and harm reduction. I think that one of the hopes with this paper is to suggest a universal approach that can normalize the conversations around overdose, which can lead to a decrease in stigma.
Hadland: Stigma is a critical barrier to folks receiving care. Although we don’t go into depth on stigma in the piece (we do in our other work), we believe that by normalizing these conversations — having them with every teen and family — we’re in fact helping to battle stigma, by helping teens and families understand that anyone can be affected by this crisis, and that safety is our number one priority.
Healio: Are there misconceptions about overdose prevention?
Bagley: I think that a lot of the misconceptions are related to stigma and teens, families and communities thinking that overdose is not really a problem for teens. One thing that I have found by having conversations about overdose prevention with teens is that it can open the door to other discussions about risk behaviors because we are creating a safe space for teens to ask questions that might be on their minds.
Hadland: Some might argue that counseling teens on overdose prevention might cause them to use more drugs — that somehow, this conversation will enable drug use. This is a common misconception, and similar arguments have been made about condoms — for example, that they’ll lead to teens having more sex — and other public health issues. This misconception has been proven wrong time and time again.
Healio: Do you expect these to become formal guidelines, and is there anything else you would like to see done?
Hadland: Our hope is for this to become formal guidance, and we plan to advocate as such.
Bagley: Although this paper is focused on overdose prevention in pediatric settings, there is a need to ensure that overdose education and naloxone is widely available for youth in other settings such as schools. I think that it’s also important to note that pediatric providers are being asked to do more and more in primary care. As we advocate for guidelines like this, we also need to make sure that providers are receiving the support to implement the counseling. Finally, these conversations can always start with the clear message that no use is the safest while still making sure they have information about overdose risk they need to stay as safe.
[Editor’s note: Schmill is president of the Becca Schmill Foundation.]
References:
Hadland SE, et al. Pediatrics. 2024;doi:10.10.1542/peds.2023-065217.
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