Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Grubb, Laura K.

doi:10.1016/j.clinthera.2019.07.019

Cited by 8 publications

(10 citation statements)

References 63 publications

(47 reference statements)

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“…(9,21,23) While OUD can impact any individual regardless of age, the pediatric and adolescent stages represent important periods for intervention as most individuals report use before 25 years of age. (9,24,25) This nding is similarly re ected in our data, where patients who had an ED visit for opioid overdose in the last year started using opioids at a mean age of 22.4 years. Recent literature has highlighted that a large proportion of individuals in treatment for OUD are actually young adults but only a small number of them are receiving MAT.…”

Section: Sociodemographic Characteristicssupporting

confidence: 81%

“…Recent literature has highlighted that a large proportion of individuals in treatment for OUD are actually young adults but only a small number of them are receiving MAT. (24)(25)(26) This underuse of an effective treatment in a vulnerable population is certainly alarming. (27) For these reasons, further research is needed on identifying barriers to accessing treatment both within and outside the clinical environment for younger adults with OUD.…”

Section: Sociodemographic Characteristicsmentioning

confidence: 99%

“…(27) For these reasons, further research is needed on identifying barriers to accessing treatment both within and outside the clinical environment for younger adults with OUD. (24,26) Treatment Characteristics…”

Section: Sociodemographic Characteristicsmentioning

confidence: 99%

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Factors Associated with Opioid Overdose During Medication-Assisted Treatment: How Can We Identify Individuals at Risk?

Rosic

Sanger

et al. 2020

Preprint

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Background: Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose. Methods: Data were collected prospectively from 2,360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status. Results: Twenty four percent of participants reported a lifetime history of overdose (n=562) and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n=179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] = 0.92, 95% confidence interval [CI] = 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR = 0.93, 95% CI = 0.89, 0.98, p = 0.007 and OR = 0.84, 95% CI = 0.77, 0.92, p <0.001, respectively), report more physical symptoms (OR = 1.02, 95% CI = 1.01, 1.03, p =0.005 and OR = 1.03, 95% CI = 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR = 1.87, 95% CI = 1.32, 2.66, p <0.001 and OR = 2.34, 95% CI = 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose. Conclusions: A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient’s overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.

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Section: Sociodemographic Characteristicssupporting

confidence: 81%

Section: Sociodemographic Characteristicsmentioning

confidence: 99%

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Factors Associated with Opioid Overdose During Medication-Assisted Treatment: How Can We Identify Individuals at Risk?

Rosic

Sanger

et al. 2020

Preprint

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“…This finding is in keeping with current research that younger individuals are often at higher risk of both fatal and non-fatal overdoses, highlighting the need for further advocacy and research to improve outcomes for this population [ 9 , 21 , 23 ]. While OUD can impact any individual regardless of age, the pediatric and adolescent stages represent important periods for intervention as most individuals report use before 25 years of age [ 9 , 24 , 25 ]. This finding is similarly reflected in our data, where patients who had an ED visit for opioid overdose in the last year started using opioids at a mean age of 22.4 years.…”

Section: Discussionmentioning

confidence: 99%

Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?

Rosic

Sanger

et al. 2021

Harm Reduct J

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Background Due to the loss of tolerance to opioids during medication-assisted treatment (MAT), this period may represent a time of heightened risk for overdose. Identifying factors associated with increased risk of overdose during treatment is therefore paramount to improving outcomes. We aimed to determine the prevalence of opioid overdoses in patients receiving MAT. Additionally, we explored factors associated with opioid overdose during MAT and the association between length of time enrolled in MAT and overdose. Methods Data were collected prospectively from 2360 participants receiving outpatient MAT in Ontario, Canada. Participants were divided into three groups by overdose status: no history of overdose, any lifetime history of overdose, and emergency department visit for opioid overdose in the last year. We used a multivariate multinomial regression model to assess demographic and clinical factors associated with overdose status. Results Twenty-four percent of participants reported a lifetime history of overdose (n = 562), and 8% reported an emergency department (ED) visit for opioid overdose in the last year (n = 179). Individuals with a recent ED visit for opioid overdose were in treatment for shorter duration (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.87, 0.97, p = 0.001). Individuals with a lifetime or recent history of overdose were more likely to be younger in age (OR 0.93, 95% CI 0.89, 0.98, p = 0.007 and OR 0.84, 95% CI 0.77, 0.92, p < 0.001, respectively), report more physical symptoms (OR 1.02, 95% CI 1.01, 1.03, p = 0.005 and OR 1.03, 95% CI 1.01, 1.05, p = 0.005, respectively), and had higher rates of non-prescription benzodiazepine use (OR 1.87, 95% CI 1.32, 2.66, p < 0.001 and OR 2.34, 95% CI 1.43, 3.81, p = 0.001, respectively) compared to individuals with no history of overdose. Conclusions A considerable number of patients enrolled in MAT have experienced overdose. Our study highlights that there are identifiable factors associated with a patient’s overdose status that may represent areas for intervention. In particular, longer duration in MAT is associated with a decreased risk of overdose.

