Latest / Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner / The Latest on Substance Use: Part 2

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The Latest on Substance Use: Part 2 · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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I'm Holly Wayment, and this is Pediatrics Now, cases, updates,
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and discussions for the busy pediatric practitioner.
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Click on the link in this podcast for free credit that may include CME,
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MOC, or ethics credit depending on our topic or podcast.
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I'm thrilled today because here in the podcast studio is Dr.
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Jennifer Schar-Potter. She is a professor of psychiatry at the University of
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Texas Health Science Center and director of the Be Well Institute.
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Dr. Potter, thank you so much for being here today. Thanks so much,
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Holly. I'm glad to be here.
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There's no evidence to show that if we talk about drugs and this type of thing
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or alcohol with the children that it makes them want to do it more.
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That's not the case, even though that may be the fear.
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What a great point to make. That's absolutely the case.
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Your children, when you tell them about drugs, are not going to run down the
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street and go to a drug dealer. What they are going to be is informed.
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The key issue here is that if you're not talking to your kids about drugs,
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there are people talking to your kids about drugs.
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It's their friends, and it's TikTok, and it's all of these other sources,
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all of which are much, much less reliable than you.
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The other thing I'd say is, because this is also going to happen,
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is that when parents do find children with drugs, it is not the case that screaming
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at them and banning them for life from whoever the friend is,
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is actually always going to be the best solution either.
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It's scary when you find out that your child might be using drugs,
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but how you react is super important. They need support. They need a diagnosis.
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They need an evaluation. And you need a way to preserve the parent-child relationship,
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the caregiver-child relationship, because that is going to be the most important
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thing in understanding their recovery, barring other contextual circumstances.
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So when you find that moment or someone calls you and is concerned about their
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child's drug use as a pediatrician, ask questions, offer a referral,
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let them know their concerns are real, but also let them know that while this
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is normal, it's something to pay attention to because you want to be able to talk about it.
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And when you were getting your master's in public health in Atlanta.
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That's when you really, you were inspired to go into this field and you saw
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the stigma that was happening? Yeah.
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So I did not enter this. I did not come to this field thinking,
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my goodness, I'm going to work in substance use. I think.
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As I talk about this, these are not things that I knew because I went to school.
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This is a journey that I've been on.
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I got my Master's of Public Health at Emory before I got my doctorate,
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and I took a course that fit my schedule, and it was about substance use.
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And it was the last possible thing I would have picked. I would have picked
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all sorts of other topics, but it fit my schedule.
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And the requirement was to go to an AA meeting, an Open Alcoholics Anonymous
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meeting. And I remember all of the feelings that that conjured up.
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And every one of the things that I have said not to do, I did.
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I thought dirty, unclean, drug addict.
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All the words that I haven't said intentionally are the words that I felt,
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whether I admitted that or not.
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And, you know, when you realize how common it is, when you realize that it could
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happen in your own family, or now when I think about,
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when I bring this up, it's, I don't think I can go five people without when
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I share what I do, someone telling me that they're in recovery or their family
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member's in recovery or they've lost a family member.
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I was talking to a podcaster just a few days ago who mentioned they'd lost a family member.
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And so that process of recognizing how common this is, it is a process.
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And I think pediatricians also need to self-evaluate what their biases and opinions
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might be, particularly if they've had substance use in their family.
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I like to think of it now as there's no wrong door to recovery,
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but one of the doors should be health care.
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And that shame can be blocking the road to recovery?
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Absolutely. I think it literally can, can, can, it could cost you a kid.
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I have substance use in my family. And I know that had I not gone through the
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transformation that I've gone to, gone through, that I probably would not have
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a relationship with those people.
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And it was hard because I was trained a certain way and I
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had a set group of beliefs but when it comes down to you
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know are you going to have a person that's alive in your life or are you going
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to have to radically accept there might be things that you are doing that are
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contributing to the problem and when you do that it helps you to realize that
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that opening ourselves up to to understanding, to finding compassion,
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and then understanding there is a pathway to recovery, but you can't let that person hit rock bottom.
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And I'll just mention, that's a story, and I'm telling that as a story.
