Medications for treating opioid use disorder are effective therapeutic approaches for adults, but we know significantly less about their use among youth. This study suggests that youth receiving pharmacotherapy were substantially less likely to discontinue treatment and behavioral services and remained in treatment up to four times longer than youths receiving behavioral treatment alone.
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Pharmacotherapies for opioid use disorder (buprenorphine, methadone, naltrexone) are effective lifesaving therapies that promote successful treatment and enhance recovery outcomes. However, few studies have investigated these medications and their relationship to treatment outcomes among young adult and adolescent populations. Treatment drop-out is relatively high in young adults and adolescents, and these medications have the potential to promote treatment retention (completing treatment rather than dropping out). The current study assessed the prevalence of medication receipt and its relationship to treatment retention among adolescent and young adult Medicaid patients with opioid use disorder.
The authors conducted a study of treatment and heath-related data from the Truven-IBM Watson Health MarketScan Medicaid Database, which included medical claims for 2.4 million adolescents and young adults ages 13 to 22. Data were collected between January 2014 and December 2015, and represented 11 deidentified U.S. states (all census regions). The study sample included 4,837 adolescents and young adults (median age of 20; 57% female; 76% white) initiating a new treatment episode for opioid use disorder, which was defined as at least 1 inpatient or emergency department insurance claim or 2 outpatient insurance claims. Participants had a primary or secondary opioid use disorder diagnosis (i.e. opioid dependence determined with the International Classification of Diseases, Ninth Revision (ICD-9)), had at least three months of data after diagnosis, and were enrolled in a Medicaid insurance plan. Investigation focused on two types of treatment for opioid use disorder: pharmacotherapy and behavioral health services. Behavioral health services were defined as outpatient, partial hospitalization, and residential/inpatient treatment. Pharmacotherapy included buprenorphine (either with naloxone (Suboxone) or without naloxone (Subutex); here we refer to buprenorphine as ‘Suboxone’ since this formulation is more commonly prescribed than Subutex), naltrexone (oral or long-acting injectable naltrexone), and methadone. In the U.S. Suboxone treatment is approved for individuals age 16 and older, whereas methadone and naltrexone are largely limited to the treatment of individuals 18 and older.
The authors first assessed (1) the prevalence of addiction treatment within 3 months of receiving an opioid use disorder diagnosis (i.e. “timely” addiction treatment). Among those with timely addiction treatment, the researchers also compared the effects of pharmacotherapy (with or without behavioral treatment) versus behavioral treatment alone on (2) retention in treatment (any addiction treatment and behavioral health services) and (3) duration of care. Retention in treatment was defined as the time from initial to final treatment claim and discontinuation of treatment was defined as no treatment claims for 60 or more consecutive days. Analyses controlled for several sociodemographic factors, including age at diagnosis, sex, race/ethnicity, Medicaid eligibility, pregnancy, depression, anxiety disorder, attention-deficit/hyperactivity disorder, other (non-opioid) substance use disorders, and pain conditions. They also controlled for the level of care received (i.e. outpatient vs. inpatient vs. partial hospitalization) to ensure that they were capturing the effects of medication treatment without the influence of other factors.
About 76% of adolescents and young adults received addiction treatment within 3 months of receiving an opioid use disorder diagnosis.
Figure 1.
Among those who received timely addiction treatment, 71% discontinued treatment. But receipt of opioid use disorder medication was associated with increased likelihood of addiction treatment and behavioral health service retention.
Among those who received timely care, retention in any addiction treatment service and retention in behavioral health services was longer in those who received medication (with or without behavioral treatment) than those who received behavioral treatment only.
Figure 2.
