Opioid agonist treatments (i.e., methadone & buprenorphine) are evidenced-based protocols that have been shown to prevent overdose and increase remission rates, but do adolescents have equal access?
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Between 1992 and 2012, the prevalence of opioid misuse and opioid use disorder doubled among adolescents, although more recent trends are declining. Opioid agonist treatment (i.e., medicated assisted treatment or MAT) is a life-saving treatment for opioid use disorder that can prevent lethal overdose and reduce injection drug use. The effectiveness of opioid agonist therapies has been well investigated among adults but is less studied among adolescents. Recently, the American Academy of Pediatrics recommended that pediatricians consider opioid-agonist treatment for adolescents with severe opioid use disorders describing it as “underused” and “severely restricted.” This study aimed to fill the knowledge gap regarding the extent of opioid agonist treatment use among adolescents treated for opioid use disorder in the US and compare the results to adults.
This study used secondary data analysis from the 2013 Treatment Episode Data Set (TEDS), a federal database of state administrative records on substance use disorder treatment episodes that occur in publicly funded facilities. Participants data were included if they received opioid agonist treatment as defined by methadone or buprenorphine (but not naltrexone) to treat heroin, nonprescription use of methadone, or other opiates at a specialty treatment facility. Five states, and an additional 5.5% of the records, were excluded for not providing the data included in the analysis. The final sample included 139,092 first treatment episodes. Adolescents comprised 2.2% of the sample of episodes, including 1.1% of episodes of treatment for heroin use and 3.2% of episodes of treatment for all other opioids.
This study compared the proportions of adolescents and adults who received opioid agonist treatment by heroin use disorder versus other opioid use disorders. For heroin use disorder, 2.4% (n=18) of the 761 adolescents received opioid agonist treatment compared to 26.3% (n=17,380) of 66,074 adults. For patients with an other opioid use disorder, 0.4% (n=9) of 2,325 adolescents received opioid agonist treatment compared to 12% (n=8,363) of 69,932 adults (see figure below).
Other factors that could affect the likelihood of receiving opioid agonist treatment were also compared. Specifically, adolescents were less likely than adults to be homeless, were more likely to report using more substances at admission, and were more likely to be referred by the criminal justice system. For example, 40.8% of adolescents compared to 22.7% of adults in treatment for an other opioid use disorder were referred through criminal justice. After adjusting the comparisons between adolescents versus adults who receive opioid agonist treatment for confounding variables (i.e, gender, race-ethnicity, number of substances used, referral source, and housing status), the results remained highly similar.
Opioid use disorder is a lethal chronic health condition. Opioid agonist treatments can prevent cravings, mitigate withdrawal symptoms, and block the effects of other opioid drugs. The availability of opioid agonist treatments has changed the trajectory of the disorder resulting in fewer deaths, HIV infections, less drug use, and increased remission rates and improved quality of life. Among adolescents, opioid agonist treatment has been shown to be a helpful treatment for increasing remission rates.
This study has found that opioid agonist treatment is rarely used for adolescents and access to this treatment is highly restricted in the US. In general, adolescents and emerging adults have lower rates of treatment retention compared with adults, underscoring the need to deliver developmentally appropriate evidenced based protocols to improve health and quality of life.
Future research should identify the barriers that restrict access to opioid agonist treatments for adolescents and adults and identify for whom opioid agonist therapies may be contraindicated.
Feder, K. A., Krawcyk, N., Saloner, B. (2017). Medicated-assisted treatment for adolescents in specialty treatment for opioid use disorder. Journal of Adolescent Health, June 60(6), 747-750.
l
Between 1992 and 2012, the prevalence of opioid misuse and opioid use disorder doubled among adolescents, although more recent trends are declining. Opioid agonist treatment (i.e., medicated assisted treatment or MAT) is a life-saving treatment for opioid use disorder that can prevent lethal overdose and reduce injection drug use. The effectiveness of opioid agonist therapies has been well investigated among adults but is less studied among adolescents. Recently, the American Academy of Pediatrics recommended that pediatricians consider opioid-agonist treatment for adolescents with severe opioid use disorders describing it as “underused” and “severely restricted.” This study aimed to fill the knowledge gap regarding the extent of opioid agonist treatment use among adolescents treated for opioid use disorder in the US and compare the results to adults.
This study used secondary data analysis from the 2013 Treatment Episode Data Set (TEDS), a federal database of state administrative records on substance use disorder treatment episodes that occur in publicly funded facilities. Participants data were included if they received opioid agonist treatment as defined by methadone or buprenorphine (but not naltrexone) to treat heroin, nonprescription use of methadone, or other opiates at a specialty treatment facility. Five states, and an additional 5.5% of the records, were excluded for not providing the data included in the analysis. The final sample included 139,092 first treatment episodes. Adolescents comprised 2.2% of the sample of episodes, including 1.1% of episodes of treatment for heroin use and 3.2% of episodes of treatment for all other opioids.
This study compared the proportions of adolescents and adults who received opioid agonist treatment by heroin use disorder versus other opioid use disorders. For heroin use disorder, 2.4% (n=18) of the 761 adolescents received opioid agonist treatment compared to 26.3% (n=17,380) of 66,074 adults. For patients with an other opioid use disorder, 0.4% (n=9) of 2,325 adolescents received opioid agonist treatment compared to 12% (n=8,363) of 69,932 adults (see figure below).