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I firmly believe had I let the individual in my life hit rock bottom,
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I would no longer have that person, and that's untenable.
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But it's also the case that that's what the literature would say,
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is that letting someone hit rock bottom.
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Is not the way to go. And I'll just give you a story on that.
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I had a colleague call me about someone in their life, and they were at wit's end.
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They'd expended a lot of money on different approaches.
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They were at the point, I think, that they were just done. They were exhausted.
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They were exhausted and mentally drained and terrified and scared.
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And this individual had a very serious addiction and opioid use disorder.
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And last grasp, and what we said was don't let go.
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You need a way to love that person and understand that there are limits to what
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you're willing to tolerate from that person.
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So one of the things that ended up happening was they came to the Be Well Clinic.
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And I don't work in the clinic. I work in another part of the Institute.
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But But, you know, a year or so later, this person was in recovery.
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And there's a quote I like to share from another patient that has a similar
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story, that after 40 years of being, and these are their words,
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a drug addict, I finally have a year sober.
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Addiction medicine, good care,
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evidence-based care offers hope to more people than I think we realize.
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And that's why it's so important to talk about this and to treat.
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And rock bottom is not the road to salvation for a young person in particular.
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Love your child and understand what your limits are, but never let them think
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that they are without love and compassion and support when they're ready.
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So rock bottom is a very dangerous direction to go.
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And Jennifer, would you say, looking at it, not as you can't control yourself,
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you've got an issue, it's we all want to feel better. So the reason that the
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person's doing this, that reason isn't bad. They want to feel better.
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They might be going through something hard or feeling terrible.
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Yeah. So what a great point, Holly. Who doesn't want to feel better?
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And when people are struggling and they're down, they start to pair behaviors
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with what makes them feel better.
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I would defy many of us to suggest they haven't gone home.
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I think the example I was giving you was during COVID. It was very stressful.
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I was working on PPE allocation at my healthcare institution and trying to find
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masks and asking scientists to donate their N95s. I was dreaming N95s for about
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60 days. before we figured it out.
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And I suddenly found myself starting to have a glass of wine every night when
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I got home from work, because I didn't get to go home. I was out scrounging N95s.
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And so I wasn't working from home. I was coming into the office,
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and who knew what was going on in those early days?
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And I clocked it. I thought, oh, I've changed my behavior.
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I am drinking every day. I wasn't drinking a lot. I was drinking a glass of wine. I was.
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But that forethought was protective to me and that awareness.
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And so I did modify my behavior.
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But I wasn't wrong in wanting to feel better. I wasn't wrong in wanting to de-stress.
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It was that I had found one solution, not a cadre of solutions.
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The drinking wine seemed easier than going for a walk. And so I was able to make the change.
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But the piece that you're raising is if the only tool in your tool bag is to
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use substances, is don't fault the intent of feeling better or feeling more
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active or trying to function in a different way.
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Acknowledge the fact that maybe that one tool in your tool bag isn't working.
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The wrench is not working.
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You need a hammer or you need a screwdriver.
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And so what are those other things? So part of what treatment is,
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in addition to medications that might help, is building resiliency and adding those tool bags.
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But just saying to someone they're unmotivated or that they're lazy or they
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just can't get it together or that they're a bad person is absolutely the wrong thing to do.
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Nora Volkov, who's the director of the National Institute on Drug Abuse,
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said once, in all my years in this field, I have never, ever met a person with
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a substance use disorder who wanted to be addicted.
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And I think if you hold that in your heart, that starts compassion. passion.
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And that's when we can start to have a conversation around how to help people.
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I think that's really beautiful.
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Can we look at a quick case in the pediatrician's office?
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There's a 14-year-old boy, Sam, and the pediatrician is talking to him.
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She asks about, have you ever tried marijuana?
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And he says, yes. Have you done it more than once?
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Yes. I do it just when I'm really stressed.
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What would you recommend? What is the step from there?
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So the first thing I would say for the pediatrician, and again,
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there's a lot of complexity to this.
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And I think also pediatricians have to be ready to decide, are they going to notify the parent?
