PDF(Pubmed)
Abstract：
We present the case of a 14-year-old who established care at our primary care clinic after hospitalization for unintentional fentanyl overdose. They were diagnosed with severe opioid use disorder (OUD) and stimulant use disorder (StUD) and initiated buprenorphine while inpatient. They were then transitioned to the only known outpatient primary care clinic in her county who was actively providing medications for opioid use disorder (MOUD) in adolescents.At the first visit, they reported a history of 20 overdoses, struggling with adherence to buprenorphine and continued opioid cravings. An overdose safety plan was reviewed with them and their parent including providing them naloxone kits, fentanyl test strips, and education handout sheets. Due to their significant overdose history and adherence challenges with sublingual buprenorphine, they were started on long-acting injectable buprenorphine (LAIB) with weekly provider visits and urine toxicology screening. In collaboration with the treatment team, they initiated behavioral treatment with contingency management (CM), with incentives for appointment completion, expected urine results, and successful medication administration. Over the next 19 months, and to date, they have increasingly engaged with care and have remained abstinent. LAIB may be an appealing alternative for adolescents with OUD to improve adherence and reduce risk of recurrent use and overdose. Adjunctive treatment with CM may improve retention in MOUD and have the benefit of treating StUD. There is a need for further research to explore innovative, community-based treatment for youth with OUD.
摘要：
我们介绍了一名14岁的患者，他因意外服用芬太尼过量而住院后在我们的初级保健诊所建立了护理。他们被诊断为严重的阿片类药物使用障碍（OUD）和兴奋剂使用障碍（StUD），并在住院期间开始丁丙诺啡。然后，他们被转移到她所在县唯一已知的门诊初级保健诊所，该诊所正在积极为青少年阿片类药物使用障碍（MOUD）提供药物。在第一次访问时，他们报告了20次用药过量的历史，努力坚持丁丙诺啡和持续的阿片类药物渴望。与他们和他们的父母一起审查了过量安全计划，包括向他们提供纳洛酮试剂盒，芬太尼试纸,和教育讲义单。由于其显著的过量病史和舌下丁丙诺啡的依从性挑战，他们开始接受长效注射用丁丙诺啡(LAIB)治疗,每周进行提供者访视和尿液毒理学筛查.与治疗小组合作，他们开始使用应急管理(CM)进行行为治疗，奖励完成任命，预期尿液结果，和成功的药物管理。在接下来的19个月里,到目前为止，他们越来越多地参与护理，并保持节制。对于患有OUD的青少年，LAIB可能是一种有吸引力的替代方案，可以提高依从性并降低反复使用和过量服用的风险。用CM辅助治疗可以改善在MOUD中的保留并且具有治疗StUD的益处。有必要进一步研究，以探索创新，针对OUD青年的社区治疗。