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“…12 Most of these deaths are unintentional. Describing her own personal interactions with treating adolescents and young adults with opioid dependence, Dr. Laura Grubb 13 shines a light on the real challenges limiting access to medication-assisted treatment programs and active recovery in teenagers with opioid use disorders. Personal and socioeconomic barriers, including homelessness, limited access to medication-assisted treatment care programs, transportation, insurance barriers, stigma, and scarce resources, are affecting the ability to get addicted teens healthy.…”

mentioning

confidence: 99%

Finding Hope: Clinical Strategies to Combat the Devastating Impact of the Opioid Epidemic on our Youth

Maron

2019

Clinical Therapeutics

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Addiction to opioids has become a global public health threat that does not discriminate based on sex, socioeconomic status, race, ethnicity, or age. In recent years, there has been an exponential increase in opioid overdoses and drug-related deaths. According to the National Institute on Drug Abuse, in 2017 > 70,200 Americans died of drug overdoses, including >17,000 deaths that involved prescription drugs. 1 These sobering statistics equate to a 2-fold increase in drug-related deaths in the United States in the past decade alone. 1 Tragically, children have not been spared from this epidemic. Gaither et al 2 recently reported that between 1999 and 2016 the pediatric mortality rate from prescription and illicit opioid poisonings increased by 268.2%. These deaths were not limited to the adolescent population, but rather spanned the pediatric age spectrum from 0 to 18 years. 2 Effects of opioids on the health of our children may start as early as in utero and continue through adolescence with devastating and often unmitigated effects of addiction. Compounding these effects are the multigenerational and transgenerational consequences of drug exposure. Parental drug exposure produces behavioral, biochemical, and neuroanatomic changes in future generations through a combination of genetic, epigenetic, and environmental influences that results in a vicious cycle of chronic drug abuse. 3 In this Specialty Update, we consider the impact of opioids throughout the pediatric age spectrumdfrom fetuses to teenagersdand present new therapeutic and treatment strategies aimed at reducing the burden of drug addiction and improving the health outcomes of our youth. In 2016, 1 in 5 women of reproductive age filled at least 1 prescription for an opioid, and an estimated 15.3% of women reported the misuse of prescription drugs or illicit drug use. 4 As a result, an estimated 32,000 babies are born in the United States each year with neonatal abstinence syndrome (NAS), now commonly referred to as neonatal opioid withdrawal syndrome. These numbers equate to an infant being born every 15 min in the United States addicted to opioids, a greater than 5-fold increase since 2004, and result in medical costs of US$563 million per year. 4 The long-term effects of these narcotics on the developing fetal brain remain largely unknown. 5 Most adults exposed to illicit drugs in utero may be physically healthy, but data suggest that vulnerability to health and neurocognitive issues are pervasive and long lasting. 6 Perhaps the optimal strategy to reduce drug exposure in infants is to limit drug use in pregnant women. It is well known that abrupt cessation of narcotics during pregnancy poses significant health threats for both mother and fetus. 7 Thus, strategies to engage mothers in treatment programs during pregnancy, along with the development of new treatment agents, are a priority. The pure opioid antagonist, naltrexone, is currently used by 11% of young adults with opioid use disorders. 8 To date, the safety profile and efficacy of this drug i...

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Personal and Socioeconomic Determinants in Medication-assisted Treatment of Opioid Use Disorder in Adolescents and Young Adults

Cited by 8 publications

References 63 publications

Factors Associated with Opioid Overdose During Medication-Assisted Treatment: How Can We Identify Individuals at Risk?

Factors Associated with Opioid Overdose During Medication-Assisted Treatment: How Can We Identify Individuals at Risk?

Factors associated with opioid overdose during medication-assisted treatment: How can we identify individuals at risk?

Finding Hope: Clinical Strategies to Combat the Devastating Impact of the Opioid Epidemic on our Youth

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