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And if you are going to notify the parent, you need to be prepared with what
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you do with that because you don't want to break the relationship with the child.
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And so I think that that's a really important piece and And I'm not going to
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make a recommendation on that. I think that's each clinician's decision on how
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to what they would do that.
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But let's imagine that they are going to have a conversation.
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I really appreciate you telling me.
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That's the first thing, because you're validating that they were honest.
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And I don't want someone punished for being honest.
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And then they, and then they, so thanks for letting me know.
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And that question about, yes, I've used more than once, clock that.
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And when they start to talk about using to stress, I think that's a point they've
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now created a functional relationship between drug use.
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It wasn't, well, I was at a party, and I was really nervous,
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but everybody else was doing it.
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And so I tried it and I didn't like it. It made me feel weird.
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Thank you for telling me. You know, that was a really smart decision.
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A lot of people have tried drugs on occasion and found they don't like them either.
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In fact, do you know that most people don't like drugs and yet we feel like we have to do it.
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So that's more of like a reinforcing the pro-social behavior of choosing not
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to use and they didn't like it And working with peer norms to go,
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it's actually the case that most people don't use this.
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Good for you for seeing that. Let me know if anything comes up.
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And I think that's great.
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The concern I have with what you've presented, again, in a very abstract way,
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is that the child is pairing the use and a feeling.
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That is a risk factor, and that is when I think there is an important conversation to be had.
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If you're a clinician who's been trained in motivational interviewing,
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I encourage you to consider that.
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I think I'd want to know, are they depressed? You might want to switch to just
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very casually asking a couple really nice screening questions about your mood.
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There's two questions, which I'm going to paraphrase them, but are you feeling
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depressed or down more than, And, you know, once a day, every day, things like that.
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So screen for the depression questions then and screen for anxiety.
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If you see a flag there, it might be useful to make a referral or to just ask
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the parent, how's, you know, Johnny doing?
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Has he been noted any changes in behavior at school? So go there because it's
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probably not the case that you've got a child with an active marijuana addiction.
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It's probably the case that there might be a risk. If nothing else is going
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on, then I think it's time to have a conversation about the risks and weigh
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the pros and cons of this use.
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It also might be useful to ask where they're getting it from and have awareness there.
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But the key is, someone once told me if a child has been sexually abused,
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you don't want to terrify them because then that's going to make them even more
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upset about the thing that's happened to them. Same with drugs.
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If you react extremely strongly rather than rolling with it and seeing where
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you're going, you are going to create a sense of fear that might suppress that
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child's willingness to talk to you again. And so keep it pro-social.
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And it's all interrelated, the anxiety, depression, even STDs,
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other big issues in the pediatric world.
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You saw that in your training, education. Well, sometimes those things are related
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and sometimes they're not.
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I mean, you are going to see some kids who just really like drugs.
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It's more common that there may be some underlying issue going on.
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What's hard, it's a little bit of a chicken and the egg because chronic marijuana
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use can actually make you depressed and it can also make you anxious.
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So it's a little hard to unpack sometime, but I think a holistic approach.
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I think the piece with infectious disease is also that there's a disinhibitory effect of these drugs.
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I think we could get into all sorts of dynamics around sexual activities and other things,
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power dynamics between partners or emerging partners, and all of the complexities
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that I know pediatricians have to deal with these days related to other activities.
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And so unpacking it is just really important.
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I will say then, I don't think we go there today, but do not,
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if you are concerned or work with a population where there's a risk or suspicion
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of trafficking and other issues,
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the intersectionality of drug use and sexual abuse and manipulation of minors
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is very commingled and very, very dangerous.
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Us. And when asking the questions to patients, is there a particular screening
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tool you recommend or a website to go to?
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Sure. So the public health, the U.S. Public Health Task Force has a couple different screeners.
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I think depending on the interest, the pediatricians who are probably going
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to go to that website and download a tool will find the one that suits them.
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I think ideally you should be able to do this with as few number of questions as possible.
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But I honestly, it's not that complicated. I think asking and then what you
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do with the information afterwards is probably the most important thing,
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particularly with that younger age group, just even asking.
