Youths with opioid use disorder (OUD) are more likely to remain in care if they receive medications to treat the condition, but very few are receiving them, results of a retrospective cohort study suggest.
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Prescribing buprenorphine, naltrexone, or methadone soon after an OUD diagnosis in this study was associated with increased retention in care for adolescents and young adults.
However, medications were provided to just 1 in 4 youths overall in the study, and only 1 in 21 adolescents, according to Scott E. Hadland, MD, MPH, MS, of Grayken Center for Addiction and Department of Pediatrics, Boston Medical Center, and coinvestigators.
These findings highlight a crucial need to improve care of youths with opioid use disorder (OUD) and enhance retention in treatment, Dr. Hadland and coauthors said in JAMA Pediatrics.
“As deaths from overdose increase among U.S. youths, it is vital that clinicians, researchers, and policy makers ensure that access to evidence-based OUD medications for young people remains a national priority,” they said. Their study, based on Medicaid enrollment and claims data from 11 states, included 4,837 youths aged 13-22 years with a diagnosis of OUD. The median age at diagnosis was 20 years, and 2,752 of the youths were female.
Timely buprenorphine, naltrexone, or methadone were received by just 34 out of 728 adolescents (4.7%) and 1,105 out of 4,109 young adults (27%). Most received buprenorphine (82%), while 12% got naltrexone and 6% got methadone. Treatment was considered timely if received within 3 months, and most patients received this treatment within 1 month.
Dr. Scott E. Hadland
Youths who received timely OUD medications were more likely to be retained in addiction treatment, the investigators found. Median retention in care was 67 days for youths who received behavioral health services only, compared with 123 days for those who received buprenorphine, 150 days for naltrexone, and 324 days for methadone.
Youths receiving buprenorphine were 42% less likely to discontinue addiction treatment, compared with those receiving behavioral services only, while those receiving naltrexone were 46% less likely to discontinue, and those receiving methadone were 68% less likely to discontinue.
Similarly, median duration of behavioral health services was longer for youths who received OUD medications versus those who did not, they added.
Retention in care is critical to successful addiction treatment, according to Dr. Hadland and coauthors.“Even when patients do not reduce their substance use, individuals engaged and retained in care can receive harm-reduction services and treatment of comorbid medical and psychiatric conditions.”
The benefit of that approach is affirmed by results of a recent meta-analysis in adults showing that staying in treatment was associated with reduced all-cause mortality and mortality from overdose, they said.
Dr. Hadland and coauthors reported no conflicts of interest related to the study. Researchers were supported by grants from the National Institutes of Health/National Institute on Drug Abuse (NIH/NIDA), a grant from the NIH/Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Thrasher Research Fund Early Career Award, and the Academic Pediatric Association Young Investigator Award.
SOURCE: Hadland SE, et al. JAMA Pediatr. 2018 Sep 10. doi:10.1001/jamapediatrics.2018.2143.