From neonates to high school students, every bit of the pediatric spectrum is getting hit hard with the opioid crisis. Our country is seeing record numbers of newborns admitted with Neonatal Abstinence Syndrome, children losing parents, and adolescents losing their own lives to this epidemic. The opioid death toll has sky-rocketed since the turn of the century, exacerbated further by the introduction of fentanyl and the COVID-19 pandemic. In 2020, drug overdose became the third leading cause of death in pediatrics. The fact of the matter is: drugs are now killing more kids than cancer. 

Unfortunately, the District has one of the highest rates of opioid abuse in the United States, with families disproportionately impacted in Wards 7 and 8. A new phenomenon showcasing the inequity of the crisis has emerged; the child psychiatrist leading opioid addiction treatment in the District, Dr. Siva Kaliamurthy, is seeing his clinic full of children and adolescents recently immigrated from Central and South America who are now addicted to fentanyl. While juggling a transition to a new country and learning a new language, these patients struggle even more when their home lives are turned upside down by their newfound addiction. A newly immigrated patient of ours, Camila*, describes the heartbreak of having her one safe haven disrupted: her insular family unit. Her mother sobs in front of us, describing the trust that has been broken by her daughter’s disease. Camila’s parents immigrated to pursue a better life for their children, and instead of realizing the American Dream, they are living their worst nightmare. 

So what can we do for children like Camila? Well, Live Long DC’s Strategic Plan is a start. The District is overturning the IMD exclusion that previously barred Medicaid funding for treatment of substance use disorders, which is a major step in the right direction. Moreover, the District is expanding access to a life-saving opioid-overdose-reversal medication, Narcan, now available for free in 28 pharmacies across all eight wards and recently made available to deliver for free directly to people’s doorsteps.  

But, there is more we can do. The District is working on expanding access to Substance Use Disorder (SUD) screening in Emergency Departments, and Children’s National Hospital is one of the first pediatric hospitals in the nation to join these efforts. However, we need to take it one step further by increasing access to addiction treatment. Suboxone is a medication that treats opioid addiction head-on, reducing withdrawal symptoms and cravings, and ultimately reducing overdose and all-cause mortality. Despite being FDA-approved for treatment of adolescents for over two decades with explicit support from the American Academy of Pediatrics, less than 5% of U.S. teens with Opioid Use Disorder have timely access to treatment. 

The solution is simple. Children’s Emergency Departments must offer both Narcan and Suboxone prescriptions to high-risk pediatric patients, especially since many do not interface with the healthcare system outside of the ER. And while hospital administrators may argue that this will attract the ‘wrong crowds’ to a Children’s hospital, if we don’t take responsibility to solve this, who will? Recent policy changes have made it easier than ever before. Removal of the X-Waiver earlier this year is one enormous step towards promoting prescriptions of these life-saving medications to treat addiction, and pediatricians need to recognize that they are a vital part of the solution. The time to take responsibility is now.  

* Name changed to protect patient privacy.

The author would like to thank Dr. Siva Kaliamurthy, leader of the Addiction Program at Children’s National, for leading opioid addiction treatment for adolescents in the district and for educating residents and faculty at the hospital.