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If it's more than that, you're probably going to want to make a referral or have an engagement.
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And then people on the side of the shop like me will continue to work to make
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sure that you have good tools and good resources to go to.
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But again, sometimes the ask is not just about the answer, because a lot of
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people will say no regardless.
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Sometimes the ask is about the gesture and what it symbolizes and that it's
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creating that space for a conversation in the future by saying,
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okay, well, if anything ever changes, I'm here to talk to.
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And we talked about as a parent, you don't recommend smoking marijuana in front
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of the child, which is a great point.
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What about alcohol is so ubiquitous that should we be more conscious about our
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kids are watching what we do with alcohol as well? Thank you.
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Yeah, I mean, so one of the things that's most protective and it's a very resilient
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protective factor is that parents pay attention.
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So this idea of parental monitoring. And I know as a parent,
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I thought a lot about that because I knew that.
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And I think I put it more in, I know where they are geographically.
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What it really means is so i
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knew where they were and i knew what friend's house they were at and that but i
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didn't know what was going on in that house but i also may not have
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been monitoring my own house enough so i do think it's
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important to understand alcohol cabinets i do think it's important
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to understand what's in your house there's a phrase called minding the medicine
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cabinet we need to understand that when we have medications when we have drugs
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in our homes which is increasingly a part of people's lives so that's why we
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need to talk about it and when we have alcohol, we need to pay attention to that.
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When you are drinking in front of your children, people are going to drink in
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front of their children.
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And I'm not suggesting that you don't, but I am suggesting you pay attention
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to what happens when you drink.
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Modeling as an adult, responsible drinking is different than having your kids
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down there where you completely lose disinhibition and are, to be crude about
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it, knocked down, inebriated.
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So model responsible drinking. Imagine modeling responsible drinking.
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If you choose to partake and it gets out of hand, wouldn't it be great if your kids didn't watch that?
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Because they are impressionable and they are watching you.
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And despite the fact that peers have influence, parents have so much influence.
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And that's protective when you're talking about very, very young kids,
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four and five-year-olds.
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Paying attention to what happens to them and what they see can set the stage
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to to amplify the education that goes on in schools.
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It's resiliency against what the kids are going to hear from their peers.
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And all of this is such great information. It's such an honor to talk to you,
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and I admire what you're doing.
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Is there anything, Jennifer, that we did not mention before we wrap up that
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you'd like to say to the pediatrician and the parent or what the pediatrician,
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what we should be saying to the parents?
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Yeah, you know, as I'm thinking about it, one of the things that I think is
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really important, and it goes back to stigma, is that that self-assessment about
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how you feel about drugs and alcohol is pretty useful.
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Because if you haven't yet, there will be a moment in your practice where you
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come across a young person who's having struggles with drugs or alcohol.
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And you're going to see them again, probably, and you're going to see their
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parents again. And what you do and how you react matters to that family or the
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caregivers, matters because they're going to watch your reactions very carefully.
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And you being a part of, even if you don't ever talk about the drugs and alcohol,
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if you know about it, how you behave to the child and to the parent matters.
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And the more stigma-free you can be, the more neutral and receptive you can
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be, thank you for sharing that information.
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Is there anything I can do to support it or support you is really therapeutic and beneficial.
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It's as important for the family member. There's a tremendous amount of guilt
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and shame that parents carry when they have a kiddo who's struggling with this.
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Parents can blame themselves.
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And that can lead them to struggle as well.
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And so, again, I go back to compassion and remembering there's an evidence base.
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So making the referrals, looking for the support, because a parent has to be
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able to take care of themselves.
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One of the things when someone comes to me, because I get a lot of this,
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that I say to parents is, okay, I really appreciate that you told me. What can I do?
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And how are you going to take care of yourself? self. Because you need to take
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care of yourself first in order to be able to take care of whatever it is that life is bringing you.
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And so giving them the validation and the pop-off valve, if you will,
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that they don't need to sit there and keep this a dirty little secret in their
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home and that they have a space where they can talk about it and try to do the
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best they can is really important.
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So I guess I'll end with that.
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And do you want to mention anything about how you unplug where it's It's not
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having a drink without my glass of wine.
