Gabriel Devlin, Neri Bernabe, Irene Lim, Alan L Nager
{"title":"儿童急诊科阿片类药物成瘾青少年的治疗和转诊:一项试点研究","authors":"Gabriel Devlin, Neri Bernabe, Irene Lim, Alan L Nager","doi":"10.1016/j.acap.2025.103143","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Fatal opioid overdoses have increased among adolescents. Emergency Departments (EDs) are critical access points for connecting adults with opioid use disorder (OUD) to medication-assisted treatment (MAT). Whether this is feasible in pediatric patients is unknown. As opioid use among adolescents results in morbidity and mortality, developing an opioid treatment program is crucial.</p><p><strong>Methods: </strong>We developed an ED buprenorphine induction and referral program based on expert opinion. All patients completed the Emergency Department Distress Response Screener (ED-DRS) and Screening to Brief Intervention (S2BI) tools. After a 13-month pilot period, we performed a retrospective chart review to assess the program's feasibility based on the degree of execution, fidelity, and resource utilization.</p><p><strong>Results: </strong>We identified 12 ED encounters for opioid withdrawal that received buprenorphine. 75% were aged 15-17 years. 75% of encounters presented with mild withdrawal, while 25% presented with moderate withdrawal. Participants reported high rates of depression (80%), anxiety (90%), and additional substance use (90%). 75% of encounters only required 1 dose of buprenorphine in the ED to treat their withdrawal. There were no medical complications. Although we referred 100% of encounters to an OUD treatment center, only 50% attended their first appointment, and 42% remained engaged after 30 days. A mix of patient, parent, and insurance factors contributed to loss of engagement.</p><p><strong>Conclusions: </strong>Pediatric ED-based buprenorphine induction is feasible for the stabilization of acute opioid withdrawal symptoms in youth without causing complications. Further data is necessary to determine the barriers adolescents face to OUD engagement after discharge.</p>","PeriodicalId":50930,"journal":{"name":"Academic Pediatrics","volume":" ","pages":"103143"},"PeriodicalIF":2.8000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Treatment and Referral of Youth with Opioid Addiction in the Pediatric Emergency Department: A Pilot Study.\",\"authors\":\"Gabriel Devlin, Neri Bernabe, Irene Lim, Alan L Nager\",\"doi\":\"10.1016/j.acap.2025.103143\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Fatal opioid overdoses have increased among adolescents. Emergency Departments (EDs) are critical access points for connecting adults with opioid use disorder (OUD) to medication-assisted treatment (MAT). Whether this is feasible in pediatric patients is unknown. As opioid use among adolescents results in morbidity and mortality, developing an opioid treatment program is crucial.</p><p><strong>Methods: </strong>We developed an ED buprenorphine induction and referral program based on expert opinion. All patients completed the Emergency Department Distress Response Screener (ED-DRS) and Screening to Brief Intervention (S2BI) tools. After a 13-month pilot period, we performed a retrospective chart review to assess the program's feasibility based on the degree of execution, fidelity, and resource utilization.</p><p><strong>Results: </strong>We identified 12 ED encounters for opioid withdrawal that received buprenorphine. 75% were aged 15-17 years. 75% of encounters presented with mild withdrawal, while 25% presented with moderate withdrawal. Participants reported high rates of depression (80%), anxiety (90%), and additional substance use (90%). 75% of encounters only required 1 dose of buprenorphine in the ED to treat their withdrawal. There were no medical complications. Although we referred 100% of encounters to an OUD treatment center, only 50% attended their first appointment, and 42% remained engaged after 30 days. A mix of patient, parent, and insurance factors contributed to loss of engagement.</p><p><strong>Conclusions: </strong>Pediatric ED-based buprenorphine induction is feasible for the stabilization of acute opioid withdrawal symptoms in youth without causing complications. Further data is necessary to determine the barriers adolescents face to OUD engagement after discharge.</p>\",\"PeriodicalId\":50930,\"journal\":{\"name\":\"Academic Pediatrics\",\"volume\":\" \",\"pages\":\"103143\"},\"PeriodicalIF\":2.8000,\"publicationDate\":\"2025-09-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Academic Pediatrics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.acap.2025.103143\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Academic Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.acap.2025.103143","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Treatment and Referral of Youth with Opioid Addiction in the Pediatric Emergency Department: A Pilot Study.
Background: Fatal opioid overdoses have increased among adolescents. Emergency Departments (EDs) are critical access points for connecting adults with opioid use disorder (OUD) to medication-assisted treatment (MAT). Whether this is feasible in pediatric patients is unknown. As opioid use among adolescents results in morbidity and mortality, developing an opioid treatment program is crucial.
Methods: We developed an ED buprenorphine induction and referral program based on expert opinion. All patients completed the Emergency Department Distress Response Screener (ED-DRS) and Screening to Brief Intervention (S2BI) tools. After a 13-month pilot period, we performed a retrospective chart review to assess the program's feasibility based on the degree of execution, fidelity, and resource utilization.
Results: We identified 12 ED encounters for opioid withdrawal that received buprenorphine. 75% were aged 15-17 years. 75% of encounters presented with mild withdrawal, while 25% presented with moderate withdrawal. Participants reported high rates of depression (80%), anxiety (90%), and additional substance use (90%). 75% of encounters only required 1 dose of buprenorphine in the ED to treat their withdrawal. There were no medical complications. Although we referred 100% of encounters to an OUD treatment center, only 50% attended their first appointment, and 42% remained engaged after 30 days. A mix of patient, parent, and insurance factors contributed to loss of engagement.
Conclusions: Pediatric ED-based buprenorphine induction is feasible for the stabilization of acute opioid withdrawal symptoms in youth without causing complications. Further data is necessary to determine the barriers adolescents face to OUD engagement after discharge.
期刊介绍:
Academic Pediatrics, the official journal of the Academic Pediatric Association, is a peer-reviewed publication whose purpose is to strengthen the research and educational base of academic general pediatrics. The journal provides leadership in pediatric education, research, patient care and advocacy. Content areas include pediatric education, emergency medicine, injury, abuse, behavioral pediatrics, holistic medicine, child health services and health policy,and the environment. The journal provides an active forum for the presentation of pediatric educational research in diverse settings, involving medical students, residents, fellows, and practicing professionals. The journal also emphasizes important research relating to the quality of child health care, health care policy, and the organization of child health services. It also includes systematic reviews of primary care interventions and important methodologic papers to aid research in child health and education.