I want to tell you this story about a
patient named Sam growing up it was a
pretty typical kid decent student good
athlete popular when he got into high
school he started hanging out with the
older kids that were drinking and
smoking pot and one day one of those
kids brought in a bottle of pain pills
and offered one to Sam nobody ever
thinks that they’re going to get
addicted just by experimenting but in
the United States more than 150,000 kids
under the age of 18 are addicted to
opioids and Sam became one of them he
started using pills everyday within a
year or so he was injecting heroin and
in the spring of 2017 he overdosed twice
after the second rescue he was sent to a
program where he was treated for his
symptoms of withdrawal and after four
days he was discharged with a
prescription for sleeping pills and
advice never to do drugs again
addictions a treatable condition there
are actually several effective
treatments but sleeping pills aren’t one
of them so it was really no surprise
that within two days
Sam relapsed and started using heroin
again in the early 1900s when kids were
diagnosed with diabetes they were
admitted to the hospital and treated
with a carbohydrate free diet when they
got better they were sent back home and
told never to eat sugar again most of
them died within a couple of months but
when we discovered insulin everything
changed and now kids with diabetes are
treated with diet and insulin and grow
up to lead a healthy productive life but
this changed hasn’t happened with
addiction since the 1970s we’ve known
that methadone reduces drug use overdose
and death but we restrict it you can
only get it from
highly regulated programs that exist
outside of mainstream medical facilities
in the 1990s a newer drug was introduced
it works like methadone but it’s safer
and in 2000 Congress passed the drug
abuse treatment Act which allows any
doctor who gets eight hours of training
to prescribe this medication from any
general medical facility so in 2017 17
years later Sam’s story should be
outrageous but actually it’s pretty
common if we think of all of the kids
who have opioid addiction as an iceberg
then the biggest part the part that
would be under water they never get any
treatment at all and even among the tip
of the iceberg that do get treatment
it’s only the very tip of the tip that
get appropriate treatment by which I
mean one of the three indicated
medications for treating addiction
combined with professional counseling
there are many reasons for this for one
thing kids with addiction are often too
ashamed or afraid to tell anybody about
their problem one of the first patients
I treated Dave it was a college freshman
who became addicted to prescription pain
medications he came to my program for
treatment we started him on medications
and he was working with a counselor he
was doing really well but he wanted to
keep his treatment a secret so he hid
his pills and he lied about his
appointments until we finally convinced
him that he’d be better off if his
parents knew and so he told them
actually he brought them into one of our
appointments and he told them right in
front of me my heart was pounding when
his father stood up and I’m sure Dave’s
heart was pounding too and his dad said
son I’m so proud of you your mom and I
have known for a while that you were in
trouble but we didn’t know exactly what
was wrong now we see that you’ve figured
out your own problem and where to
help that moment made a really big
impression on me as a young pediatrician
and addiction medicine specialist and
for the past 15 years I’ve been the
director of an adolescent substance use
disorders program where we treat kids
like Dave every day but we can only get
to the kids who can get to us which is a
big problem because too few doctors
treat addiction in the United States
there are more than 750,000 practicing
physicians every single one of us can
prescribe addictive pain medications
that really started the opioid crisis in
the first place but only about 37,000 of
us have taken the training to prescribe
medications to treat addiction only half
of us actually prescribed and only 1% of
us are pediatricians
a year or two ago the directors of a
network of primary care pediatrics
offices contacted me they wanted my help
improving substance use care for
adolescents within the network with some
support from the BlueCross BlueShield
foundation we selected one practice and
we designed an experiment that had three
parts first we put a licensed clinical
social worker on staff then we trained
the pediatricians to prescribe
medications for addiction finally as a
specialist I provided consultation and
backup medical support well it just so
happens that our guinea pigs were Sam’s
doctors about two weeks after he
relapsed he ran out of sleeping pills so
he made an appointment to ask for a
refill when he got to the office he was
a little bit unkempt and smelly and he
nodded off in the waiting room when a
staff member woke him up to go see the
doctor he was a little bit irritable so
