Nationally, just one in four residential facilities that treat adolescents addicted to opioids such as fentanyl use a medication shown to be “lifesaving,” according to a new study carried out by Oregon Health & Science University researchers.
The study, published Tuesday in the Journal of the American Medical Association, comes as the country, and Oregon especially, confronts a rise in the use of fentanyl, a cheap, plentiful and potent synthetic opiate.
Between 2018 and 2021, Oregon saw the fastest growth in the country in drug-related deaths among 15 to 19 year olds, federal data shows.
Yet researchers at OHSU found that few centers that treat adolescents provide buprenorphine, a medication that’s been effective in treating opioid use disorder among younger people. The medication is the only one approved by the U.S. Food and Drug Administration for adolescents and recommended by the American Society of Addiction Medicine in treating opioid use disorder in younger people.
About two-thirds of adult residential treatment facilities offer the medication, a 2020 study found.
Dr. Todd Korthuis, head of the addiction medicine section at OHSU, co-authored the study with Dr. Caroline King, an emergency medicine resident at the Yale School of Medicine.
The idea for the study came out of dinner conversations between Korthuis and his wife, Dr. Olivia Wright, a family medicine doctor and addiction medicine specialist at PeaceHealth Southwest Washington Medical Center.
Wright said in her own work she noticed a significant spike in the number of adolescents with fentanyl dependence in the past two or so years.
“And these were kids who really didn’t know what they had gotten themselves into,” she said.
She said she’s seen the same cycle play out over and over.
“A lot of them had already had an overdose and had been using for well over a year and had been at another facility where that treatment wasn’t even offered,” she said.
The couple wondered if the problem was widespread; Korthuis and his colleagues devised a study to find out.
Korthuis said their findings revealed a widespread misunderstanding among treatment providers about the vital role buprenorphine can play in helping young people.
“There are people in the treatment community who don’t believe any medication should be used or using buprenorphine is just replacing one drug for another,” he said. “That line of thinking is just not consistent with the overwhelming scientific data that shows buprenorphine allows the brain to heal.
He said buprenorphine provides relief to “the adolescent whose life is being consumed by fentanyl.”
Korthuis declined to say whether treatment centers in Oregon that work with adolescents were contacted as part of the study. The Substance Abuse and Mental Health Services Administration’s treatment locator identifies four centers that provide adolescent treatment in the state: NARA, Madrona Recovery, Rimrock Trails and Adapt Integrated Health Care.
The Oregonian/OregonLive sent emails or left voicemails for leaders of each organization Monday, asking whether the medication is part of their adolescent treatment programs.
A spokesperson for Adapt Integrated Health Care said the facility does not provide the medication. The center is based in southern Oregon.
“Our team is not licensed for detox treatment for our youth residential facility,” Grey Garris, a spokesperson for the center, wrote in an email.
Erica Fuller, CEO of Rimrock Trails Treatment Services, said the center provides buprenorphine. Rimrock Trails operates in central Oregon.
Karli McLaughlin, a nurse at Madrona Recovery in Tigard, said the center provides Suboxone, a medication that contains buprenorphine, to adolescents.
Representatives of NARA, located in Portland, did not respond.
Medications for opioid use disorder, including buprenorphine, disrupt the ability of drugs like heroin and fentanyl to attach to certain receptors in the brain.
Researchers suspect these medications may be particularly effective in younger people because their brains are still developing and those receptors may be less damaged than those in the brains of older people suffering from long-term opioid use, Wright said.
Researchers used a “secret shopper” approach, posing as the aunt or uncle of a 16-year-old who had survived a fentanyl overdose in calls to treatment centers around the country. The research took place last fall.
They identified 160 residential treatment centers nationally that serve patients younger than 18. The survey found about 24% provided buprenorphine and of those only 18% were located in the West. A dozen offered the medication but discontinued it before the patient was discharged, though it is typically recommended younger patients use it for six to 12 months. Only four offered long-acting injectable buprenorphine.
Nearly all offered counseling and a quarter of them offered equine therapy, Korthuis said.
“Basically, horse programs, literally exposure to horses, as a therapeutic innovation, which has almost no data behind it,” he said. “That was actually the thing that was most jaw dropping to me. Say what you will about buprenorphine, but I guarantee it’s more effective than riding horses.”
Korthuis said that while the study highlights the shortcomings of residential treatment for adolescents, pediatricians and family doctors should be screening for opioid use disorders at annual checkups and in sports physicals.
“And then be prepared to actually prescribe what’s appropriate for kids,” he said.
This article was originally published by The Oregonian/Oregonlive, and is used with permission. The original can be found here.
