by Anissa Durham
When a teenager arrives at a trauma center after a car crash or sports-related injury, the immediate priority is to save their life. The doctors stabilize them, run tests, and prepare a treatment plan.
But somewhere in the flurry of activity, a decision is made — one that has less to do with their medical condition, and more to do with who they are.
New research shows Black, American Indian, Hispanic, uninsured, and female adolescents are more likely to be screened for drug and alcohol use at pediatric trauma centers across the country than their white peers.
With drug overdoses being the third leading cause of death in adolescents in 2022 surpassing car accidents and gun violence, some say the disproportionate screening of minority youths isn’t necessarily the problem.
Why Screenings Are Inequitable
Trauma center staff might decide to do a blood screen of a teen because they need to make sure any medications they administer don’t conflict with drugs or alcohol. No patient consent is needed. And there are no specific guidelines providers are required to follow when deciding whether to screen adolescent trauma patients.
Health care providers who decide to screen a pediatric patient for substance and alcohol use, take blood and urine samples to test for any range of cannabis, opiates, amphetamines, methamphetamines, MDMA, and alcohol. Dr. Jordan Rook, a general surgery resident at University of California, Los Angeles says the tests commonly exclude synthetic opioids, which currently drive the surge in drug overdose deaths.
Rook spearheaded the research to identify where providers are going wrong when screening injured pediatric patients. After analyzing data from more than 85,000 adolescent patients, Rook and his fellow researchers found that nearly 25% of youth from marginalized communities were screened for alcohol use and about 22% were screened for drug use.
“That’s where some of my concerns with the guidelines come into place. It’s kind of left up to the providers to determine how they want to do the screening,” he says. “Do they have a system where all patients get an interview-based screen? Or do all patients get a biochemical screen, or do they leave it up to the providers to make that decision?”
To get a better idea of which adolescents are being screened, Rook analyzed data using a method to control for reasonable factors that would influence a provider’s decision to do a biochemical screen.
“What was left over were these inequitable patterns of screening,” he says. “That’s where I become concerned that providers are selecting patients they deem to be higher risk for substance use disorders and active intoxication.”
Dr. Lorraine Kelley-Quon, senior author of the report and an associate professor of clinical surgery, says while on one hand adolescents of color are more likely to be screened for substance and alcohol use, not enough adolescents from other demographics are being screened.
“I’m in the prescription opioid and substance use space, I can tell you people do not think of children when they think of the opioid epidemic,” Kelley-Quon, who works at Children’s Hospital Los Angeles and the University of Southern California, says. “People aren’t used to thinking about that when they think about pediatric health.”
And, she says, it’s very challenging to find support for adolescents who are uninsured or on Medicaid.
The Burden and Danger of Stigma
Since interview-based and biochemical screenings are left to the discretion of providers, intervention and prevention care usually is, too. The American College of Surgeons released best practices guidelines in 2022, to help providers in trauma centers screen for mental health disorders and substance use, and follow up with intervention. But it’s still only a recommendation.
The stigmatization of substance use is common within health care settings, and Rook worries this could keep injured adolescents who may be struggling with substance or alcohol use disorder from seeking treatment. A positive drug or alcohol test result could make it easier for providers to blame a young patient for what happened to them.
“Our job is to take care of the patient, no matter how they got there, and provide them with the best care possible,” Rook says. “There’s a push these days to make trauma care more humanistic and remove these stigmatizing biases.”
The issue extends beyond the hospital, too. Adolescents from marginalized communities are already over-policed and are more likely to be screened for substance and alcohol use. A positive test, Rook says, could lead to an arrest and conviction, contributing to the overcriminalization these communities already face, as medical records can be subpoenaed in criminal investigations, like if a patient was driving under the influence.
Kelley-Quon says things need to change at the policy level as well.
To make things more equitable, she says, providers should screen all adolescents who come into a trauma center for drug and alcohol use. Doctors should also provide young people who are struggling with substance use disorders with interventions and referrals.
“When a child comes in after an injury, this is a moment in their life where you could change the trajectory of their decisions,” Kelley-Quon says. “If you’re not screening for substance use and referring people, you’re missing that moment to make a lifesaving intervention.”
Source: Seattle Medium