the staff weren’t certain that this
experiment that was supposed to bring
more kids like Sam into the office was
such a great idea but he saw the doctor
he started on medications started
working with the counselor he stuck with
it and he did really well in fact it was
really pretty completely transformed and
within a couple of weeks he even became
the practices favorite patient he asked
his doctors if they would help his
girlfriend who also had an addiction and
they immediately said yes and the staff
reached out to enroll her as a new
patient even though the office policy
had been not to accept new patients over
the age of 15 when that story got back
to me I knew the experiment was a
success I want to share some epilogues
with you so Dave the kid who brought his
parents with him to an appointment he
ultimately graduated college and became
a professional he got a job in a
different City and he moved away the
last time I saw him in the clinic he
thanked me said he couldn’t imagine what
would have happened had it not been for
treatment Sam is doing really well it’s
he’s been more than six months drug-free
he looks great and he’s working
full-time we never did catch up with his
girlfriend she was underage and the
Department of Child Welfare got involved
she’s still on the bottom part of that
iceberg under water but if she’s ever
available we’re here waiting for her the
practice is working hard to find kids
who need treatment for opioid addiction
they’ve hung posters in every room
they’ve sent news letters home to
parents and older patients they’ve even
gone to the local schools to try and
find kids who need help the social
worker is counseling these kids and
helping them get their lives back on
track and when she’s not working with
kids with opioid addiction she’s helping
kids who are using alcohol and marijuana
trying to prevent them from going down
the path in the first place my
colleagues and I are planning to open a
second practice in a couple of months we
have a waiting list of pediatricians
that want to work with us we’re working
hard to raise resources so we can spread
the program as widely as possible I want
to leave you secure in the knowledge
that addiction is treatable if you
happen to be a physician treat addiction
outcomes from good addiction treatment
or similar to or better than other
chronic medical conditions so there’s
really no reason not to and if you know
somebody who’s struggling with opioid
addiction help them find good treatment
you could be saving a life thank you
[Applause]
patient named Sam growing up it was a
pretty typical kid decent student good
athlete popular when he got into high
school he started hanging out with the
older kids that were drinking and
smoking pot and one day one of those
kids brought in a bottle of pain pills
and offered one to Sam nobody ever
thinks that they’re going to get
addicted just by experimenting but in
the United States more than 150,000 kids
under the age of 18 are addicted to
opioids and Sam became one of them he
started using pills everyday within a
year or so he was injecting heroin and
in the spring of 2017 he overdosed twice
after the second rescue he was sent to a
program where he was treated for his
symptoms of withdrawal and after four
days he was discharged with a
prescription for sleeping pills and
advice never to do drugs again
addictions a treatable condition there
are actually several effective
treatments but sleeping pills aren’t one
of them so it was really no surprise
that within two days
Sam relapsed and started using heroin
again in the early 1900s when kids were
diagnosed with diabetes they were
admitted to the hospital and treated
with a carbohydrate free diet when they
got better they were sent back home and
told never to eat sugar again most of
them died within a couple of months but
when we discovered insulin everything
changed and now kids with diabetes are
treated with diet and insulin and grow
up to lead a healthy productive life but
this changed hasn’t happened with
addiction since the 1970s we’ve known
that methadone reduces drug use overdose
and death but we restrict it you can
only get it from
highly regulated programs that exist
outside of mainstream medical facilities
in the 1990s a newer drug was introduced
it works like methadone but it’s safer
and in 2000 Congress passed the drug
abuse treatment Act which allows any
doctor who gets eight hours of training
to prescribe this medication from any
general medical facility so in 2017 17
years later Sam’s story should be
outrageous but actually it’s pretty
common if we think of all of the kids
who have opioid addiction as an iceberg
then the biggest part the part that
would be under water they never get any
treatment at all and even among the tip
of the iceberg that do get treatment
it’s only the very tip of the tip that
get appropriate treatment by which I
mean one of the three indicated
medications for treating addiction
combined with professional counseling
there are many reasons for this for one
thing kids with addiction are often too
