Receipt of medications for opioid use disorder among youth engaged in primary care: data from 6 health systems

Angela J. Silva,Bethann M. Pflugeisen ,Gwen T. Lapham ,Mary Akolsile,Joseph E. Glass,Angela L. Stotts,Jordan M. Braciszewski,Rebecca C. Rossom,Katharine A. Bradley,Denise M. Boudreau,Mark T. Murphy,Jane M. Liebschutz,Jeffrey H. Samet,Brian K. Ahmedani,Gavin Bart,Ingrid A. Binswanger,Bobbi Jo H. Yarborough,Laura J. Chavez ,Robert P. Schwartz,Sarah M. Bagley,Thomas F. Northrup,Andrew J. Saxon,Viviana E. Horigian,Cynthia I. Campbell,José Szapocznik

doi:10.1186/s13722-021-00249-3

Abstract

PurposeLittle is known about prevalence and treatment of OUD among youth engaged in primary care (PC). Medications are the recommended treatment of opioid use disorder (OUD) for adolescents and young adults (youth). This study describes the prevalence of OUD, the prevalence of medication treatment for OUD, and patient characteristics associated with OUD treatment among youth engaged in PC.MethodsThis cross-sectional study includes youth aged 16–25 years engaged in PC. Eligible patients had ≥ 1 PC visit during fiscal years (FY) 2014–2016 in one of 6 health systems across 6 states. Data from electronic health records and insurance claims were used to identify OUD diagnoses, office-based OUD medication treatment, and patient demographic and clinical characteristics in the FY of the first PC visit during the study period. Descriptive analyses were conducted in all youth, and stratified by age (16–17, 18–21, 22–25 years).ResultsAmong 303,262 eligible youth, 2131 (0.7%) had a documented OUD diagnosis. The prevalence of OUD increased by ascending age groups. About half of youth with OUD had documented depression or anxiety and one third had co-occurring substance use disorders. Receipt of medication for OUD was lowest among youth 16–17 years old (14%) and highest among those aged 22–25 (39%).ConclusionsIn this study of youth engaged in 6 health systems across 6 states, there was low receipt of medication treatment, and high prevalence of other substance use disorders and mental health disorders. These findings indicate an urgent need to increase medication treatment for OUD and to integrate treatment for other substance use and mental health disorders.

Highlights

Opioid-related deaths continue to increase in the United States among adolescents and young adults [1]
We evaluated the prevalence of opioid use disorder (OUD) and office-based medication treatment for OUD in a large sample of youth and young adults aged 16–25 who received primary care (PC) in one of 6 health systems across 6 states
The objectives of this study were to describe, among youth engaged in PC, (1) the prevalence of documented OUD, (2) the prevalence of office-based medication treatment for OUD, and (3) patient characteristics associated with OUD medication treatment

Summary

Introduction

Opioid-related deaths continue to increase in the United States among adolescents and young adults (youth) [1]. Similar to the adult population, the rise in deaths is driven by illicitlymanufactured fentanyl, which is about 100 times more. Emergency department visits and intensive care unit admissions related to opioid poisonings among youth have increased [2]. Rising opioid-related deaths have led to efforts to increase access to medication for opioid use disorder (OUD) for all ages [4, 5]. Federal regulations limit access to methadone as a treatment for OUD for youth younger than 18 years, two of the FDA-approved medications for OUD (i.e., buprenorphine and naltrexone) can be prescribed in primary carethat care for youth (PC; e.g., office-based settings)

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