On June 20, 2016, the American Academy of Pediatrics issued a clinical report entitled “Substance Use Screening, Brief Intervention, and Referral to Treatment” for adolescents. Given Maine’s explosive rate of drug use and its consequences, including overdose deaths, this is a welcome development indeed.
First to review some all-too-familiar Maine statistics. Drug abuse, especially use of opioids and heroin, has mushroomed in our state over the last several years. In 2015 deaths from heroin overdose was up 30 percent from 2014 (272 vs. 203) and 2016 is expected to be way ahead of that. Another statistic specific to Maine is that one out of ten high school students report taking a prescription drug for recreational purposes. Since prescription medications are a frequent “gateway” into opiate abuse, the significance of this is (hopefully) obvious. The opportunity for positive intervention is tremendous as well.
Adolescent substance abuse carries with it a large component of completely preventable morbidity and mortality. Adolescence is legally complete by 18 years of age, but neurodevelopment ally it continues into the early twenties. Whereas it is common for teens and young adults to experiment with psychoactive substances, it is unfortunately also a time when the brain is especially vulnerable. Besides the risk of injury – and even death – related to substance abuse and its associated behaviors there appears to be a greater risk of addiction developing in this age range. In fact, the younger the age at first substance use the more likelihood of developing a substance abuse disorder.
There is a golden opportunity for primary care and others to intervene in this time frame as most adolescents see a health provider yearly. Even better, these kids generally consider their providers as authorities on substance use and the kids at highest risk also seem to be the most likely to get benefit from these efforts. It is not about lecturing adolescents. The goal of the published guidelines is to have all teens screened whenever and wherever they are seen for health concerns in an effective, easy and systematic way using small number of questions that yield accurate answers. Despite the best of intentions, providers “gut feelings” about substance use by their patients are often completely wrong, so use of a validated tool (there are several) is paramount.
The report emphasizes the importance of confidentiality to teens, though often their parents will eventually become involved by mutual agreement of the teen and provider. Confidentiality should be maintained unless there is risk of imminent harm to the patient or someone else. Actively alleviating other worries adolescents often have about disclosure – not wanting to get peers into trouble, revealing dealers’ identity, etc. – is very important to the process as well.
A brief intervention by the provider in the moment is critical. It is a conversation that focuses on encouraging health choices so that risk behaviors are prevented, reduced, or stopped. For the adolescent who has never used any substances, actively reinforcing and normalizing their good decision-making is as important as a referral to specialty treatment for those with an already established drug problem. For those who have used or are actively experimenting, engaging in a respectful dialogue about their choices and exploring readiness to change can go a long way toward averting the devastating life-long disease of addiction.
1. Levy SJ, Williams JF, AAP COMMITTEE ON SUBSTANCE ABUSE AND PREVENTION. Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics 2016;138(1):e20161211
2. Substance Abuse Trends in Maine, Epidemiological Profile, 2015. http://www.maine.gov/dhhs/samhs/osa/documents/SEOWEpiProfile2015FINALDRAFT.pdf
A self proclaimed “Country Mouse,” Amy Movius, MD, was attracted to Bangor and Eastern Maine Medical Center because of the highly skilled care offered in an area bursting with recreational opportunities. Dr. Movius, a pediatric intensivist in EMMC’s Pediatric Intensive Care Unit (PICU), continues to be impressed at how well we Mainers take care of our own, “This is an environment I am happy to be working in,” she says. Dr. Movius also staffs EMMC’s dedicated Pediatric Sedation Program, and helps with various outreach programs and other opportunities that provide additional support to practitioners throughout central, eastern, and northern Maine.