DENVER \u2014 When Denver Health wanted to open an inpatient opioid detox unit specifically for teens, doctors there searched high and low for a model to copy. They didn\u2019t find one.<\/p>\n

Teens who land in emergency rooms with an opioid overdose generally receive naloxone to reverse the effects of dangerous drugs in their system and are sent home with a list of places they can go for follow-up care. But too often, those teens never seek additional help. They are left to suffer through the agony of withdrawal with no medications to ease their cravings. As a result, many, seeking relief, go back to opioids, often with tragic consequences.<\/p>\n

Christian Thurstone<\/a>, the director of behavioral health services at the Denver hospital, said six of his teen patients have died of fentanyl overdoses in the past two years. Denver Health has now opened what he believes to be the nation\u2019s first adolescent inpatient detox unit.<\/p>\n

\u201cI\u2019ve been doing adolescent substance treatment here in Denver for 20 years,\u201d Thurstone said. \u201cI wouldn\u2019t know where to send somebody for adolescent detox.\u201d<\/p>\n

New research has found that most areas of the U.S. lack facilities<\/a> that offer medically managed withdrawal for patients under 18. With adolescent overdoses continuing to rise<\/a> along with the rapid growth of intentional and unintentional fentanyl use, there is a stark lack of options for teens.<\/p>\n

Researchers at Oregon Health & Science University posed as an aunt or uncle of a teen who recently overdosed. The researchers called every U.S. teen addiction treatment facility they could find to ask if their niece or nephew could go there to detox and whether the facility offered medications to help with the process.<\/p>\n

Of the 160 adolescent residential treatment facilities they contacted, only 63 said they would allow adolescents to detox on-site. Of those 63, only 18 offered buprenorphine \u2014 the one medication that\u2019s FDA-approved to treat opioid use disorder in kids as young as 16 \u2014 and some of those offered no additional medications to manage withdrawal symptoms.<\/p>\n

\u201cI\u2019m not sure if inhumane is too strong of a word,\u201d said Caroline King<\/a>, an emergency medicine resident at Yale University, who graduated from OHSU in 2023 and led the research. \u201cOffering nothing, offering no additional medication, even nausea medication or really basic things, is really a travesty.\u201d<\/p>\n

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Staff members at one facility told the researchers they don\u2019t offer medications because kids are resilient, implying they don\u2019t suffer as much as adults, or perhaps that they deserve to suffer, King said. Workers at another told researchers they \u201ctry to push Gatorade down them and just lay them down in a cot,\u201d she said.<\/p>\n
King said multiple locations responded that they couldn\u2019t think of a single place in their state where kids could go to detox.<\/p>\n
\u201cIt\u2019s just really terrible to hear that that\u2019s the case,\u201d King said.<\/p>\n
The American Society of Addiction Medicine is revising its standards for treating opioid use disorder in adults (this year) and children (in 2024). Sandra Gomez-Luna<\/a>, the chief medical officer for psychiatry at the Yale School of Medicine, who is leading the pediatric effort, said most adolescents do not experience significant withdrawal symptoms and that, in general, withdrawal isn\u2019t as intense for teens as it is for adults.<\/p>\n
\u201cThat doesn\u2019t mean that there isn\u2019t a portion of teens with substance use disorders that will require medically monitored withdrawal management,\u201d she said.<\/p>\n
Because teens usually haven\u2019t been using drugs for as long as adults, Gomez-Luna said, they may not suffer the consequences of chronic use or have as many accompanying health conditions that can make withdrawal more difficult, or more complex to treat.<\/p>\n
But the rise in the more potent opioid fentanyl may be changing that thinking.<\/p>\n
\u201cAs more and more teens will get involved in fentanyl use,\u201d Gomez-Luna said, \u201cthere will be more adolescents that will require medically monitored withdrawal.\u201d<\/p>\n
Gomez-Luna said the addiction medicine group is also concerned there are too few facilities for teens and a lack of specialized personnel to treat them.<\/p>\n
Scott Hadland<\/a>, chief of adolescent and young adult medicine at Mass General for Children and Harvard Medical School, said there are fewer facilities for adolescents in part because many teens are never identified as needing help or connected to care, despite the growing number of overdoses.<\/p>\n
\u201cThe patient volume is surprisingly not always there to support a program like this, even though we know that this is a huge public health problem,\u201d Hadland said. \u201cIt becomes financially difficult to build a program whose sole service line is to provide detoxification services for young people.\u201d<\/p>\n
When no dedicated detox units are available, teens sometimes get admitted to a hospital, often to the intensive care unit, where more monitoring is available than on regular inpatient floors. But that also means teens are less likely to be cared for by a team specializing in adolescent addiction medicine.<\/p>\n
\u201cOur pediatric workforce has not traditionally received strong training in the management of addiction,\u201d Hadland said. \u201cWhen patients do go to general pediatric hospital settings, it\u2019s possible that there isn\u2019t someone there who has the expertise needed to manage that patient\u2019s care.\u201d<\/p>\n
Thurstone said the biggest hurdle in getting Denver Health\u2019s teen detox unit running was staffing. It took more than a year to find a certified addiction specialist to run the unit.<\/p>\n
Addiction specialists stress that not all teens with opioid use disorder need inpatient detox. Withdrawal can be managed at home if teens have a stable family environment to support them and monitor their symptoms. Many adolescents with opioid use disorders, however, come from broken homes in which the parents may be struggling with addiction themselves. And coming out of the pandemic, specialists are also seeing more teens with opioid use disorders who have other psychiatric problems, such as depression, anxiety, attention-deficit\/hyperactivity disorder, or eating disorders.<\/p>\n
\u201cAll of these conditions have been on the rise in the wake of covid, alongside the rise in overdoses that we\u2019re seeing,\u201d Hadland said. \u201cPart of the charge of our pediatric workforce right now is not just to address addiction, but also to tackle the underlying mental health conditions that young people are working through.\u201d<\/p>\n
Thurstone said that nationwide about half of all adolescents drop out of treatment, but that it\u2019s worse in marginalized communities.<\/p>\n
Denver Health repurposed beds from an inpatient psychiatric unit to get its teen detox program running. The unit saw its first patient this spring and has been admitting about one patient a week, mostly teens with a fentanyl dependence.<\/p>\n
The teens start medication-assisted therapy, most often with buprenorphine, to address their cravings; get additional meds to manage any side effects of withdrawal; and receive cognitive behavioral therapy to help them with their recovery. Once they can be safely discharged, they are connected to addiction treatment programs in their communities. Thurstone believes providing that continuum of care will help reduce teen overdoses in the Denver region.<\/p>\n
\u201cWe can do better than, you know, an ER visit and a list of resources to call,\u201d he said.<\/p>\n
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