Medication-Assisted Treatment of Adolescents With Opioid Use Disorders

Levy, Sharon; Ryan, Sheryl; Gonzalez, Pamela K.; Patrick, Stephen W.; Quigley, Joanna; Siqueira, Lorena M.; Walker, Leslie R.; Faden, Vivian B.; Tau, Gregory; Jarrett, Renee

doi:10.1542/peds.2016-1893

Cited by 137 publications

(62 citation statements)

References 12 publications

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“…This finding reconfirms the 2016 Surgeon General’s Report on Alcohol, Drugs, and Health , which highlighted the large number of youth with untreated addiction, 28 and also supports the recent policy statement from the AAP calling for expanded access to medications for youth with OUD. 26 Notably, we observed a decrease in the percentage of youth receiving pharmacotherapy from 2009 onwards after a preceding rise. This decrease occurred amidst an escalating OUD diagnosis rate, as well as an increasing number of young adults nationwide receiving health insurance under an Affordable Care Act provision allowing coverage under a parent’s plan.…”

Section: Discussionmentioning

confidence: 61%

“…Although clinical practice guidelines recommend considering pharmacotherapy as soon as possible after OUD diagnosis, 24,26 we examined a 6-month timeframe to allow for any delay in linking youth to treatment services. We identified pharmacy claims that included a National Drug Code for buprenorphine (excluding the transdermal buprenorphine patch marketed exclusively for pain control) or naltrexone (see Supplemental Table 1).…”

Section: Methodsmentioning

confidence: 99%

“…25 Despite the much earlier documented efficacy and FDA approval of buprenorphine and naltrexone, the American Academy of Pediatrics (AAP) did not release a policy statement calling for the use of pharmacotherapy for youth with OUD until August 2016. 26 The absence of such a statement may have delayed adoption of pharmacotherapy by pediatricians, even despite preexisting recommendations from the Substance Abuse and Mental Health Services Administration 24 and amidst a worsening youth opioid epidemic. 7 …”

Section: Introductionmentioning

confidence: 99%

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Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

et al. 2017

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IMPORTANCE Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy.OBJECTIVE To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt.EXPOSURES Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. MAIN OUTCOMES AND MEASURESDispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis.RESULTS Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). CONCLUSIONS AND RELEVANCEIn this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.

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Section: Discussionmentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

et al. 2017

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“…Pharmacological treatments have been shown to be effective in the management of opioid use disorders in adults (Marsch et al, 2005; Woody et al, 2008), and the American Academy of Pediatrics (AAP) has recently advocated for pediatricians to provide increased access to effective treatment for adolescents with opioid use disorders, including developmentally appropriate counseling and medication (AAP, 2016). Additional research is needed to assess the utility of combining outpatient A-CRA therapy with pharmacological treatments to improve the management of withdrawal and relapse prevention in this complex group of youth.…”

Section: 0 Discussionmentioning

confidence: 99%

Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

Godley

Passetti

Subramaniam

et al. 2017

Drug and Alcohol Dependence

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Background This paper compares adolescents with primary opioid problem use (OPU) to those with primary marijuana or alcohol problem use (MAPU) who received up to six months of Adolescent Community Reinforcement Approach (A-CRA), an empirically supported treatment. Methods Intake clinical characteristics, treatment implementation measures, and clinical outcomes of two substance problem groups (OPU and MAPU) were compared using data from 1,712 adolescents receiving A-CRA treatment. Data were collected at intake and 3, 6, and 12 months post-intake. Results At intake, adolescents in the OPU group were more likely than those in the MAPU group to be Caucasian, older, female, and not attending school; report greater substance and mental health problems; and engage in social and health risk behaviors. There was statistical equivalence between groups in rates of A-CRA treatment initiation, engagement, retention, and satisfaction. Both groups decreased significantly on most substance use outcomes, with the OPU group showing greater improvement; however, the OPU group had more severe problems at intake and continued to report higher frequency of opioid use and more days of emotional problems and residential treatment over 12 months. Conclusions The feasibility and acceptability of A-CRA for OPUs was demonstrated. Despite significantly greater improvement by the OPU group, they did not improve to the level of the MAPU group over 12 months, suggesting that they may benefit from A-CRA continuing care up to 12 months, medication to address opioid withdrawal and craving, and the inclusion of opioid-focused A-CRA procedures.

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“…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]. A recent policy statement supports use of medication-assisted treatment for youth with opioid use disorder [31], and as this practice becomes increasingly common, future studies should examine the extent to which medications promote and sustain cessation of injecting.…”

Section: Discussionmentioning

confidence: 99%

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

Hadland

Wood

Nosova

et al. 2017

Journal of Adolescent Health

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Purpose Injection drug use is prevalent among street-involved youth, but patterns of cessation are poorly described. We identified drug use patterns preceding injection cessation among street-involved youth. Methods From September 2005 to May 2015, we collected data from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada, and limited the sample to actively injecting youth. The primary outcome was cessation of injecting self-reported at semiannual follow-up visits. We used Cox regression to identify drug use patterns preceding cessation. Results Among 383 youth, 65% were male, mean age was 22.3 (SD, 2.5; range, 15–30) years, and 171 (45%) ceased injecting for 6 months or more (crude incidence density 22 per 100 person-years; 95% confidence interval [CI], 19–26). Youth who ceased were less likely to have injected daily (adjusted hazard ratio [AHR], 0.40; 95% CI, 0.28–0.56), injected heroin (AHR, 0.40; 95% CI, 0.29–0.56), or injected crystal methamphetamine (AHR, 0.43; 95% CI, 0.31–0.59) prior to cessation. Non-injection heroin use was positively associated with injection cessation (AHR, 1.52; 95 CI, 1.12–2.08). Addiction treatment was not associated with cessation. At the time of cessation, 101 (59%) youth continued to use ‘hard’ non-injection drugs such as heroin and crystal methamphetamine. Conclusions Periods of injection cessation were common but frequently accompanied by ongoing non-injection drug use. Findings indicate that trajectories of injection drug use among youth are complex and highlight the need to further explore relationships between ongoing non-injection drug use and injection cessation.

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Medication-Assisted Treatment of Adolescents With Opioid Use Disorders

Cited by 137 publications

References 12 publications

Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

Adolescent Community Reinforcement Approach implementation and treatment outcomes for youth with opioid problem use

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

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