This study lends insight to the clinical approaches that are most helpful for adolescents and young adults with opioid use disorder. Although 75% of this population appears to receive treatment within 3 months of a diagnosis, the majority of these individuals are using behavioral health services without opioid use disorder medication. Medication treatment, with Suboxone, methadone, or naltrexone, was associated with greater retention in addiction treatment and behavioral health services over the course of 2 years, compared to behavioral treatment alone. Median retention in care was about 66 days with behavioral treatment only, whereas retention duration was around 4X higher for methadone and 2X higher for Suboxone and naltrexone. With only about 24% of adolescents and young adults receiving these medications, a large proportion of individuals may be at increased risk for treatment discontinuation. Retention in care is a key contributor to positive addiction recovery outcomes and can substantially reduce one’s risk for overdose, with treatment and behavioral health sevices typically offering care for comorbid mental/physical health conditions and harm-reduction services, in addition to addiction-focused treatment. Although medication treatment by itself is not typically talked about as a behavioral treatment, utilizing these services often comes with patient progress check-ups and a level of clinical care, and progress. Randomized controlled trials have previously revealed the shorter-term benefits of Suboxone on treatment retention among adolescents and young adults, and the current study suggests that these benefits extend across longer periods of time and to methadone and naltrexone. Importantly, this study does not suggest that behavioral treatment is ineffective for opioid use disorder but, rather, that medication may offer benefits above and beyond behavioral health services, specifically with respect to treatment retention. With only about 2 in 5 addiction treatment programs for adolescents offering opioid use disorder medication, increased access to these services might benefit adolescent treatment seekers and program retention. However, it is not clear whether increased access would be accompanied by increased use of medication services, given that other factors like medication attitudes and perceptions could play a role in medication treatment seeking. Furthermore, as the authors mentioned, this study was unable to control for the severity of opioid use disorder, and youth with more severe disorders may have been more likely to have been prescribed pharmacotherapy and more likely to stay in treatment for longer durations, which could account for differences in retention prevalence and duration. More research is needed to help clarify these issues. Randomized controlled investigation will help to confirm the current study’s findings, determine how long these beneficial effects last, and if they translate to retention in other less formal addiction recovery services (e.g., 12-step) and across levels of severity.
Hadland, S. E., Bagley, S. M., Rodean, J., Silverstein, M., Levy, S., Larochelle, M. R., … & Zima, B. T. (2018). Receipt of Timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA pediatrics, 172(11), 1029-1037.
l
Pharmacotherapies for opioid use disorder (buprenorphine, methadone, naltrexone) are effective lifesaving therapies that promote successful treatment and enhance recovery outcomes. However, few studies have investigated these medications and their relationship to treatment outcomes among young adult and adolescent populations. Treatment drop-out is relatively high in young adults and adolescents, and these medications have the potential to promote treatment retention (completing treatment rather than dropping out). The current study assessed the prevalence of medication receipt and its relationship to treatment retention among adolescent and young adult Medicaid patients with opioid use disorder.
The authors conducted a study of treatment and heath-related data from the Truven-IBM Watson Health MarketScan Medicaid Database, which included medical claims for 2.4 million adolescents and young adults ages 13 to 22. Data were collected between January 2014 and December 2015, and represented 11 deidentified U.S. states (all census regions). The study sample included 4,837 adolescents and young adults (median age of 20; 57% female; 76% white) initiating a new treatment episode for opioid use disorder, which was defined as at least 1 inpatient or emergency department insurance claim or 2 outpatient insurance claims. Participants had a primary or secondary opioid use disorder diagnosis (i.e. opioid dependence determined with the International Classification of Diseases, Ninth Revision (ICD-9)), had at least three months of data after diagnosis, and were enrolled in a Medicaid insurance plan. Investigation focused on two types of treatment for opioid use disorder: pharmacotherapy and behavioral health services. Behavioral health services were defined as outpatient, partial hospitalization, and residential/inpatient treatment. Pharmacotherapy included buprenorphine (either with naloxone (Suboxone) or without naloxone (Subutex); here we refer to buprenorphine as ‘Suboxone’ since this formulation is more commonly prescribed than Subutex), naltrexone (oral or long-acting injectable naltrexone), and methadone. In the U.S. Suboxone treatment is approved for individuals age 16 and older, whereas methadone and naltrexone are largely limited to the treatment of individuals 18 and older.
