<scp>A</scp>ccess to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

Pilarinos, Andreas; Bromberg, Daniel J.; Karamouzian, Mohammad

doi:10.1001/jamapediatrics.2021.4606

Cited by 27 publications

(19 citation statements)

References 78 publications

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“…This similarly raises concerns of a specific bias or stigma against prescribing MOUD to adolescents versus young adults, which is reinforced by evidence that adolescent-tailored treatment facilities are significantly less likely to provide MOUD to AYA in comparison to adult facilities. 61–63 Study results signal the importance of further research into stigma towards MMT and other MOUD within nonpharmacological treatment settings, especially among adolescent populations. Additionally, there may be benefits to implementing protections to ensure access to MOUD for all AYA to address stigma-related barriers to treatment access and continuation.…”

Section: Discussionmentioning

confidence: 91%

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

et al. 2022

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Objective Retaining adolescents and young adults (AYA) in medications for opioid use disorder (MOUD), like methadone maintenance treatment (MMT), is critical to reducing toxic drug fatalities. This analysis sought to identify factors associated with MMT discontinuation among AYA. Method Data were derived from the At-Risk Youth Study, a prospective cohort study of street-involved AYA in Vancouver, Canada, between December 2005 and June 2018. Multivariable extended Cox regression identified factors associated with time to MMT discontinuation among AYA who recently initiated MMT. In subanalysis, multivariable extended Cox regression analysis identified factors associated with time to “actionable” MMT discontinuation, which could be addressed through policy changes. Results A total of 308 participants reported recent MMT during the study period. Participants were excluded if they reported MMT in the past 6 months at baseline and were retained in MMT ( n = 94, 30.5%); were missing MMT status data ( n = 43, 14.0%); or completed an MMT taper ( n = 11, 3.6%). Of the remaining 160 participants who initiated MMT over the study period, 102 (63.8%) discontinued MMT accounting for 119 unique discontinuation events. In multivariable extended Cox regression, MMT discontinuation was positively associated with recent weekly crystal methamphetamine use (adjusted hazard ratio [AHR] = 1.67, 95% confidence interval [CI]: 1.19 to 2.35), but negatively associated with age of first “hard” drug use (per year older) (AHR = 0.95, 95% CI: 0.90 to 1.00) and female sex (AHR = 0.66, 95% CI: 0.44 to 0.99). In subanalysis, recent weekly crystal methamphetamine use (AHR = 4.61, 95% CI: 1.78 to 11.9) and weekly heroin or fentanyl use (AHR = 3.37, 95% CI: 1.21 to 9.38) were positively associated with “actionable” MMT discontinuation, while older age (AHR = 0.87, 95% CI: 0.76 to 0.99) was negatively associated. Conclusions Efforts to revise MMT programming; provide access to a range of MOUD, harm reduction, and treatments; and explore coprescribing stimulants to AYA with concurrent stimulant use may improve treatment retention and reduce toxic drug fatalities.

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Section: Discussionmentioning

confidence: 91%

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

et al. 2022

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“…Prior studies have revealed that young people might be less likely to come in contact with care due to unique fears not facing adults, including concerns about involuntary detention, or disclosure of their substance use to family members [45,46]. Youth are known to encounter stigma in seeking OAT [47] and OAT dispensations are lower in youth compared to adults [48]. In addition to efforts to expand accessibility of OAT for youth, youth advocates have recently called for a movement away from abstinence-based approaches, and ensuring the availability of confidential, peer-led interventions [49].…”

Section: Discussionmentioning

confidence: 99%

Stimulant use disorder diagnosis and opioid agonist treatment dispensation following release from prison: a cohort study

Palis

Zhao²,

Young³

et al. 2022

Subst Abuse Treat Prev Policy

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Background Concurrent opioid and stimulant use is on the rise in North America. This increasing trend of use has been observed in the general population, and among people released from prison in British Columbia (BC), who face an elevated risk of overdose post-release. Opioid agonist treatment is an effective treatment for opioid use disorder and reduces risk of overdose mortality. In the context of rising concurrent stimulant use among people with opioid use disorder, this study aims to investigate the impact of stimulant use disorder on opioid agonist treatment dispensation following release from prison in BC. Methods Linked health and corrections records were retrieved for releases between January 1st 2015 and December 29th 2018 (N = 13,380). Hospital and primary-care administrative health records were used to identify opioid and stimulant use disorder and mental illness. Age, sex, and health region were derived from BC’s Client Roster. Incarceration data were retrieved from provincial prison records. Opioid agonist treatment data was retrieved from BC’s provincial drug dispensation database. A generalized estimating equation produced estimates for the relationship of stimulant use disorder and opioid agonist treatment dispensation within two days post-release. Results Cases of release among people with an opioid use disorder were identified (N = 13,380). Approximately 25% (N = 3,328) of releases ended in opioid agonist treatment dispensation within two days post-release. A statistically significant interaction of stimulant use disorder and mental illness was identified. Stratified odds ratios (ORs) found that in the presence of mental illness, stimulant use disorder was associated with lower odds of obtaining OAT [(OR) = 0.73, 95% confidence interval (CI) = 0.64–0.84)] while in the absence of mental illness, this relationship did not hold [OR = 0.89, 95% CI = 0.70–1.13]. Conclusions People with mental illness and stimulant use disorder diagnoses have a lower odds of being dispensed agonist treatment post-release compared to people with mental illness alone. There is a critical need to scale up and adapt opioid agonist treatment and ancillary harm reduction, and treatment services to reach people released from prison who have concurrent stimulant use disorder and mental illness diagnoses.

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…This includes psychosocial and pharmacological treatment, harm reduction, and long-term supports that are tailored to youths' needs and preferences [10,11]. While youth-focused research on opioid use treatment is scant and emerging [12], the available evidence has consistently shown worrisome disparities in youths' engagement with such treatments [13][14][15][16][17][18][19][20]. For instance, a recent systematic review found that youth were less likely to access medications for opioid use disorder (MOUD; e.g., methadone, buprenorphine) than other age groups, with MOUD access further differentiated by broader structural inequities, such as race and socioeconomic status [15].…”

Section: Introductionmentioning

confidence: 99%

“…While youth-focused research on opioid use treatment is scant and emerging [12], the available evidence has consistently shown worrisome disparities in youths' engagement with such treatments [13][14][15][16][17][18][19][20]. For instance, a recent systematic review found that youth were less likely to access medications for opioid use disorder (MOUD; e.g., methadone, buprenorphine) than other age groups, with MOUD access further differentiated by broader structural inequities, such as race and socioeconomic status [15]. This gap appears to persist even after youth experience non-fatal drug toxicity events, as demonstrated by a recent population-based study where close to 70% of youth received no treatment within 30 days of such an event [17].…”

Section: Introductionmentioning

confidence: 99%

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“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

Marchand

Turuba

Katan

et al. 2023

Addict Sci Clin Pract

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Background Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. Methods This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers’ (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. Results Three overarching themes were identified, reflecting service providers’ goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers’ priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. Conclusion These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths’ needs (micro-level).

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Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

Cited by 27 publications

References 78 publications

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

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

Stimulant use disorder diagnosis and opioid agonist treatment dispensation following release from prison: a cohort study

“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

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