Wednesday, May 22, 2024

Drug addiction is a mental health issue and kids are suffering too – Maryland Matters

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A view of Naloxone (Narcan) nasal spray on display at a Naloxone demonstration at the headquarters of the U.S. Department of Health and Human Services in 2023 in Washington, D.C. Photo by Drew Angerer/Getty Images.

By David Myles

The writer is a board-certified general pediatrician at Walter Reed National Military Medical Center, fellow of the American Academy of Pediatrics and editorial board Member of Pediatrics.

Presidential candidate Robert F. Kennedy Jr. openly discusses having been addicted to heroin at age 15, following the assassination of his father. While some may associate his introduction to and misuse of opioids to his privileged access, substance use disorder among kids is not exclusive to the rich and well connected. In fact, the only relevant “benefit” of his privileged upbringing may have been the financial resources that allowed him to receive the services needed to treat his substance use disorder.

In nearly 60 years after a teenage RFK Jr. first misused opioids, little has changed. We’ve known as far back as 2015 of a tripling in overdose deaths among adolescents 15-19 years of age; most of which were unintentional.

Today, over 75% of all drug overdose deaths are attributable to opioids and more kids are dying as a result of drug overdoses — even in Montgomery County. Throughout Maryland, annual deaths of people under 25 from opioid overdoses increased slightly during the pandemic and hasn’t come back down since. As challenging as it can be for society to acknowledge these sobering statistics, even more difficult to reconcile is the paucity of treatment options for adolescents who suffer from substance use disorder (sometimes referred to as drug addiction).

As a child of the 1980’s, I sat through many Drug Abuse Resistance Education (D.A.R.E.) sessions that endeavored to help us resist the pressure to be interested in, or experiment with, illicit and illegal drugs.  While well intentioned, we have since recognized that focusing solely on a prevention model can keep time and resources from being devoted to those who do experiment with, and may become addicted to, such drugs.

On a positive note, the Maryland General Assembly did pass the Start Talking Maryland Act” in 2017, which mandated counties to have overdose treatment drugs (e.g. naloxone/Narcan) available in schools.  While administering naloxone is needed and life saving in the context of an active overdose, people (including kids) who have overdosed often still need treatment after they have been resuscitated. Long-term treatment is still difficult for most kids to obtain because most treatment centers only serve people 18 years of age and older.

In my own practice as a pediatrician, I have had patients and families reach out to me to get drug rehabilitation treatment for them or their child. In one most unfortunate case, the patient had been on a waiting list and, shortly after turning 18 years old (and thus becoming eligible for drug rehabilitation programs open to adults), the patient died prior to receiving treatment. This occurred in the most affluent county (Montgomery) in one of the most affluent states (Maryland) in the U.S.

The COVID-19 pandemic significantly exacerbated the opioid epidemic. One pandemic-related silver lining was the implementation of a federal rule that made it easier to dispense certain medical treatments (e.g., methadone) to treat substance use disorder—also known as medication assisted treatment.

Data indicates that using such medications can reduce the need for inpatient detoxification services, as well as improve patient survival, employment retention, and birth outcomes among pregnant people. These medications can also reduce the risk of contracting HIV and hepatitis C and have been associated with a decrease in opioid-associated criminal activity.

Unfortunately, less than one-third of adolescents and adults eligible for such therapy actually receive it.  Some of the barriers (in addition to young age) are geographic, socioeconomic, race, and whether one has had an interaction with the criminal justice system.

Providing evidence-based effective treatment for patients who are dealing with substance use disorder is personal. I’ve commented before how, as a function of my training as a physician here in Maryland, I am likely complicit in a medical system that has enabled some patients to become addicted to opioids. Since then, I have made it my mission as a professor to inform other aspiring and seasoned pediatricians about best practices for treating pediatric patients with substance use disorder.

Serving on Maryland’s Opioid Restitution Fund Advisory Council provided another opportunity for me to remind others (including Gov. Wes Moore) to expand the scope of addiction treatment services for adolescents. Here’s hoping we can collectively advocate so that kids suffering from opioid misuse no longer have to wait to get the care they need.

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