Levy S, Mountain-Ray S, Reynolds J, Mendes SJ, Bromberg J. (2018). A novel approach to treating adolescents with substance use disorder in pediatric primary care. Substance Abuse. doi: 10.1080/08897077.2018.1455165
The authors describe and present initial results for a quality improvement project involving implementation of integrated treatment for adolescents with substance use disorder (SUD) in primary care. This paper describes one clinic that implemented a treatment program that included hiring a clinical social worker (CSW) with specialty training in adolescent SUDs, buprenorphine waiver training for all primary care physicians (PCPs), and phone consultations with an adolescent substance use program to address clinical questions. Researchers collected information from electronic health records and notes from the CSW regarding numbers of patient visits, mental health and SUD diagnoses, referrals for SUD treatment, and SUD treatment received. The authors presented 3 vignettes describing patients who used opioids to highlight barriers to care for adolescents. Over a 4-month period, 1,804 unique patients attended primary care appointments, 20 of whom were referred for SUD treatment. Thirteen referred patients initiated treatment (completed at least 1 appointment with the CSW) and completed a total of 80 appointments (5.3 appointments per patient on average). Patients presented with alcohol (5), marijuana (10), opioid (2), cocaine (2), sedative (1), and hallucinogen (2) use disorders. PCPs completed 11 buprenorphine visits. Two patients were referred for more intensive SUD treatment and 1 decided to seek more intensive SUD treatment themselves. Vignettes highlighted the need to identify adolescents with opioid use disorder early, before they overdose, and the importance of the CSW in treating co-occurring mental health diagnoses. Results indicated that integrated treatment of SUDs in primary care is feasible and acceptable to providers.