Buprenorphine, shown in this provided photo, is the only opioid dependence medication approved for adolescents. New research from OHSU shows the drug is only offered in about a quarter of the country's adolescent residential treatment centers.
Courtesy Oregon Health & Science University
The FDA has approved three medications to treat opioid dependence. But only one — buprenorphine — is approved for patients under age 18. The Society for Adolescent Health and Medicine recommends the medication as a “critical component” of treating addiction in teens, especially with adolescent overdose deaths on the rise. However, a new study from Oregon Health & Science University found that only one in four adolescent treatment facilities offers the drug.
Caroline King led the study as a medical student at OHSU. She joins us with more details on the findings.
This transcript was created by a computer and edited by a volunteer.
Jenn Chávez: This is Think Out Loud on OPB. I’m Jenn Chávez, in this week for Dave Miller. There’s only one medication for treating opioid dependence that’s approved by the FDA for use in teens: buprenorphine. The Society for Adolescent Health and Medicine says medication is a critical component of treating addiction in teens. But new research from the Oregon Health and Science University finds that the drug isn’t being used in most adolescent treatment facilities in the US. Here to talk more about these findings is Caroline King who led this research as a medical student at OHSU. She’s now an emergency medicine resident physician at Yale University. Caroline, thank you so much for being with us.
Caroline King: Hi, thanks so much for having me.
Chávez: Yeah, it’s our pleasure. So before we dig into your findings, you did this study as there is an ever rising number of teens dying from opioid overdoses right now, especially because of fentanyl. How are young people being affected by this overdose crisis?
King: That’s a great question. When we think about kids who are part of the overdose crisis, we really are thinking about two things. First, for some kids, they end up taking one pill from a friend or taking a pill that they find at home that they think is something else that’s actually contaminated with fentanyl. This can be deadly for kids, and there’s a large problem in the US with drug contamination in general.
On the other end of the spectrum though, there are a group of kids in our communities that are very vulnerable. These are kids who have become dependent on fentanyl or other opiates, and are also at very high risk of overdosing, but also have an opioid use disorder. And those are the kids that are study focused on.
Chávez: So to be clear, buprenorphine is not the only FDA approved drug for treating opioid dependence, there are three. But it is the only one approved for use in patients younger than 18 years old. So first of all, what is buprenorphine? How does it work?
King: As you mentioned, there are three drugs that are FDA approved in adults. When people think about opiates, they think about fentanyl or heroin, those are what we call full agonists. Those sit on our opioid receptors and provide a maximum impact to them. Methadone is also a full agonist, so it works a little bit differently than buprenorphine, which is what we call a partial agonist. What buprenorphine does is it actually goes into your body and sits on the opioid receptors, and it bonds to them really tightly. But it doesn’t produce the same effect as heroin or fentanyl.
The really amazing thing about it is especially for kids, but really for anyone who has an opioid use disorder, it gives the brain an opportunity to heal while social/environmental pieces are kind of figured out and going on in a child or adult’s life. It decreases cravings for drugs, and allows your brain to kind of put itself back together again while you’re in recovery.
Chávez: Got it. My understanding is that this drug is FDA approved for people older than 16 years old. So when would this drug be used for treating kids and teens?
King: That’s a great question too. It’s gonna be for children who have moderate or severe opioid use disorder. This is not a drug that you would start in someone who has just used an opioid one time or didn’t know what they were using. This is for someone who’s experiencing the effects of having an opioid use disorder in their life - may be having difficulty in school, difficulty at home with their family, and really experience that tolerance, needing to use higher amounts of the substance to get the same effect and to really feel normal. That’s who’s a good candidate for a medication like this.
Chávez: You set out with this study to see how often residential treatment facilities for adolescents were actually providing buprenorphine. First of all, how did you conduct this research?
King: Whenever we talk to families about where to find treatment for adults or kids, we typically point them towards a website called findtreatment.gov. We started there because that’s where we send families, and we pulled a list of about 350 centers that said that they provided residential treatment for opioid use disorder for patients under 18. We also added a couple of other sites that we found that advertised using Google to make sure that we were getting the full scope of what families might see.
And then we actually called all of the centers, using an approach called a secret shopper approach. We took on the role as the aunt or uncle of a 16-year-old child who had recently had a non-fatal overdose. We called and said “hi, I’m Katie Johnson, I am helping my sister look for residential treatment for my nephew. Can I talk to you about your program?”
Chávez: And you know, in your study, you found that only one in four adolescent treatment facilities were providing buprenorphine, most of them are not. What are some of the main reasons you heard that centers don’t carry this drug?
King: We heard a wide variety of reasons why they don’t offer bupe. Some are similar to barriers in adult facilities. But the number one thing that we heard was misinformation about it. We heard things that were just really blatantly untrue, like that bupe soaks into your bones, that it’s more dangerous than fentanyl.
Chávez: Wow.
King: Yeah. Some people would say “I’m not a doctor, but I would never put my child on this.”
Other sites had really thoughtful challenges in trying to think about providing bupe, one of which is that in many communities, it’s very hard to find pediatricians or family med doctors who are willing to continue bupe after kids leave the facility, or it’s hard to find someone who offers that service, so centers are reluctant to start it.
There were also some really encouraging stories of centers who told us they previously hadn’t, but in the era of fentanyl were working with academic centers or family med docs or pediatricians, and now were providing bupe, and were having very positive experiences doing so
Chávez: Now that you’ve identified this gap in treatment availability, what changes do you hope to see as a result of your research?
King: I think that we need two things: We need better regulation of these centers, because any parent or family member who is calling a center in the middle of a crisis should be able to call and know that if their loved one goes there, they will receive evidence-based care. That is not currently something that could happen, which is just an incredible shame.
On the other side, we need pediatricians, family med doctors, and academic centers to provide technical support and partnership with these sites to help provide the best care for kids in our communities.
Chávez: Caroline, thank you so much for joining us today and talking us through some of this research that you’ve come out with.
King: Thanks for having me.
Chávez: I’ve been speaking with Caroline King, who led research into the use of buprenorphine in adolescent treatment centers. She’s now an emergency resident physician at Yale University. Their research found that only one in four adolescent treatment centers in the United States were providing buprenorphine.
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