Pediatric Grand Rounds (RECORDING) How the Pediatric Workforce Can Address the Nation’s Overdose Crisis

This presentation is a recording of a Stanford Pediatric Grand Rounds Session.  World-renowned experts will present the latest research, practice guidelines, and treatment protocols to advance best practices in the care of pediatric patients. These online recordings will provide pediatricians and family physicians with up-to-date clinical information on a wide range of clinical issues encountered in daily pediatric practice.  In this presentation, Dr. Hadland begins by reviewing the epidemiology of substance use and overdose among youth in the US. Next, then reviews best practices for opioid prescribing, and finally, reviews evidence-based screening and addiction treatment for youth with opioid use disorders.

  Release Date: June 30, 2023
  Expiration Date: June 29, 2024
  Estimated Time to Complete: 1.0 hour
  Registration Fee: FREE
 *Originally recorded 05/05/2023.

View more DEA MATE resources and training accredited by Stanford CME at https://med.stanford.edu/cme/dea.html

1. Describe the epidemiology of substance use-related harm in the US, with a focus on overdoses among adolescents and young adults (“youth”).
2. Prescribe opioids in a manner that reduces the likelihood of risk for long-term opioid use.
3. Ensure evidence-based screening and treatment for youth with substance use disorders.

In support of improving patient care, Stanford Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

Credit Designation 
American Medical Association (AMA) 
Stanford Medicine designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Accessibility Statement
 Stanford University School of Medicine is committed to ensuring that its programs, services, goods and facilities are accessible to individuals with disabilities as specified under Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Amendments Act of 2008.  If you have needs that require accommodations, please contact the CME Conference Coordinator.

Cultural and Linguistic Competency
The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area for the purpose of complying with California Assembly Bill 1195. Moreover, the Stanford University School of Medicine Multicultural Health Portal contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.  You are encouraged to visit the Multicultural Health Portal: https://laneguides.stanford.edu/multicultural-health

References/Bibliography

Alinsky, R. H., Hadland, S. E., Quigley, J., Patrick, S. W., & COMMITTEE ON SUBSTANCE USE AND PREVENTION (2022). Recommended Terminology for Substance Use Disorders in the Care of Children, Adolescents, Young Adults, and Families. Pediatrics, 149(6), e2022057529. https://doi.org/10.1542/peds.2022-057529

American Psychological Association. (2013). Diagnostic and statistical manual of mental disorders: DSM 5. American Psychiatric Publishing, Inc. https://doi.org/10.1176/appi.books.9780890425596

Barocas, J. A., White, L. F., Wang, J., Walley, A. Y., LaRochelle, M. R., Bernson, D., Land, T., Morgan, J. R., Samet, J. H., & Linas, B. P. (2018). Estimated Prevalence of Opioid Use Disorder in Massachusetts, 2011-2015: A Capture-Recapture Analysis. American journal of public health, 108(12), 1675–1681. https://doi.org/10.2105/AJPH.2018.304673

Massachusetts Department of Public Health. (2019). Advisory: Best Practices in Prescribing Opioids. Board of Registration in Medicine, Division of Quality and Patient Safety. https://www.mass.gov/doc/september-2019-best-practices-in-prescribing-opioids/download 

Centers for Disease Control and Prevention. (2022). Fentanyl Test Strips: A Harm Reduction Strategy. Centers for Disease Control and Prevention. https://www.cdc.gov/stopoverdose/fentanyl/fentanyl-test-strips.html

Centers for Disease Control and Prevention. (2023). Provisional Drug Overdose Death Counts. Centers for Disease Control and Prevention, National Vital Statistics System. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Chua, K. P., Brummett, C. M., Conti, R. M., & Bohnert, A. (2020). Association of Opioid Prescribing Patterns With Prescription Opioid Overdose in Adolescents and Young Adults. JAMA pediatrics, 174(2), 141–148. https://doi.org/10.1001/jamapediatrics.2019.4878

COMMITTEE ON SUBSTANCE USE AND PREVENTION (2016). Medication-Assisted Treatment of Adolescents With Opioid Use Disorders. Pediatrics, 138(3), e20161893. https://doi.org/10.1542/peds.2016-1893

Connor, J. P., Haber, P. S., & Hall, W. D. (2016). Alcohol use disorders. Lancet (London, England), 387(10022), 988–998. https://doi.org/10.1016/S0140-6736(15)00122-1

Drug Enforcement Administration. (2021). Counterfeit Pills Fact Sheet. Department of Justice, Drug Enforcement Administration. https://www.dea.gov/sites/default/files/2021-09/DEA_Fact_Sheet-Counterfeit_Pills.pdf

Food and Drug Administration. (2017). FDA Drug Safety Podcast: FDA restricts use of prescription codeine pain and cough medicines and tramadol pain medicines in children; recommends against use in breastfeeding women. Food and Drug Administration. https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-drug-safety-podcast-fda-restricts-use-prescription-codeine-pain-and-cough-medicines-and-tramadol

Friedman, J., Godvin, M., Shover, C. L., Gone, J. P., Hansen, H., & Schriger, D. L. (2022). Trends in Drug Overdose Deaths Among US Adolescents, January 2010 to June 2021. JAMA, 327(14), 1398–1400. https://doi.org/10.1001/jama.2022.2847

Goldman, J. E., Waye, K. M., Periera, K. A., Krieger, M. S., Yedinak, J. L., & Marshall, B. D. L. (2019). Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. Harm reduction journal, 16(1), 3. https://doi.org/10.1186/s12954-018-0276-0

