Patient-Reported Goals of Youths in Canada Receiving Medication-Assisted Treatment for Opioid Use Disorder

Abstract

IMPORTANCEIn the literature on opioid use disorder (OUD), opioid abstinence is used as an outcome measure for individuals receiving medication-assisted treatment (MAT), without consideration of patient-reported goals (PRGs).OBJECTIVES To identify common PRGs for youths receiving MAT for OUD and assess whether these patients achieve their stated goals. DESIGN, SETTING, AND PARTICIPANTSThis prospective cohort study examined data from 152 individuals aged 16 to 25 years (noninclusive) recruited between May 22, 2018, and March 11, 2020, from 45 outpatient MAT clinics in the Pharmacogenetics of Opioid Substitution Treatment Response study. Youths receiving MAT for OUD were included and were followed up for 3 months. EXPOSURES Medication-assisted treatment for OUD. MAIN OUTCOMES AND MEASURES The frequency of each PRG; the success of goal attainment, compared between those who reported specific PRGs and those who did not; and associations between reporting certain goals and achieving them. RESULTS Among the 152 youths in the study, 82 were male (53.9%), and the mean (SD) age was 22.8 (1.8) years. Ten overarching goals were identified, with the most common being to taper the dose of or stop MAT (96 [63.2%]), avoid use of recreational substances (71 [46.7%]), manage OUD symptoms (25 [16.4%]), live a normal life (14 [9.2%]), improve mental health (11 [7.2%]), and gain employment (8 [5.3%]). Overall, individuals who reported PRGs had similar odds of achieving themas those who did not for the goals of taper dose of or stop MAT (OR, 1.98; 95% CI, 0.88-4.46; P = .10), avoid recreational substances (OR, 1.34; 95% CI, 0.65-2.74; P = .43), manage OUD symptoms (β coefficient, -0.93; 95% CI, -4.24 to 2.38; P = .58), and improve mental health (β coefficient, -0.76; 95% CI, -6.31 to 4.78; P = .79). Furthermore, multivariable logistic regression showed that goals to taper the dose of or stop MAT (odds ratio, 1.90; 95% CI, 0.78-4.63; P = .16) or avoid recreational substances (odds ratio, 1.27; 95% CI, 0.60-2.67; P = .53) were not associated with achieving these respective outcomes. CONCLUSIONS AND RELEVANCEThis study suggests that youths have highly variable PRGs regarding MAT for OUD and that reporting a goal may not mean one is at higher odds of achieving it.There is a need to develop treatment plans that effectively incorporate PRGs. In addition, the finding that most youths aim to minimize or stop their MAT dose warrants the creation of a tapering protocol to guide clinicians. Because a diagnosis of OUD has substantial psychosocial implications in this population, clinicians must ensure that these dimensions of care are part of routine clinical practice.

“The system always undermined what I was trying to do as an individual”: identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada

“…Importantly, these findings from service providers resonate with studies that have been done with youth using opioids and other drugs [13,18,21,23,24]. Youth in many settings have articulated their challenges accessing environments that are adultoriented [13,21], engaging in treatments that apply a 'one-size fits all' ideology [23], and that do not reflect their unique goals and preferences [18,[22][23][24]37]. This suggests that service providers and youth may have similar priorities during their point-of-care interactions.…”

“…To better respond to the unique needs of youth, service providers suggested numerous solutions, such as engaging youth in service/treatment planning, providing youth with programs that help them maintain meaningful connections (i.e., positive relationships, cultural connection, and recreational activities), and creating services that are youth-specific. Importantly, these findings from service providers resonate with studies that have been done with youth using opioids and other drugs [13,18,21,23,24]. Youth in many settings have articulated their challenges accessing environments that are adultoriented [13,21], engaging in treatments that apply a 'one-size fits all' ideology [23], and that do not reflect their unique goals and preferences [18,[22][23][24]37].…”

“…Substance use among adolescents and young adults, collectively referred to as youth (ages [12][13][14][15][16][17][18][19][20][21][22][23][24], is a longstanding global health issue for families/caregivers, communities, and policy makers. Substance use typically begins and peaks during this period and can impede cognitive, emotional, and psychosocial development, potentially leading to further adverse outcomes (e.g., riskier substance use patterns, health burdens) [1][2][3][4].…”

“…Another potential source for these disparities is the incongruence between youths' treatment goals and preferences and the procedures and policies through which treatments are delivered. Studies have shown that youth have diverse goals when accessing MOUD, such as reducing opioid use, MOUD tapering, gaining employment, and improving mental health, that are not always compatible with current practices or standards (e.g., focus on abstinence and withdrawal symptoms, long-term retention) [13,18,[22][23][24].…”

Methadone Maintenance Treatment Discontinuation Among Young People who use Opioids in Vancouver, Canada

“…16 Additionally, a study examining the association between OUD treatment goals and factors associated with their attainment among AYA in Canada found that those receiving MMT were more likely to decrease their dose 3 months after treatment initiation (odds ratio = 4.42, 95% confidence interval [CI]: 1.40 to 14.0) in comparison to those receiving buprenorphine. 17 This finding is supported by evidence of a higher preference for MMT among AYA who are interested in initiating opioid agonist treatment (OAT), which may be explained by perceptions that it is more effective at addressing mental illness and physical pain. 18 Within the study setting, Vancouver, BC, research among adults found self-reported Indigenous identity, recent incarceration, sex work, and injection heroin use were negatively associated with MMT use, while female sex, HIV-positive status, and crack cocaine smoking were positively associated.…”