Treatment and Referral of Youth With Opioid Addiction in the Pediatric Emergency Department: A Pilot Study

Fatal opioid overdoses have increased among adolescents. Emergency Departments (EDs) are critical access points for connecting adults with opioid use disorder (OUD) to medication-assisted treatment. Whether this is feasible in pediatric patients is unknown. As opioid use among adolescents results in morbidity and mortality, developing an opioid treatment program is crucial.

We developed an ED buprenorphine induction and referral program based on expert opinion. All patients completed the Emergency Department Distress Response Screener (ED-DRS) and Screening to Brief Intervention (S2BI) tools. After a 13-month pilot period, we performed a retrospective chart review to assess the program's feasibility based on the degree of execution, fidelity, and resource utilization.

We identified 12 ED encounters for opioid withdrawal that received buprenorphine. Seventy-five percent were aged 15 to 17 years. Seventy-five percent of encounters presented with mild withdrawal, while 25% presented with moderate withdrawal. Participants reported high rates of depression (80%), anxiety (90%), and additional substance use (90%). Seventy-five percent of encounters only required 1 dose of buprenorphine in the ED to treat their withdrawal. There were no medical complications. Although we referred 100% of encounters to an OUD treatment center, only 50% attended their first appointment, and 42% remained engaged after 30 days. A mix of patient, parent, and insurance factors contributed to loss of engagement.

Pediatric ED-based buprenorphine induction is feasible for the stabilization of acute opioid withdrawal symptoms in youth without causing complications. Further data are necessary to determine the barriers adolescents face to OUD engagement after discharge.