Hadland, S. E., Bagley, S. M., Gai, M. J., Earlywine, J. J., Schoenberger, S. F., Morgan, J. R., & Barocas, J. A. (2021). Opioid use disorder and overdose among youth following an initial opioid prescription. Addiction (Abingdon, England), 116(10), 2790–2800. https://doi.org/10.1111/add.15487

Hadland, S. E., Bagley, S. M., Rodean, J., Silverstein, M., Levy, S., Larochelle, M. R., Samet, J. H., & Zima, B. T. (2018). Receipt of Timely Addiction Treatment and Association of Early Medication Treatment With Retention in Care Among Youths With Opioid Use Disorder. JAMA pediatrics, 172(11), 1029–1037. https://doi.org/10.1001/jamapediatrics.2018.2143

Levy, S., Weiss, R., Sherritt, L., Ziemnik, R., Spalding, A., Van Hook, S., & Shrier, L. A. (2014). An electronic screen for triaging adolescent substance use by risk levels. JAMA pediatrics, 168(9), 822–828. https://doi.org/10.1001/jamapediatrics.2014.774

Levy, S., Weitzman, E. R., Marin, A. C., Magane, K. M., Wisk, L. E., & Shrier, L. A. (2021). Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care. Substance abuse, 42(3), 388–395. https://doi.org/10.1080/08897077.2020.1803180

Lim, J. K., Earlywine, J. J., Bagley, S. M., Marshall, B. D. L., & Hadland, S. E. (2021). Polysubstance Involvement in Opioid Overdose Deaths in Adolescents and Young Adults, 1999-2018. JAMA pediatrics, 175(2), 194–196. https://doi.org/10.1001/jamapediatrics.2020.5035

National Institute on Drug Abuse. (2022). Monitoring the Future. National Institutes of Health, National Institute on Drug Abuse. https://nida.nih.gov/research-topics/trends-statistics/monitoring-future

Renny, M. H., Yin, H. S., Jent, V., Hadland, S. E., & Cerdá, M. (2021). Temporal Trends in Opioid Prescribing Practices in Children, Adolescents, and Younger Adults in the US From 2006 to 2018. JAMA pediatrics, 175(10), 1043–1052. https://doi.org/10.1001/jamapediatrics.2021.1832

Ries, R. K., Fiellin, D. A., Miller, S. C., & Saitz, R. eds. (2014). The ASAM Principles of ddiction Medicine, 5th ed. Lippincott Williams & Wilkins; 5th edition, IBSN: 9781451173574.

Robinson, C. A., & Wilson, J. D. (2020). Management of Opioid Misuse and Opioid Use Disorders Among Youth. Pediatrics, 145(Suppl 2), S153–S164. https://doi.org/10.1542/peds.2019-2056C

Volkow, N. D., Koob, G. F., & McLellan, A. T. (2016). Neurobiologic Advances from the Brain Disease Model of Addiction. The New England journal of medicine, 374(4), 363–371. https://doi.org/10.1056/NEJMra1511480

Wenren, L. M., Rodean, J., Zima, B. T., Bagley, S. M., Nurani, A., & Hadland, S. E.. (2021). Treatment Initiation and Engagement for Adolescents and Young Adults with Substance Use Disorder. 2021 AMERSA National Conference; 45th Annual Conference, Nov. 3-5, 2021. https://amersa.org/wp-content/uploads/2021-book-of-abstracts-final.pdf 

For CME general questions, please contact 
     Email: [email protected]

Mitigation of Relevant Financial Relationships

Stanford Medicine adheres to the Standards for Integrity and Independence in Accredited Continuing Education. 

There are no relevant financial relationships with ACCME-defined ineligible companies for anyone who was in control of the content of this activity, except those listed in the table below. All of the relevant financial relationships listed for these individuals have been mitigated.

Member Information

Role in activity

Nature of Relationship(s) / Name of Ineligible Company(s)

Alan R. Schroeder, MD
Clinical Professor
Stanford University

Co-Course Director

Olivera Marsenic Couloures, MD
LPCH

Course Director and Reviewer

Nothing to disclose

Scott Hadland, MD, MPH

Faculty

Nothing to disclose

Debra Babcock, MD
Stanford Childrens (PCHA)

Planner

Nothing to disclose

Lisa Jo Chamberlain, MD
Professor of Pediatrics – General Pediatrics
Stanford Children's Health

Planner

Baraka Dechelle Floyd, MD
Clinical Assistant Professor and Associate Chair for Diversity, Equity, and Inclusion
Stanford University School of Medicine

Planner

Nothing to disclose

Charles Gawad, MD, PhD
Associate Professor
Stanford

Planner

Allison Guerin, EdD
Stanford

Planner

Nothing to disclose

Mary Beth Leonard, MD, MSCE
Arline and Pete Harman Professor and Chair, Department of Pediatrics
Stanford University

Planner

Nothing to disclose

Ryan Lion, MD, MS
Stanford University

Planner

Nothing to disclose

Lauren E O'Brien, MD
Clinical Assistant Professor
LPCH

Planner

Nothing to disclose

Stephen J Roth, MPH, MD
Attending, Cardiovascular ICU
Lucile Packard Children's Hospital Stanford

Planner

Nothing to disclose

Stephanie Squires, MD
Pediatric Hospital Medicine Fellow
Stanford Health Care/ Stanford Children's Hospital

Planner

Nothing to disclose

Ke-You Zhang, MD
Stanford University

Planner

Nothing to disclose