Description 

Substance use disorders (SUD) remain a long-standing problem for adolescents. As impacts of the opioid epidemic continue to expand throughout the adolescent and young adult population, pediatricians and child and adolescent psychiatrists are increasingly frequently identifying and managing opioid use disorders (OUD) as well as other SUD. Adolescent-medicine is thus critical in combating this epidemic. Growing evidence suggests the paramount responsibility of SUD-management incorporation throughout the healthcare system, including in primary care. While medication assisted treatment (MAT) is now standard treatment for adult SUD, it remains less common in adolescents. Considering biopsychosocial influences, the adolescent demographic is highly vulnerable to developing SUD and poses further concerns regarding chronic dependence and complications including corresponding effects on neurocognitive development. Studies and literature evaluating treatment of SUD in the adolescent population, however, remain limited, as do formal United States Food and Drug Administration (FDA) indications. While varying by specific disorder and treatment, the literature finds an overall predominance showing similar efficacy, safety profiles, and adverse effects of psychotropic MAT for SUD in adolescents to that of the adult demographic. Buprenorphine/naloxone and extended-release naltrexone (XR-NTX) are evidence-based treatments for opioid use disorder (OUD), safe and appropriate for use in adolescents. The American Academy of Pediatrics (AAP) Committee on Substance Use and Prevention (2016) thus emphasizes the evidence of these medications, including buprenorphine, for use in adolescent patients, and the importance of provider training and education. Additional safe MAT options with at least some demonstrated efficacy for adolescents further include: N-acetylcysteine (NAC) for cannabis use disorder (CUD); naltrexone, disulfiram, and acamprosate for alcohol use disorder (AUD); and nicotine replacement therapy (NRT), bupropion-SR, and varenicline for cessation of tobacco use. This general session includes an overview of DSM-5 TR criteria for various substance use disorders (SUD) and overview of the FDA-approved and off-label indications, adverse effects, and efficacy of medication assisted treatment (MAT) in adolescents with NAC, naltrexone, acamprosate, NRT, and varenicline. This session is intended to examine, identify, and evaluate the various means of psychotropic medical management of SUD in the adolescent population to improve the clinical care and medical management of this highly vulnerable population. While management is multidisciplinary and complex, both FDA-approved and off-label uses of MAT show great promise for this demographic and act in the continued battle against the opioid epidemic, aiding in apt management, reduced stigma, improved quality of life, and increased societal integration of these adolescents and young adults.

Recorded webinar.

This content was recorded during the APA 2023 Annual Meeting.

Learning Objectives 

1. To identify diagnostic criteria and recognize presentations of substance use disorders (SUD) in adolescents, including opioid use disorder (OUD), alcohol use disorder (AUD), and cannabis use disorder.
2. To categorize and assess varying evidence, efficacy, risks, and indications of MAT in adolescents, including NAC, naltrexone, disulfiram, acamprosate, NRT, buproprion-S.
3. To elucidate and establish evidence-based practices for medication-assisted management of adolescents with substance use disorders (SUD)

Target Audience 

Medical Students, Residents/Fellows, Psychiatrists, non-psychiatrist Physicians

Estimate Time to Complete 

Estimated Duration: 1.5 hours
Program Start Date: May 1, 2025
Program End Date: May 1, 2028

Faculty and Planner Disclosures 

The American Psychiatric Association adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Medical Education. Any individuals in a position to control the content of a CME activity — including faculty, planners, reviewers or others — are required to disclose all relevant financial relationships with ineligible entities (commercial interests). All relevant conflicts of interest have been mitigated prior to the commencement of the activity. 

Instructors 

• Nita Bhatt, MD, MPH, FAPA
• Jesse Cannella, MD
• Julie Gentile, MD, MBA
• Kari Harper, MD
• Philip Steiner, MD

Planners  

• Vishal Madaan, MD, Chief of Education and Deputy Medical Director at the American Psychiatric Association.

How to Earn Credit 

Participants who wish to earn AMA PRA Category 1 Credit™ may do so after completing all sections of the course including the evaluation. After evaluating the program, course participants will be provided with an opportunity to claim hours of participation and print an official CME certificate (physicians) or certificate of participation (non-physicians) showing the completion date and hours earned. 

Continuing Education Credit  

In support of improving patient care, the American Psychiatric Association 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. 

The APA designates this live activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. 

Accessibility for Participants with Disabilities 

The American Psychiatric Association is committed to ensuring accessibility of its website to people with disabilities. Please contact the American Psychiatric Association at 202-559-3900, if you require assistance seven (7) business days prior to the start of a live webinar. 

Technical Requirements 

This internet-based CME activity is best experienced using any of the following: 

• The latest and 2nd latest public versions of Google Chrome, Mozilla Firefox, or Safari 
• Internet Explorer 11+ 

This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Acrobat Reader, Microsoft PowerPoint, and Windows Media Player. 

Optimal System Configuration: 

• Browser: Google Chrome (latest and 2nd latest version), Safari (latest and 2nd latest version), Internet Explorer 11.0+, Firefox (latest and 2nd latest version), or Microsoft Edge (latest and 2nd latest version) 
• Operating System: Windows versions 8.1+, Mac OS X 10.5 (Leopard) +, Android (latest and 2nd latest version), or iOS/iPad OS (latest and 2nd latest version) 
• Internet Connection: 1 Mbps or higher 

Minimum Requirements: 

• Windows PC: Windows 8.1 or higher; 1 GB (for 32-bit)/2 GB (for 64-bit) or higher RAM; Microsoft DirectX 9 graphics device with WDDM driver; audio playback with speakers for programs with video content 
• Macintosh: Mac OS X 10.5 or higher with latest updates installed; Intel, PowerPC G5, or PowerPC G4 (867MHz or faster) processor; 512 MB or higher RAM; audio playback with speakers for programs with video content 

For assistance: Contact educme@psych.org for questions about this activity | Contact learningcenter@psych.org for technical assistance