Pediatrician Hoover Adger Jr., a member of the American Board of Addiction Medicine and The Addiction Medicine Foundation, and former deputy director of the White House Office of National Drug Control Policy, has dedicated much of his 33-year career to adolescent substance abuse. Here he addresses steps at Johns Hopkins Children’s Center to improve physician training and the care of patients with substance abuse issues.

Is medicine today equipped to manage addiction?

If you have a heart problem, you will have no problem finding a cardiologist, or a nephrologist for a kidney problem. Go to any community hospital in this country, however, and you will find that 30 to 50 percent of the patients there have a primary or secondary issue related to alcohol or substance abuse, but there is no addiction medicine service in that hospital to treat it.

Do you see substance abuse as primarily a pediatric issue?

Yes, the majority of individuals who develop a substance abuse problem get their start as an adolescent. If we wait until we see people who are significantly involved with substance abuse when they are older, it is going to be a harder mission. Why not start upstream, get ahead of the curve, and intervene at times when we know we can do best? As pediatricians, we can build on our existing relationship and trust with families.

How do we work with patients and families facing substance abuse?

We try to emphasize a family-centered approach with a focus on prevention and early intervention. I have been unable to provide quality pediatric care for many of my patients because either a parent or caretaker also has substance abuse issues. We need to help parents and patients understand what being at risk means. We have to reach out to parents to help them get into a healthy relationship with their child affected by substance use.

Are our pediatricians educated and equipped to do that?

We have a wonderful corps of people in our Harriet Lane primary care clinic who want to assist in addiction training, but we need to breathe some life into this enterprise. Thanks in part to a $25,000 grant from the American Board of Addiction Medicine, we have developed an addiction medicine track for our adolescent medicine fellows that gives them in excess of 2,000 hours devoted to addiction medicine. That has allowed them to sit for certification as addiction medicine specialists by the American Board of Addiction Medicine. Notably, pediatricians who have trained here in addiction medicine have been highly recruited to practice addiction medicine in other children’s hospitals around the country and to lead their efforts against the opioid crisis.

Next steps?

Currently there are some 46 addictionmedicine fellowship programs across the country, but only two focus on pediatrics or children related issues. Our response has been to create a center to take advantage of all the things we have available to us, including access to resources in the Johns Hopkins Bloomberg School of Public Health. Then the task will be to arm our medical community with credentialed state-of-the-art addiction medicine programs and consultation services.