2023 14th Annual NUBE Conference

Although addiction has been the bread and butter of emergency physicians it is becoming an emerging area that pediatric emergency medicine (PEMs) physicians are now encountering. Pediatricians often get little to no training in substance abuse and treatment options for substance abuse. In 2016, the American Academy of Pediatrics (AAP) advised pediatric residency programs to teach the Substance use screening, brief intervention, and referral to treatment (SBIRT) model. However, little is taught on how to treat substance use disorders and generally focuses on alcohol, cannabis, and tobacco. Psychiatrists on the other hand have been trained to treat substance use disorders. Substance use disorders is one of the required medical knowledge milestones created by the American College of Graduate Medical Education (ACGME). Psychiatry residents are also a required to have 1 month of clinical rotation in addiction in order to graduate from psychiatric residency. Although child and adolescent psychiatry (CAP) fellowship programs are required to show how substances impact mental health, there is no clinical rotation requirement for understanding and utilizing treatment. Since COVID-19, children’s hospitals are seeing an increase in the number of patients presenting with substance abuse complaints. In the DC-Maryland-Virginia (DMV) region, the hospitals and community clinics have seen an increase in pediatric opioid use disorder by 600 percent in the past 6 months. With this vast increase in substance use presentations, PEMs are being forced to identify and treat substance use complaints will minimal clinical training. Consequently, psychiatrists become the de-facto content experts despite having limited formalized training about substance use during their fellowship. With both CAPs and PEMs feeling ill prepared to take on the growing opioid overdose epidemic, children’s hospitals are being pressed to essentially start from scratch to find novel ways to undertake the pediatric substance use epidemic.This presentation will focus on four aspects of developing a substance abuse program in pediatric emergency departments. Part 1 will discuss the current epidemiology of substance use in children. While highlighting the trends of current substance use, it will also accentuate why children’s hospitals need to start their own plan for developing substance abuse programs. Part 2 will focus pediatric substance abuse screeners and withdrawal power plans and how to implement them into electronic medical records. Part 3 will focus on the need for naloxone distribution and the stigma that needs to be broken to help with implementation. Part 4 will focus on training and education of pediatric physicians and nurses and creating substance abuse champions to help disseminate information.

Learning Objectives:

1. Participants will be able to describe the growing trends in pediatric substance use/abuse.
2. Participants will be able to differentiate how pediatric substance abuse differs from adults and how that creates unique challenges in substance abuse treatment options.
3. Participants will be able to develop ways to implement a pediatric substance abuse service line in the emergency department.