Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Abstract

Purpose Little is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC. Methods This cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years). Results Among 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%). Conclusions In this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

Population-based examination of substance use disorders and treatment use among US young adults in the National Survey on Drug Use and Health, 2011–2019

“…Particularly, older young adults aged 22–25 were more likely to seek treatment compared to those aged 18–21. These findings largely converge with previous studies ( Bagley et al., 2021 ; Liebling et al., 2016 ; Windle et al., 1991 ; Wu et al., 2011 ). For example, the Primary Care Opioid Use Disorders (PROUD) trial revealed that less than one in six youth aged 16–17 received buprenorphine or naltrexone for opioid use disorders while about a third of young adults aged 18–25 years received medications for opioid use disorders ( Bagley et al., 2021 ).…”

“…These findings largely converge with previous studies ( Bagley et al., 2021 ; Liebling et al., 2016 ; Windle et al., 1991 ; Wu et al., 2011 ). For example, the Primary Care Opioid Use Disorders (PROUD) trial revealed that less than one in six youth aged 16–17 received buprenorphine or naltrexone for opioid use disorders while about a third of young adults aged 18–25 years received medications for opioid use disorders ( Bagley et al., 2021 ). Our findings underscore the pressing need for the treatment of SUDs, especially among younger young adults.…”

Informing youth‐centred opioid agonist treatment: Findings from a retrospective chart review of youths' characteristics and patterns of opioid agonist treatment engagement in a novel integrated youth services program

“…Careful assessment of youths' goals and preferences as part of treatment planning may also reveal additional substance use, health, and psychosocial service needs. As shown by our study and others (Bagley et al, 2021;Krebs et al, 2021;Lim et al, 2021), youth with OUD were engaging in poly-substance use and have concurrent mental health conditions, which are crucial to address as they can increase risk of overdose (Moe et al, 2021) and impact OAT initiation and continuity (Lind et al, 2019). In this novel integrated youth-specific OAT program, youth had access to interdisciplinary services (e.g., primary care, psychiatry, counselling) as needed, and our chart review suggests that a high proportion of youth engaged in these optional supports.…”

Risk mitigation guidance and safer supply prescribing among young people who use drugs in the context of COVID-19 and overdose emergencies

“…However, the majority of participants in these existing studies were over the age of 30, and studies have not focused on the impact of RMG and safer supply prescribing on YPWUD, including those who have received an OUD diagnosis. Improving access to a continuum of care for these populations – ranging from comprehensive harm reduction services to abstinence-orientated treatment and recovery programming – has been identified as an urgent public health priority globally ( Bagley et al 2021 ; Canêdo et al, 2022 ; Hadland et al, 2018 ; Ingoglia, 2020 ; Winhusen et al, 2020 ). We undertook this qualitative study to examine how RMG prescriptions of hydromorphone tablets specifically shaped YPWUD's substance use and care trajectories.…”