Medication-Assisted Treatment for Adolescents in Specialty Treatment for Opioid Use Disorder

Abstract

Purpose The American Academy of Pediatrics recently recommended that pediatricians consider medication-assisted treatment (MAT) for adolescents with severe opioid use disorders. Little is known about adolescents’ current use of MAT. Methods We use data on episodes of specialty treatment for heroin or opioid use (n = 139,092) from a database of publicly funded treatment programs in the U.S. We compare the proportions of adolescents and adults who received MAT, first using unadjusted comparison of proportions, then using logistic regression to adjust for potential confounders. Results Only 2.4% (95% confidence interval [CI], 1.4%–3.7%) of adolescents in treatment for heroin received MAT, as compared to 26.3% (95% CI, 26.0%–26.6%) of adults. Only .4% (95% CI, .2%–.7%) of adolescents in treatment for prescription opioids received MAT, as compared to 12.0% (95% CI, 11.7%–12.2%) of adults. Regression-adjusted results were qualitatively similar. Conclusions Regulatory changes and expansions of Medicaid/CHIP coverage for MAT may be needed to improve MAT access.

Cessation of Injecting and Preceding Drug Use Patterns Among a Prospective Cohort of Street-Involved Youth

“…Historically, in many treatment settings, young people with opioid use disorder have not been not offered medication-assisted treatment (including pharmacotherapy with methadone, buprenorphine, or naltrexone) [27], which have been shown to reduce opioid withdrawal, improve avoidance of opioids, and reduce the frequency of injection drug use [28,29]. Providers may not have experience offering medication-assisted treatment to young people, or may be less likely to prescribe medications when encountering a young person, whose history of injecting is likely to be shorter than that of older individuals [30].…”

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

“…While this is primarily focused on non-prescribed use of pharmaceutical opioids in USA currently, heroin has been the main concern elsewhere, including Ireland [1, 2]. The prevalence of heroin dependence tends to fluctuate over time and is much more common in adults than adolescents [1, 3].…”

“…While this is primarily focused on non-prescribed use of pharmaceutical opioids in USA currently, heroin has been the main concern elsewhere, including Ireland [1, 2]. The prevalence of heroin dependence tends to fluctuate over time and is much more common in adults than adolescents [1, 3]. In Dublin, heroin use first emerged as a concern among adolescents in the 1990s, in the midst of a dramatic increase in heroin dependence among adults [3, 4].…”

“…The main medications used are methadone, a full agonist or buprenorphine, a partial agonist. There are legislative and administrative obstacles in many jurisdictions to provision of OST to adolescents [1]. The limited evidence base for this treatment in this younger age range is also an issue which may be contributing to wariness by clinicians to prescribe [2, 6].…”

“…The limited evidence base for this treatment in this younger age range is also an issue which may be contributing to wariness by clinicians to prescribe [2, 6]. A recent study in USA found that just 2.4% of adolescents attending treatment for heroin use received medication [1]. …”