Higher-Risk Opioid Use

Overview

Almost 15% of families report living with a family member who has a substance use disorder*, which has implications for the management of children’s pain.
_{^{*Jun et al. 2021. https://doi.org/10.1093/pch/pxz162 Hadland et al. 2021. https://doi.org/10.1111/add.15487}}

Screening children and their families for higher risk opioid use and opioid use disorder (OUD) prior to prescribing opioids can help identify at-risk families for treatment referral and improve safety counselling regarding medication use at home. Further, prescribing or providing a take home naloxone kit provides an opportunity to discuss harm reduction with families and children/youth who may be at risk for adverse outcomes such as overdose.

This toolkit section includes resources about screening for and treating higher-risk opioid use in children and youth and OUD risk assessment.

Recommendations for screening or treating children and youth for higher-risk opioid use or opioid use disorder (OUD) include:

• Take time to provide thorough discharge instructions and education when sending a family home with a prescription for therapeutic opioids; this includes safe storage, side effects, and safe disposal
• When treating a child/youth who reveals a personal or family history of higher risk opioid use or an opioid use disorder, consider providing or prescribing a naloxone take-home kit
• When dispensing opioids for a child/youth (or their caregiver) who has an OUD, risk-mitigating options include pharmacy dispensing of partial prescriptions, involvement of another caregiver for dispensing of medications, and closer follow-up for signs of higher risk use
• All children and youth should be screened for OUD and other substance use disorders, using a validated tool such as S2BI or BSTAD
• When treating an OUD in a child/youth, the healthcare provider should consult and/or refer to a substance use disorder specialist/team with experience treating youth with OUD
• Treatment plans for youth with OUD should be developmentally-appropriate, youth centered, trauma informed, culturally appropriate, confidential, promote recovery, and include family involvement when appropriate
• When treating an OUD, the full range of available treatments should be considered including pharmacologic treatments, non-pharmacologic interventions, and recovery-oriented services, with buprenorphine/naloxone recommended as first line treatment for moderate/severe opioid use disorder
• Transitioning to methadone should be considered in youth who do not respond to adequately dosed buprenorphine/ naloxone

Have feedback? Visit linktr.ee/youthinpain or kidsinpain.ca/youth-in-pain to learn more about this toolkit. For content suggestions please e-mail contact@kidsinpain.ca

Production of this document has been made possible through a financial contribution from Health Canada. The views expressed herein do not necessarily represent the views of Health Canada.