ashamed or afraid to tell anybody about
their problem one of the first patients
I treated Dave it was a college freshman
who became addicted to prescription pain
medications he came to my program for
treatment we started him on medications
and he was working with a counselor he
was doing really well but he wanted to
keep his treatment a secret so he hid
his pills and he lied about his
appointments until we finally convinced
him that he’d be better off if his
parents knew and so he told them
actually he brought them into one of our
appointments and he told them right in
front of me my heart was pounding when
his father stood up and I’m sure Dave’s
heart was pounding too and his dad said
son I’m so proud of you your mom and I
have known for a while that you were in
trouble but we didn’t know exactly what
was wrong now we see that you’ve figured
out your own problem and where to
help that moment made a really big
impression on me as a young pediatrician
and addiction medicine specialist and
for the past 15 years I’ve been the
director of an adolescent substance use
disorders program where we treat kids
like Dave every day but we can only get
to the kids who can get to us which is a
big problem because too few doctors
treat addiction in the United States
there are more than 750,000 practicing
physicians every single one of us can
prescribe addictive pain medications
that really started the opioid crisis in
the first place but only about 37,000 of
us have taken the training to prescribe
medications to treat addiction only half
of us actually prescribed and only 1% of
us are pediatricians
a year or two ago the directors of a
network of primary care pediatrics
offices contacted me they wanted my help
improving substance use care for
adolescents within the network with some
support from the BlueCross BlueShield
foundation we selected one practice and
we designed an experiment that had three
parts first we put a licensed clinical
social worker on staff then we trained
the pediatricians to prescribe
medications for addiction finally as a
specialist I provided consultation and
backup medical support well it just so
happens that our guinea pigs were Sam’s
doctors about two weeks after he
relapsed he ran out of sleeping pills so
he made an appointment to ask for a
refill when he got to the office he was
a little bit unkempt and smelly and he
nodded off in the waiting room when a
staff member woke him up to go see the
doctor he was a little bit irritable so
the staff weren’t certain that this
experiment that was supposed to bring
more kids like Sam into the office was
such a great idea but he saw the doctor
he started on medications started
working with the counselor he stuck with
it and he did really well in fact it was
really pretty completely transformed and
within a couple of weeks he even became
the practices favorite patient he asked
his doctors if they would help his
girlfriend who also had an addiction and
they immediately said yes and the staff
reached out to enroll her as a new
patient even though the office policy
had been not to accept new patients over
the age of 15 when that story got back
to me I knew the experiment was a
success I want to share some epilogues
with you so Dave the kid who brought his
parents with him to an appointment he
ultimately graduated college and became
a professional he got a job in a
different City and he moved away the
last time I saw him in the clinic he
thanked me said he couldn’t imagine what
would have happened had it not been for
treatment Sam is doing really well it’s
he’s been more than six months drug-free
he looks great and he’s working
full-time we never did catch up with his
girlfriend she was underage and the
Department of Child Welfare got involved
she’s still on the bottom part of that
iceberg under water but if she’s ever
available we’re here waiting for her the
practice is working hard to find kids
who need treatment for opioid addiction
they’ve hung posters in every room
they’ve sent news letters home to
parents and older patients they’ve even
gone to the local schools to try and
find kids who need help the social
worker is counseling these kids and
helping them get their lives back on
track and when she’s not working with
kids with opioid addiction she’s helping
kids who are using alcohol and marijuana
trying to prevent them from going down
the path in the first place my
colleagues and I are planning to open a
second practice in a couple of months we
have a waiting list of pediatricians
that want to work with us we’re working
hard to raise resources so we can spread
the program as widely as possible I want
to leave you secure in the knowledge
that addiction is treatable if you
happen to be a physician treat addiction
outcomes from good addiction treatment
or similar to or better than other
chronic medical conditions so there’s
really no reason not to and if you know
somebody who’s struggling with opioid
addiction help them find good treatment
you could be saving a life thank you
[Applause]
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