PECARN STELAR Podcast – Episode 5: Addressing Substance Use Disorder in children and adolescents – The impactful role of the ED

The emDOCs.net team is very happy to collaborate with PECARN STELAR (Seattle, Dallas/Texas, and Los Angeles) Node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC) in presenting high-yield pediatric topics that highlight evidence based medicine with solid research.

This podcast is a collaboration between PECARN STELAR node and the Emergency Medical Services for Children Innovation and Improvement Center (EIIC).

Show notes by:  Mohsen Saidinejad, MD and Ilene Claudius MD – Harbor UCLA Medical Center

Adolescent substance use is significantly more prevalent than is recognized.  The emergency department (ED) can be a great resource to acutely manage complications and help set up long term management goals and provide resources.

Examples of how the ED can address substance use.

• Distribute naloxone
  1. Direct distribution (to the patient and perhaps friends of the patient)
  2. Point out potential outside programs like needle exchange programs
  3. Inform patient about certain over the counter naloxone
  4. Prescription of naloxone
  5. National Harm Reduction Coalition may have links to assist in obtaining naloxone
• Teach naloxone use with involvement of the family if patient gives permission
• Create safe environment to discuss drug use
• Consider buprenorphine (a partial opioid agonist which produces significantly with much weaker opiate response, by binding t the receptor sites and making less receptor sites available to full opiate). It is used to treat opioid use disorder (OUD), also known as opioid addiction. It works by reducing withdrawal symptoms and cravings without producing the same euphoric effects as other opioids. Buprenorphine can also be used to manage severe pain, both acute and chronic
  1. Start when in patient is in withdrawal; if not, it will precipitate an opiate-like response
  2. Most kids require 4-16 mg/d dose
• Safer use
  1. Don’t use buprenorphine alone
  2. Never Use Alone Hotline
  3. Use in safer ways (eg, oral instead of parenteral)
• Address risky behaviors related to drug use
  1. Condoms
  2. Pregnancy protection
  3. Consider HIV PrEP
  4. Consider prescription for doxy-PREP

https://harmreduction.org/  is the National Harm Reduction Coalition.  They have a link right at the top of their page that people can use to find naloxone or get it through the mail (in most states).

https://neverusealone.com/ Never Use Alone is the US Overdose Prevention Hotline.  The people that answer the phones there are amazing, very sweet, non-judgmental, and dedicated. They will stay on the line with someone that is using and if they can’t confirm that they are responding will send help.

One resource not specifically discussed in the podcast but is of great value is a resource made for WA state but useful anywhere.  https://wafriendsforlife.com/  Washington Friends for Life is a place where adults (parents and teachers- doctors, too) can go to learn more about how to talk to kids about drug use, the dangers of fentanyl, and naloxone use. It also has a section to help teens learn how to use their influence over their friends to stay safer, which we chatted about a little.

I think that the most user-friendly website on Doxy PEP is from the San Francisco AIDS Foundation: https://www.sfaf.org/collections/beta/about-doxy-pep-for-prevention-of-stis/

But the CDC also has one (for now): https://www.cdc.gov/sti/hcp/doxy-pep/index.html

I think that the same 2 resources have good info about HIV PrEP. San Francisco in particular has good stuff around prn PrEP: https://www.sfaf.org/collections/status/prep-2-1-1-offered-at-magnet/