The authors first assessed (1) the prevalence of addiction treatment within 3 months of receiving an opioid use disorder diagnosis (i.e. “timely” addiction treatment). Among those with timely addiction treatment, the researchers also compared the effects of pharmacotherapy (with or without behavioral treatment) versus behavioral treatment alone on (2) retention in treatment (any addiction treatment and behavioral health services) and (3) duration of care. Retention in treatment was defined as the time from initial to final treatment claim and discontinuation of treatment was defined as no treatment claims for 60 or more consecutive days. Analyses controlled for several sociodemographic factors, including age at diagnosis, sex, race/ethnicity, Medicaid eligibility, pregnancy, depression, anxiety disorder, attention-deficit/hyperactivity disorder, other (non-opioid) substance use disorders, and pain conditions. They also controlled for the level of care received (i.e. outpatient vs. inpatient vs. partial hospitalization) to ensure that they were capturing the effects of medication treatment without the influence of other factors.
About 76% of adolescents and young adults received addiction treatment within 3 months of receiving an opioid use disorder diagnosis.
Figure 1.
Among those who received timely addiction treatment, 71% discontinued treatment. But receipt of opioid use disorder medication was associated with increased likelihood of addiction treatment and behavioral health service retention.
Among those who received timely care, retention in any addiction treatment service and retention in behavioral health services was longer in those who received medication (with or without behavioral treatment) than those who received behavioral treatment only.
Figure 2.
This study lends insight to the clinical approaches that are most helpful for adolescents and young adults with opioid use disorder. Although 75% of this population appears to receive treatment within 3 months of a diagnosis, the majority of these individuals are using behavioral health services without opioid use disorder medication. Medication treatment, with Suboxone, methadone, or naltrexone, was associated with greater retention in addiction treatment and behavioral health services over the course of 2 years, compared to behavioral treatment alone. Median retention in care was about 66 days with behavioral treatment only, whereas retention duration was around 4X higher for methadone and 2X higher for Suboxone and naltrexone. With only about 24% of adolescents and young adults receiving these medications, a large proportion of individuals may be at increased risk for treatment discontinuation. Retention in care is a key contributor to positive addiction recovery outcomes and can substantially reduce one’s risk for overdose, with treatment and behavioral health sevices typically offering care for comorbid mental/physical health conditions and harm-reduction services, in addition to addiction-focused treatment. Although medication treatment by itself is not typically talked about as a behavioral treatment, utilizing these services often comes with patient progress check-ups and a level of clinical care, and progress. Randomized controlled trials have previously revealed the shorter-term benefits of Suboxone on treatment retention among adolescents and young adults, and the current study suggests that these benefits extend across longer periods of time and to methadone and naltrexone. Importantly, this study does not suggest that behavioral treatment is ineffective for opioid use disorder but, rather, that medication may offer benefits above and beyond behavioral health services, specifically with respect to treatment retention. With only about 2 in 5 addiction treatment programs for adolescents offering opioid use disorder medication, increased access to these services might benefit adolescent treatment seekers and program retention. However, it is not clear whether increased access would be accompanied by increased use of medication services, given that other factors like medication attitudes and perceptions could play a role in medication treatment seeking. Furthermore, as the authors mentioned, this study was unable to control for the severity of opioid use disorder, and youth with more severe disorders may have been more likely to have been prescribed pharmacotherapy and more likely to stay in treatment for longer durations, which could account for differences in retention prevalence and duration. More research is needed to help clarify these issues. Randomized controlled investigation will help to confirm the current study’s findings, determine how long these beneficial effects last, and if they translate to retention in other less formal addiction recovery services (e.g., 12-step) and across levels of severity.
