Key Takeaways

  • A nationwide survey of pediatricians found that slightly less than half felt prepared to counsel patients on opioid use disorder (OUD)
  • Only 5% of pediatricians had ever prescribed standard of care OUD medications to their patients, despite rising rates of opioid-related overdose deaths among youths nationwide
  • The findings indicate a need for stronger OUD training throughout medical school and in continuing medical education programs, along with better incentives to treat patients with OUD, the team says

BOSTON – Despite the soaring increase in deaths among adolescents from drug overdoses due primarily to opioids, relatively few pediatricians are prepared to counsel or treat patients with opioid use disorder (OUD), according to a nationwide research survey led by Mass General for Children and Yale School of Medicine researchers.

The results, reported in JAMA Pediatrics, include a call for stronger OUD training through medical school and continuing medical education programs, along with greater financial incentives for pediatricians to treat often complex and time-consuming addiction cases in their practices.

“Our survey suggests that a wide gap exists between adolescents in need of treatment for an opioid use disorder and the ability of families to turn to their pediatrician for that care,” says first author Scott Hadland, MD, MPH, chief of Adolescent and Young Adult Medicine at Mass General for Children and an international leader in educating physicians on substance use disorders in teenagers.

“These findings underscore the need for greatly expanded workforce training aimed at treating opioid use disorder in the pediatric primary care setting, just like other physical and mental health conditions.”

Adolescent mortality from drug overdose more than doubled in the United States between 2019 and 2021 and is now the third leading cause of death in children under 19.

Opioids, including fentanyl, are the most common drugs involved in overdose.

To assess the preparedness of pediatricians to provide adolescent care and counseling in the face of this epidemic, researchers at Mass General, Yale School of Medicine, and the American Academy of Pediatrics analyzed results from 474 respondents to a national survey they conducted of primary care pediatricians who treat adolescents.

The team learned that while most pediatricians (94%) strongly agreed it is their responsibility to identify substance use disorders in adolescent patients, only 48% felt prepared to counsel them about opioids, far fewer than with alcohol (87%), cannabis (82%), or e-cigarette use (80%).

Moreover, though nearly one-quarter of respondents reported having diagnosed an adolescent with OUD, only 5% had ever prescribed an OUD medication, such as buprenorphine or naltrexone, the standards-of-care recommended by the American Academy of Pediatrics.

“The most common barrier to managing OUD was a lack of appropriately trained personnel and behavioral health support services within pediatric practices,” says senior author Deepa Camenga, MD, MHS, associate professor of Emergency Medicine, Pediatrics and Public Health, at Yale School of Medicine.

“As a result, many pediatricians refer their patients to outside treatment programs. Our goal is to help these pediatricians understand that prescribing medications is one part of treatment that is truly lifesaving, and that they can start this therapy immediately while linking patients and families to appropriate care.”

To that end, the researchers believe an expansion of medical school training is urgently needed, citing a 2019 survey in which Hadland was a senior author, showing that less than one-third of pediatric residency programs in the U.S. included education on prescribing OUD medicines.

The investigators emphasized that not only residency, but fellowship and continuing medical education programs need to broaden their pediatric training efforts.

MGH, for its part, offers a one-year clinical fellowship with advanced training in addiction medicine as part of the Mass General Program in Substance Use & Addiction Services. That program is committed to improving outcomes for addiction treatment while reducing cost of care.

“We will continue our advocacy with the American Academy of Pediatrics, government agencies, and medical schools to increase pediatric training opportunities that can pave the way for greater evidence-based care of opioid addiction in young patients,” explains Hadland.

“We will also push for greater financial incentives for pediatricians to treat patients with addiction problems. Youth with an opioid use disorder benefit from dedicated time and care from a clinician, and this critical work should be adequately compensated.”

Hadland is associate professor of Pediatrics at Harvard Medical School. Camenga is associate professor of Emergency Medicine at Yale School of Medicine.

The research survey was supported by the Conrad N. Hilton Foundation and the National Institute on Drug Abuse (NIDA).


About the Massachusetts General Hospital 

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2023, Mass General was named to U.S. News & World Report’s list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.