How Should Harm Reduction Strategies Differ for Adolescents and Adults?

Overall rates of opioid use are low in adolescents; however, recent increases in mortality from overdose in adolescents have outpaced increases in the general population.This article highlights the importance of expanding evidence-based treatment for adolescent opioid use, especially medication, while also addressing key ethical considerations of harm reduction practices and how application of such practices with adolescents may differ from adults.Concepts related to adolescent populations are discussed, including autonomy, confidentiality, and brain development.Application of harm reduction practices should be age appropriate, express respect for patients' autonomy, include social support, and be accompanied by broader aims to minimize adolescent initiation, escalation, and overall harm caused by opioid use.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM .Physicians should claim only the credit commensurate with the extent of their participation in the activity. Opioid Crisis and AdolescentsThe opioid crisis has had a profound influence on individuals, families, and communities throughout the United States.Increasing rates of overdose deaths-fueled largely by fentanyl and by the simultaneous use of other substances, including stimulants-are alarming. 1,2Yet overdose deaths represent only a fraction of the all-cause mortality and devastation caused by opioid use disorder (OUD). 3,4,5Harm reduction represents a promising approach to limiting the morbidity and mortality associated with OUD, a disorder recognized as a disease and condition in need of treatment. 6,7Harm Reduction International defines harm reduction as "policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences" of substance use, 8 and, as others have noted, it focuses on "the prevention of harm, rather than on the prevention of drug use itself." 9The Substance Abuse and Mental Health Services Administration (SAMHSA) includes "prevention, risk reduction, and health promotion" as key aspects of harm reduction and further specifies that, within a harm reduction framework, "abstinence is neither required nor discouraged." 10