“Most individuals with substance use disorders do not have access to evidence-based treatment and this is particularly true of adolescents,” says Melissa Weimer, DO, MCR, associate professor of medicine (general medicine) at Yale School of Medicine (YSM) and of epidemiology (chronic diseases) at Yale School of Public Health (YSPH), and medical director of the Yale Addiction Medicine Consult Service (YAMCS). “Our country is experiencing confluent addiction and mental health crises and we see this in our day-to-day work at Yale New Haven Hospital (YNHH), where adolescents are hospitalized with complications of substance use at an increasing rate.”
Indeed, in 2022, adolescents with a substance use disorder in Connecticut utilized emergency services at twice the rate of adults (18% versus 9%) with comparatively low engagement in lifesaving substance use disorder treatments (1%).
Since its inception in 2018, YAMCS, in affiliation with the Yale Program in Addiction Medicine (YPAM), has cared for over 7,000 adults admitted to YNHH, providing evidence-based treatments for substance use disorders and related complications, counseling on harm reduction, and linkage to ongoing care in the community after discharge. In response to a growing need for adolescent addiction treatment and prevention services in Connecticut, Weimer and Deepa Camenga, MD, MHS, associate professor of emergency medicine and associate program director for pediatric programs within YPAM, expanded YAMCS in 2020 to provide services to adolescents and young adults. Camenga is one of the few pediatricians in the state who is board certified in addiction medicine. “People assume that teens are not interested in stopping [using substances], but when we consult in the hospital, we find that teens are very open to learning about addiction in general, as well as treatment options and supports,” she explains.
In addition to providing urgently needed access to treatment, prevention, and harm reduction services, the newly established adolescent addiction medicine consult service affords a valuable opportunity to train addiction specialists to work with children, teens, and their families – an area of service that is currently experiencing a critical workforce shortage. “When children and families are at their most vulnerable in the hospital,” says Weimer, “it is of the utmost importance that they have access to clinicians, who are trained to meet their needs and get them on a healthier path.”
Under Camenga’s leadership, the adolescent addiction medicine consult service joins a growing complement of addiction services offered to pediatric and adolescent populations through Yale and affiliated community partners. “After we started seeing patients in the hospital, it became very clear that we needed to build outpatient services for teens to easily access after discharge,” she shares. In 2021, Camenga established the Adolescent Addiction Prevention Clinic in partnership with Fair Haven Community Healthcare, the Yale Department of Pediatrics, and YPAM. This program provides outpatient treatment, including medications, for Fair Haven’s pediatric patients. Reflecting national trends in adolescent substance use and substance use disorders, the clinic commonly sees patients for nicotine vaping and cannabis use disorder, as well as binge drinking.
The clinic offers both in-person and virtual appointments, as well as a new telemedicine service for middle and high school students embedded within local school-based health centers. Students are referred to the telemedicine service by their school-based health center medical providers and can receive up to six sessions of voluntary, confidential care which can include psychoeducation, coordination of mental health and substance treatment services, as well as counseling around harm reduction and preventing return to use.
“I am always heartened by how resilient young people are when they receive accurate information and evidence-based treatments at the right time,” says Camenga. “It is my goal to continue to build these services so children, teens, and families can access substance use prevention and treatment services as easily as they can access any other type of medical care.”