Background/Rationale

Although opioid use rates among youth are decreasing from a high of 9.2% of school-attending 12th graders in 2009, nevertheless 3.1% (800,000) youth aged 12-17 years reported opioid misuse in 2017, and 0.4% (99,000) met criteria for an opioid use disorder (OUD). In 2017, 4,094 youth aged 15-24 years died of an opioid overdose. Most youth with OUD have co-occurring psychiatric disorders which makes child and adolescent psychiatrists well positioned to identify and address OUD in their patients.

Buprenorphine/naloxone is a medication that is FDA approved for the treatment of moderate to severe OUD in adolescents and has been shown in randomized controlled trials to increase abstinence in youth . Naltrexone extended release and methadone are FDA approved for the treatment of moderate to severe OUD in adults although no randomized controlled trials have been done with these medications in youth. A case series with naltrexone extended release, however, demonstrated promising results. Medication to treat OUD has also been shown to improve treatment engagement in youth. In addition to medication, psychosocial treatment is an important evidence based intervention for youth with substance use disorders, having demonstrated acceptability and effectiveness for youth with OUD.

The American Academy of Child and Adolescent Psychiatry Recommends:

• Increasing implementation of valid screening and assessment tools for youth who present with psychiatric disorders to improve the identification of OUD. Examples of evidence based screening tools for adolescent substance use include Screening to Brief Intervention and Brief Screener for Alcohol, Tobacco, and Other Drugs.
• Increasing youth’s access to medication for the treatment of OUD by:
• Obtaining waivers to prescribe buprenorphine.
• Decreasing insurance and regulatory barriers to the use of medication to treat OUD in youth under the age of 18 years.
• Offering youth choice in their preference of medication to treat OUD and duration of treatment.
• Offering psychosocial treatments to youth with OUD and their caregivers to enhance retention in treatment and prevent relapse.
• Treating OUD concurrently with treatment of psychiatric disorders to maximize improvements.
• Providing education on overdose risk factors and prescribing naloxone for the prevention of opioid overdose in youth and caregivers.

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The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health.

Approved by Council June 2020