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My alternative strategy, well, first I lean into my partners and my peers, my familial support.
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How I take care of myself is when I come home, my husband is now trained,
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that I need five minutes because I have a high stress job and I bring it home and then I feel badly.
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And we have a joke, it's the walk around the block. So literally,
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we have a block, it's five minutes, it can be 103 and I can still get around the block.
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But that temperature check of walking around the block and just having that
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ritual is actually a very beneficial alternative to a glass of wine. That's wonderful.
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And I know we're wrapping up. If you want to mention anything,
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it's been in the news just real fast about the opioid uptick of overdoses in Austin.
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That was one of the top stories on network news last night. Yes.
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So this goes back to another key piece I mentioned earlier.
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Drugs are very dangerous right now. Drugs are always dangerous,
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but particularly now because of fentanyl.
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Drugs are very dangerous. So if you are a person that worries about alcohol,
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you should also be worried about fentanyl.
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And that's why I emphasize naloxone so that you can reverse an overdose.
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There are parents out there who did not know that their child was going to use
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an opioid that lost their child to a fentanyl overdose and did not have the tools they needed.
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This is very safe to use naloxone.
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It is not something that's going to hurt anyone. It's going to save a life.
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So people People really should have naloxone in their homes,
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particularly, as I said before, if there is any suspicion.
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If Sue only uses marijuana every once in a while and you'd wish her stop,
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assume she's using other drugs and have naloxone in your home.
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What's happening right now is we have, and it's a little bit of a strange thing
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to say, but we have a poisoned drug supply.
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Let's assume in the United States there is a supply of illicit drugs.
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It flows in the universe of the United States.
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Let's accept that. Right now, that drug supply, regardless of what it is,
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is contaminated with fentanyl.
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Because of that, it is just so dangerous to use illicit drugs because the likelihood
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of an overdose is really active.
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What appears to have happened in Austin, it also happened in Hayes County several
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months ago where there were six or seven children that died of an overdose.
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What happened, although this was, I believe some of these were adults in Austin,
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I would would need to verify that, was that they took fentanyl that was,
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they took an opioid or a pill that was extremely potent when it came to fentanyl and they overdosed.
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They may not have even known they
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were taking fentanyl and it led to an overdose. So it is very dangerous.
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And this is why have naloxone.
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Do not take pills, even if they look real, that you don't know where they came
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from and where they came from is not your friend or your partner or the mom
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down the street, because she may not know where she got it.
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Do not share pills, including prescribed stimulants.
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You need to have picked them up from the pharmacy yourself and talk to your
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children about the risk.
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Because if we don't talk to our kids about this, they may not be with you the
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moment they try something.
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And that's a scary thing. So it's just really important.
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And other stuff is put into vaping now too.
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Yeah, so vaping, there's a lot of different ways to vape. I'm more concerned
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about that with marijuana, quite honestly, because you need to pay attention.
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It's not just nicotine that can go in a vape.
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But most importantly, it's letting kids know that right now illegal drugs are
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not safe. They are very harmful.
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And so it is a really important time not to use drugs in our society.
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Dr. Jennifer Sharp-Potter with the University of Texas Health Science Center
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at San Antonio and the Be Well Institute, thank you so much for being here today on PDF.
24:26
Click on the link in this podcast for free credit that may include CME,
24:31
MOC, or ethics credit, depending on the topic or podcast.
24:35
Our website is pediatricsnowpodcast.com. Thank you so much for listening.
24:42
Our sister podcast is Pediatrics Now for Parents.
24:46
Coming up next week. You know, in the summer, the most common bug bites that
24:53
we're going to see are going to be mosquito bites.
24:57
And, but I think that when parents come in and they're worried about bug bites,
25:01
maybe the thing that they are often worried about are bedbugs.
25:06
And so I think for the pediatrician, there are a few little clues that you can
25:11
use to distinguish bedbug bites from, from mosquito bites.
25:20
I'm holly weyment you're listening to pediatrics now cases updates and discussions
25:26
for the busy pediatric practitioner thank you for the honor of your time i'll see you next time.