Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014

Abstract

IMPORTANCE Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy.OBJECTIVE To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt.EXPOSURES Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. MAIN OUTCOMES AND MEASURESDispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis.RESULTS Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). CONCLUSIONS AND RELEVANCEIn this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.

Evidence on the Effectiveness of Heroin-Assisted Treatment

“…While the availability of medication treatment has increased substantially over the past decade, significant and persistent gaps have been well-documented, particularly in the U.S. context (Feder et al, 2017;Hadland et al, 2017;Jones et al, 2015;Morgan et al, 2018;Romo et al, 2018;Saloner and Karthikeyan, 2015). Estimates using 2012 U.S. data place the gap between treatment need and treatment capacity at nearly one million persons out of an estimated 2.3 million individuals with past-year opioid abuse or dependence (Jones et al, 2015), with evidence suggesting more pronounced disparities in rural and socioeconomically disadvantaged counties (Stein et al, 2018).…”

Opioid Use Disorders in Adolescents—Updates in Assessment and Management

“…A large retrospective cohort study from a national commercial insurance database had similar findings [53]. They found 28% of youth ages 13 to 25 years with an opioid use disorder were started on buprenorphine or naltrexone in 2014 [53]. Within the age range of 13 to 25 years younger individuals were less likely to receive medication.…”

“…Only 18% of adolescents admitted for treatment due to heroin use in 2015 had a treatment plan that included treatment with buprenorphine/naloxone or methadone compared to 42% of adults aged 45 years and older [8]. A large retrospective cohort study from a national commercial insurance database had similar findings [53]. They found 28% of youth ages 13 to 25 years with an opioid use disorder were started on buprenorphine or naltrexone in 2014 [53].…”

Risk Factors for Overdose in Young People Who Received Substance Use Disorder Treatment

“…Our findings are consistent with the existing literature that has identified intravenous drug use and opioid use as risk factors associated with OD in previous studies of young people. Since research has demonstrated medication for opioid UD decreases OD risk, and opioid use/disorder is a risk factor for OD in young people, increased research is needed to identify and address barriers to the underutilization of medication for opioid UD in young people …”