Other factors that could affect the likelihood of receiving opioid agonist treatment were also compared. Specifically, adolescents were less likely than adults to be homeless, were more likely to report using more substances at admission, and were more likely to be referred by the criminal justice system. For example, 40.8% of adolescents compared to 22.7% of adults in treatment for an other opioid use disorder were referred through criminal justice. After adjusting the comparisons between adolescents versus adults who receive opioid agonist treatment for confounding variables (i.e, gender, race-ethnicity, number of substances used, referral source, and housing status), the results remained highly similar.
Opioid use disorder is a lethal chronic health condition. Opioid agonist treatments can prevent cravings, mitigate withdrawal symptoms, and block the effects of other opioid drugs. The availability of opioid agonist treatments has changed the trajectory of the disorder resulting in fewer deaths, HIV infections, less drug use, and increased remission rates and improved quality of life. Among adolescents, opioid agonist treatment has been shown to be a helpful treatment for increasing remission rates.
This study has found that opioid agonist treatment is rarely used for adolescents and access to this treatment is highly restricted in the US. In general, adolescents and emerging adults have lower rates of treatment retention compared with adults, underscoring the need to deliver developmentally appropriate evidenced based protocols to improve health and quality of life.
Future research should identify the barriers that restrict access to opioid agonist treatments for adolescents and adults and identify for whom opioid agonist therapies may be contraindicated.
Feder, K. A., Krawcyk, N., Saloner, B. (2017). Medicated-assisted treatment for adolescents in specialty treatment for opioid use disorder. Journal of Adolescent Health, June 60(6), 747-750.
l
Between 1992 and 2012, the prevalence of opioid misuse and opioid use disorder doubled among adolescents, although more recent trends are declining. Opioid agonist treatment (i.e., medicated assisted treatment or MAT) is a life-saving treatment for opioid use disorder that can prevent lethal overdose and reduce injection drug use. The effectiveness of opioid agonist therapies has been well investigated among adults but is less studied among adolescents. Recently, the American Academy of Pediatrics recommended that pediatricians consider opioid-agonist treatment for adolescents with severe opioid use disorders describing it as “underused” and “severely restricted.” This study aimed to fill the knowledge gap regarding the extent of opioid agonist treatment use among adolescents treated for opioid use disorder in the US and compare the results to adults.
This study used secondary data analysis from the 2013 Treatment Episode Data Set (TEDS), a federal database of state administrative records on substance use disorder treatment episodes that occur in publicly funded facilities. Participants data were included if they received opioid agonist treatment as defined by methadone or buprenorphine (but not naltrexone) to treat heroin, nonprescription use of methadone, or other opiates at a specialty treatment facility. Five states, and an additional 5.5% of the records, were excluded for not providing the data included in the analysis. The final sample included 139,092 first treatment episodes. Adolescents comprised 2.2% of the sample of episodes, including 1.1% of episodes of treatment for heroin use and 3.2% of episodes of treatment for all other opioids.
This study compared the proportions of adolescents and adults who received opioid agonist treatment by heroin use disorder versus other opioid use disorders. For heroin use disorder, 2.4% (n=18) of the 761 adolescents received opioid agonist treatment compared to 26.3% (n=17,380) of 66,074 adults. For patients with an other opioid use disorder, 0.4% (n=9) of 2,325 adolescents received opioid agonist treatment compared to 12% (n=8,363) of 69,932 adults (see figure below).
Other factors that could affect the likelihood of receiving opioid agonist treatment were also compared. Specifically, adolescents were less likely than adults to be homeless, were more likely to report using more substances at admission, and were more likely to be referred by the criminal justice system. For example, 40.8% of adolescents compared to 22.7% of adults in treatment for an other opioid use disorder were referred through criminal justice. After adjusting the comparisons between adolescents versus adults who receive opioid agonist treatment for confounding variables (i.e, gender, race-ethnicity, number of substances used, referral source, and housing status), the results remained highly similar.
Opioid use disorder is a lethal chronic health condition. Opioid agonist treatments can prevent cravings, mitigate withdrawal symptoms, and block the effects of other opioid drugs. The availability of opioid agonist treatments has changed the trajectory of the disorder resulting in fewer deaths, HIV infections, less drug use, and increased remission rates and improved quality of life. Among adolescents, opioid agonist treatment has been shown to be a helpful treatment for increasing remission rates.
This study has found that opioid agonist treatment is rarely used for adolescents and access to this treatment is highly restricted in the US. In general, adolescents and emerging adults have lower rates of treatment retention compared with adults, underscoring the need to deliver developmentally appropriate evidenced based protocols to improve health and quality of life.
Future research should identify the barriers that restrict access to opioid agonist treatments for adolescents and adults and identify for whom opioid agonist therapies may be contraindicated.
Feder, K. A., Krawcyk, N., Saloner, B. (2017). Medicated-assisted treatment for adolescents in specialty treatment for opioid use disorder. Journal of Adolescent Health, June 60(6), 747-750.
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