The United States is in the midst of a national opioid epidemic. Physicians are encouraged both to prevent and treat opioid-use disorders (OUDs). Although there are 3 Food and Drug Administration-approved medications to treat OUD (methadone, buprenorphine, and naltrexone) and there is ample evidence of their efficacy, they are not used as often as they should. We provide a brief review of the 3 primary medications used in the treatment of OUD. Using data from available medical literature, we synthesize existing knowledge and provide a framework for how to determine the optimal approach for outpatient management of OUD with medication-assisted treatments.

During the current COVID-19 epidemic many outpatient chemical dependency treatment programs and clinics are decreasing the number of in-person patients contact. This has widened an already large gap between patients with substance use disorders (SUD) that need treatment and those that actually received treatment. For a disorder where group therapy is the mainstay treatment option for decades, social distancing, shelter in place and treatment discontinuation have created an urgent need for alternative approaches to addiction treatment. In an attempt to continue some care for patients in need, many a medical interventions have transitioned to a virtual environment in order to promote safe social distancing. Although there is ample evidence to support tele-medical interventions, these can be difficult to implement especially in SUD populations. This article reviews current literature for the use of tele/virtual interventions in the treatment of SUDs and offers recommendations on safe an effective implementation strategies based on the current literature.

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BackgroundBetween 2009 and 2014, nearly 3% of US children (age ≤ 17 years) lived in households with at least 1 parent with substance use disorder. The present systematic review aimed to evaluate effects of parental opioid use disorder on the parent–child relationship and child developmental and behavioral outcomes.MethodsSeveral databases were comprehensively searched for studies published from January 1980 through February 2018 that reviewed effects of parental opioid addiction on parent–child relationships and outcomes of children (age, 0–16 years).ResultsOf 304 unique studies, 12 evaluated effects of parental opioid addiction on the parent–child relationship as the primary outcome and on children’s outcomes, including behaviors and development. Observation of mother–child interaction showed that mothers with opioid use disorders are more irritable, ambivalent, and disinterested while showing greater difficulty interpreting children’s cues compared with the control group. Children of parents with opioid use disorders showed greater disorganized attachment; they were less likely to seek contact and more avoidant than children in the control group. The children also had increased risk of emotional and behavioral issues, poor academic performance, and poor social skills. Younger children had increased risk of abuse or neglect, or both, that later in life may lead to such difficulties as unemployment, legal issues, and substance abuse.ConclusionsCurrent evidence shows association between parental opioid addiction and poorer mother–child attachment and suboptimal child developmental and behavioral outcomes. Further research and treatment targeting children and families with parental opioid use are needed to prevent difficulties later in life.Electronic supplementary materialThe online version of this article (10.1186/s13034-019-0266-3) contains supplementary material, which is available to authorized users.

CRAFFT scores in adolescent inpatients were correlated with other measures of substance use, supporting its efficacy as a screening tool in this population. CRAFFT scores were also positively correlated with a history of psychiatric trauma and past suicide attempts, which is consistent with the results of previous studies associating pediatric substance use and traumatic life events with an increased risk of suicide.