Clinical Practice Guidelines: Adolescent Opioid Use Disorder

CLINICAL PRACTICE GUIDELINES (FULL LIST)

Adolescent Opioid Use Disorder (CPG)

Appendix

In recent years (data as late as 2021), adolescent deaths from opioid overdose have continued to rise. [1] Though high-quality evidence is limited, the evidence that exists supports using MOUD in adolescents. [2] The American Academy of Pediatrics recommends MOUD in the form of Oral Buprenorphine be offered to adolescents with severe OUD [3] , largely in part thanks to the wealth of observational study data supporting the working paradigm that short term stabilization followed by daily administration of Buprenorphine is more efficacious at preventing return to use (and therefore death due to loss of tolerance or continuance of high risk ingestion) than short-term stabilization with buprenorphine or adjuncts alone [4]. Despite these recommendations, few adolescents with OUD are treated w/ Buprenorphine, and other programs implementing these protocols [5], as well as our team’s experience with adolescents at MCJVCH, have found outpatient access after stabilization to be a major barrier. With new avenues to coordinate care outpatient on the horizon in Middle TN that could reduce this barrier, and data in adult populations supporting cost-effectiveness of such approaches to the system [6], our team recommends a standardized protocol for the evidence-based treatment of OUD in adolescents presenting to MCJVCH for treatment of OUD [7]. This protocol would include:

  • Work-up and treatment for common comorbid conditions including malnutrition and sequelae, other SUDs, chronic pain disorders, HBV/HCV/HIV, TSRDs, Anxiety disorders, and mood disorders.
  • Stabilization of opioid withdrawal with Buprenorphine + Adjuncts or Adjuncts dependent on patient and/or guardian goals of care.
  • Connection to outpatient resource options ranging from IN Naloxone to Outpatient MAT referrals

Authors:

  • Pediatric Hospital Medicine, led by Dr. Alison Herndon
  • Pediatric Psychology, led by Dr. Heather Kreth
  • Pediatric Consult/Liaison Psychiatry, led by Drs. Tasia York and Nadia Zaim
  • Pediatric Emergency Medicine, led by Dr. Michelle Walsh
  • Addiction Psychiatry, led by Dr. Kris Kast and Dr. Michael Levin
  • MCJVCH Nursing (Specifically the Unit 12c team), led by Christian Loaiza
  • MCJVCH Patient Safety Team, led by Delana Vallery
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