Both things are true. Chronic pain patients were undertreated as prescribing collapsed. And counterfeit pills containing fentanyl are now the leading driver of teen overdose deaths, per CDC data. Holding both realities at once is exactly what good policy requires.
Good research doesn't implement itself. A trial can show something works and still sit unused for a decade. Funders want efficacy. Systems want feasibility. Patients need access. Those aren't the same thing. The gap between evidence and practice is where most interventions go to die.
One pill can kill. Fentanyl is now in counterfeit pills that look exactly like Adderall or Xanax. Per CDC data, it's the leading cause of death in teens. The ED sees kids who had no idea what they took. Naloxone in the home changes that math.
Parental SUD is one of the strongest predictors of adolescent addiction. Not just genetics. The household environment, the stress, the modeling. Family-based interventions improve teen treatment outcomes per SAMHSA data. Treating the parent is pediatric care.
Pediatric ERs are not just small adult ERs. We train specifically for kids in crisis. High fever in a toddler, that's often urgent care territory. But a child who looks wrong to you, limp, glassy, not acting right, trust that instinct. Parents know their kids. We take that seriously.
$38.2M headed to Oregon for treatment and recovery. Pharmacy chains were a real part of how this crisis spread. Holding them accountable and routing funds directly to treatment is exactly how settlement money should work.
A classroom's worth of adolescents and young adults dies from overdose every week in the US.
21% had a health care visit in the 7 days before they died.
Only 2.5% got buprenorphine.
The ED is often the last chance. We have to use it.
tinyurl.com/5yak6z4d
#OpioidCrisis #Fentanyl #Adolescents
The Pitt is doing something rare. Most medical dramas sanitize the ED. Fentanyl overdoses, withdrawal, housing instability. these are daily realities for EM docs. When fiction erases that, it makes it easier for policy to erase it too.
One pill can kill. Fentanyl is 100x stronger than morphine and now contaminates nearly every illicit drug supply, per CDC data. Kids aren't doing "heroin." They're taking what looks like a Xanax or Perc. The ED sees what prevention missed. Naloxone changes that math.
Parental SUD is one of the strongest predictors of adolescent addiction. Not just genetics. The family environment, the chaos, the modeling. Research shows treating a parent's SUD changes pediatric outcomes downstream. The family is the intervention. We're just slow to fund it that way.
Purdue Pharma's aggressive litigation tactics silenced journalists and researchers for years while opioid deaths climbed.
Urgent care handles most fevers, ear infections, and minor cuts faster than we can. Save the pediatric ED for breathing trouble, altered mental status, severe pain, or anything that feels wrong in your gut. We're built for crises. Knowing the difference matters.
Naloxone requiring no training to use is accurate. Intranasal formulations like Narcan are designed for bystander use. Venues like this normalizing access is exactly the kind of community-level distribution that expands reach beyond clinical settings.
Pharmacy chains dispensing opioids while flagging suspicious orders is exactly what made them liable. This $773M settlement follows similar pharmacy chain accountability in other states. The money needs to reach treatment programs, not just general funds.
One pill can kill. Fentanyl is 100x stronger than morphine, per CDC data. Teens aren't buying heroin. They're buying fake Xanax or Adderall, not knowing what's inside. The ED sees kids who made one mistake. Naloxone in the home changes that outcome.
Zip code predicts who survives an overdose more than almost any clinical variable. Kids in low-income areas reach the ED sicker, get buprenorphine less often, and follow up less. Per CDC data, the gaps are widening. What we call a clinical problem is often just poverty with a pulse.
New piece out in @kevinmd.bsky.social with peer-led recovery storytelling in schools works when curricula don't. 10,000 students. 240 schools. The data are clear.
kevinmd.com/2026/04/peer-led-storytelling-in-adolescent-substance-use-prevention.html
Full paper: doi.org/10.1186/s13722-025-00595-6
Fever alone rarely needs the ER. What does: a child who won't wake up easily, is breathing hard, has a rash that doesn't fade when pressed, or seems "not right" to you. Trust that instinct. Parents know their kids. Urgent care handles most everything else.
Implementation science exists precisely because this gap is real. The average research finding takes 17 years to reach routine practice. Deployment is the discipline. The evidence doesn't sell itself.
Good evidence doesn't implement itself. A study can change what we know and nothing else. Real-world uptake requires champions, workflow redesign, payer buy-in, and sustained funding. The science of getting science used is its own discipline. Most researchers never learn it.
Clinicians who've watched consultants redesign care pathways without ever seeing a patient have a perspective worth having in those rooms. The McKinsey book documented real harm in real institutions. That voice belongs at the table.
Minnesota's opioid council shapes real policy. Clinicians and researchers on boards like this one move evidence into action at scale.
Parental SUD is one of the strongest predictors of adolescent addiction. Not genetics alone. The family environment, stress, modeling, and access to substances all compound the risk. Family-based interventions reduce teen use more than individual therapy alone. The parent's recovery is pediatr…
Fever alone rarely needs the ER. Breathing trouble, severe dehydration, altered mental status. those do. Urgent care handles most minor stuff well. What PEM docs actually spend time on is way more complex than "sick kids." That gap between perception and reality matters.
One pill can kill. Fentanyl is now in counterfeit pills that look exactly like Adderall or Xanax. Per CDC, it's the leading cause of death in teens 14-18. Most parents don't know. Most kids don't know. The ED does. Naloxone at home changes that math.
New research on ED-initiated buprenorphine for adolescents with opioid use disorder. Youth OUD is rising and the ED is a critical intervention point. We need to know if this approach works in kids the way it does in adults. Read the full study
Zip code predicts overdose risk as well as any drug. Kids from high-poverty areas hit our EDs sicker and get buprenorphine less often, per CDC data. What I see in the pediatric ED is social determinants of health made visible. That gap is a choice someone made.
Most kids in the pediatric ED don't need the pediatric ED. Urgent care handles fever, ear infections, minor cuts. Save the ED for breathing trouble, altered mental status, severe pain, or anything that scares you in your gut. That instinct is data too.
Good evidence doesn't implement itself. The gap between what we know works for SUD and what actually happens in clinics is enormous. Research gets published. Practice barely moves. Dissemination is the science most scientists skip.
One pill can kill. Fentanyl is now in counterfeit pills that look exactly like real prescriptions. Per CDC, it drives most teen overdose deaths. The ER sees kids who had no idea what they took. Harm reduction saves lives while we work on the rest.