As opioid use disorder (OUD) has continued to increase across the United States, only one in four young adults and teenagers with OUD have received treatment, according to a new Boston Medical Center (BMC) study published online in JAMA Pediatrics.
One of the benefits of buprenorphine and naltrexone, two relatively new medications that can help prevent relapse and overdose, is that they can be obtained from primary care providers — unlike methadone. In late 2016, the American Academy of Pediatrics recommended, for the first time, that providers offer medication treatment to adolescents with OUD.
Yet, most young adults and teens with AUD are not receiving medication-assisted treatment (MAT), the researchers found. The most common reason is a nationwide shortage of priamrty care physcians who have received a waiver or certification to preascribe buprenorphine.
Research has shown that among all adults in treatment for opioids, one-third first used opioids before age 18, and two-thirds started before age 25.
“We know that experimentation with opioids often begins in adolescence, and early signs of addiction most commonly emerge in the teenage years or early 20s,” said Scott Hadland, MD, MPH, MS, pediatrician and addiction specialist at BMC who led the study. “It is critical that providers caring for young people intervene early in the evolution of addiction and provide effective treatment with medication which can potentially prevent a lifetime of harm.”
Researchers studied nearly 21,000 teens and young adults aged 13-25 across the U.S. who had been diagnosed with OUD between 2001 and 2014 and tracked whether or not they received buprenorphine or naltrexone within six months of their diagnosis. They found that 27 percent were given a medication within six months, and buprenorphine was dispensed eight times more often than naltrexone. Also, diagnoses for OUD increased almost 600 percent from 2001 to 2014.
The study also found some disparities in access to MAT, based on sociodemographic factors. Patients who were younger or female were less likely to receive pharmacotherapy in adjusted analyses. In addition, non-Hispanic black or Hispanic youth were less likely to receive medication compared with white youth. The researchers said that while the reasons for these gender and race differences are unknown, they may involve access issues, denial of care or provider bias.
“Prior studies have shown that poorer access to substance use treatment among minorities is in part explained by disparities in health insurance coverage,” the authors wrote. “However, our results indicate that, even with coverage, non-Hispanic black and Hispanic youth are less likely than non-Hispanic white youth to receive medications for OUD.”
“Amidst emerging recommendations calling for expanded access to pharmacotherapy for youth with [OUD], medications may have been historically underutilized and disparities may exist by age, sex, and race/ethnicity,” Hadland and colleagues said in a statement. Teens were much less likely than young adults to receive MAT, with less than 1 in 50 teens aged 13-15 and 1 in 10 teens aged 16-17 provided buprenorphine or naltrexone.
“Our study highlights a critical gap in addiction treatment for teens and young adults. We need tangible strategies to expand access to medications that do not worsen the gender and racial disparities we observed,” said Hadland, who is also an assistant professor of pediatrics at Boston University School of Medicine. “It’s imperative that access to addiction treatment is widespread and equitable.”
In a related editorial, Brendan Saloner, PhD, an assistant professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, and colleagues cited an urgent need to improve access to MAT for all patients with OUD.
They note that fatal drug overdoses increased 3.5-fold for youth aged 15 to 24 years from 1999 to 2014. “Amidst this epidemic, relatively little is known about how primary care clinicians treat youth with OUD,” Saloner and associates wrote. “These findings suggest that provision of MAT is not keeping up with the growing need for these treatments among youth.”
They note that evidence from two trials has suggested that opioid-dependent adolescents receiving MAT are more likely to remain in treatment and less likely to resort to injectable drugs.
There is widespread misinformation and stigmatization around MAT, they wrote, which needs to be addressed before positive change can take place. “The discourse surrounding ‘opioid substitution’ has created a misconception among both patients and prescribers that medications simply ‘substitute one addiction for another’ rather than treating the underlying disorder.”
To broaden access to MAT, the researchers called for adding capacity in pediatric primary care and equipping more physicians with the knowledge and support to prescribe MAT. They also suggest developing better links between pediatricians and family physicians and specialized opioid treatment programs.