Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Abstract

Aim First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high‐risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high‐risk opioid use among youth. After full‐text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost‐effectiveness for opioid agonist treatment than abstinence‐based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions From the limited findings, there is no evidence to deny youth with high‐risk opioid use the same treatment options available to adults. A combination of pharmacological and youth‐specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.

Weaving community-based participatory research and co-design to improve opioid use treatments and services for youth, caregivers, and service providers

“…Current guidelines to treat opioid use disorder (OUD) among youth include a combination of pharmacological (e.g., OAT) and psychosocial (e.g., cognitive behavioral therapy) interventions, as well as family-oriented treatments and long-term recovery services [30]. Yet, youth experience a number of barriers when trying to access these services, including age-based restrictions [31,32], service provider hesitancy to prescribe OAT to youth [33,34], a lack of confidentiality and privacy [32,35], and limited youth-friendly service options [32,34,36,37], which may explain why youth are less likely to access or remain engaged in opioid use treatments/services compared to adults [38][39][40][41]. Several qualitative studies have found that youth often feel unsafe accessing adult-oriented harm reduction services (e.g., safe consumption sites, OAT), which can prevent them from accessing life-saving programs [32,34,42].…”

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

“…These medications are effective in reducing symptoms of opioid withdrawal and craving, overdose risk, mortality, and morbidity (Mattick et al, 2009(Mattick et al, , 2014Sordo et al, 2017;Strang et al, 2020). Although empirical studies on the effectiveness of OAT in youth are limited, emerging research suggests it is beneficial (Camenga et al, 2019;Pilarinos et al, 2022;Westenberg et al, 2021) Addictions, 2018;Krausz et al, 2022).…”

“…These medications are effective in reducing symptoms of opioid withdrawal and craving, overdose risk, mortality, and morbidity (Mattick et al, 2009, 2014; Sordo et al, 2017; Strang et al, 2020). Although empirical studies on the effectiveness of OAT in youth are limited, emerging research suggests it is beneficial (Camenga et al, 2019; Pilarinos et al, 2022; Westenberg et al, 2021), and clinical guidance recommends its delivery to youth (American Academy of Pediatrics Committee On Substance Use and Prevention, 2016; British Columbia Centre on Substance Use, B.C. Ministry of Health, & B.C.…”

Improving Treatment Together: a protocol for a multi-phase, community-based participatory, and co-design project to improve youth opioid treatment service experiences in British Columbia

“…However, the effectiveness of this range of interventions remains largely understudied among youth using opioids [ 14 , 23 , 24 ]. Emerging evidence also suggests that youth encounter barriers to seeking and remaining in opioid treatment services [ 26 – 28 ].…”