Hadland, S. E., Bagley, S. M., Rodean, J., Silverstein, M., Levy, S., Larochelle, M. R., … & Zima, B. T. (2018). Receipt of Timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA pediatrics, 172(11), 1029-1037.
l
Pharmacotherapies for opioid use disorder (buprenorphine, methadone, naltrexone) are effective lifesaving therapies that promote successful treatment and enhance recovery outcomes. However, few studies have investigated these medications and their relationship to treatment outcomes among young adult and adolescent populations. Treatment drop-out is relatively high in young adults and adolescents, and these medications have the potential to promote treatment retention (completing treatment rather than dropping out). The current study assessed the prevalence of medication receipt and its relationship to treatment retention among adolescent and young adult Medicaid patients with opioid use disorder.
The authors conducted a study of treatment and heath-related data from the Truven-IBM Watson Health MarketScan Medicaid Database, which included medical claims for 2.4 million adolescents and young adults ages 13 to 22. Data were collected between January 2014 and December 2015, and represented 11 deidentified U.S. states (all census regions). The study sample included 4,837 adolescents and young adults (median age of 20; 57% female; 76% white) initiating a new treatment episode for opioid use disorder, which was defined as at least 1 inpatient or emergency department insurance claim or 2 outpatient insurance claims. Participants had a primary or secondary opioid use disorder diagnosis (i.e. opioid dependence determined with the International Classification of Diseases, Ninth Revision (ICD-9)), had at least three months of data after diagnosis, and were enrolled in a Medicaid insurance plan. Investigation focused on two types of treatment for opioid use disorder: pharmacotherapy and behavioral health services. Behavioral health services were defined as outpatient, partial hospitalization, and residential/inpatient treatment. Pharmacotherapy included buprenorphine (either with naloxone (Suboxone) or without naloxone (Subutex); here we refer to buprenorphine as ‘Suboxone’ since this formulation is more commonly prescribed than Subutex), naltrexone (oral or long-acting injectable naltrexone), and methadone. In the U.S. Suboxone treatment is approved for individuals age 16 and older, whereas methadone and naltrexone are largely limited to the treatment of individuals 18 and older.
The authors first assessed (1) the prevalence of addiction treatment within 3 months of receiving an opioid use disorder diagnosis (i.e. “timely” addiction treatment). Among those with timely addiction treatment, the researchers also compared the effects of pharmacotherapy (with or without behavioral treatment) versus behavioral treatment alone on (2) retention in treatment (any addiction treatment and behavioral health services) and (3) duration of care. Retention in treatment was defined as the time from initial to final treatment claim and discontinuation of treatment was defined as no treatment claims for 60 or more consecutive days. Analyses controlled for several sociodemographic factors, including age at diagnosis, sex, race/ethnicity, Medicaid eligibility, pregnancy, depression, anxiety disorder, attention-deficit/hyperactivity disorder, other (non-opioid) substance use disorders, and pain conditions. They also controlled for the level of care received (i.e. outpatient vs. inpatient vs. partial hospitalization) to ensure that they were capturing the effects of medication treatment without the influence of other factors.
About 76% of adolescents and young adults received addiction treatment within 3 months of receiving an opioid use disorder diagnosis.
Figure 1.
Among those who received timely addiction treatment, 71% discontinued treatment. But receipt of opioid use disorder medication was associated with increased likelihood of addiction treatment and behavioral health service retention.
Among those who received timely care, retention in any addiction treatment service and retention in behavioral health services was longer in those who received medication (with or without behavioral treatment) than those who received behavioral treatment only.
Figure 2.
This study lends insight to the clinical approaches that are most helpful for adolescents and young adults with opioid use disorder. Although 75% of this population appears to receive treatment within 3 months of a diagnosis, the majority of these individuals are using behavioral health services without opioid use disorder medication. Medication treatment, with Suboxone, methadone, or naltrexone, was associated with greater retention in addiction treatment and behavioral health services over the course of 2 years, compared to behavioral treatment alone. Median retention in care was about 66 days with behavioral treatment only, whereas retention duration was around 4X higher for methadone and 2X higher for Suboxone and naltrexone. With only about 24% of adolescents and young adults receiving these medications, a large proportion of individuals may be at increased risk for treatment discontinuation. Retention in care is a key contributor to positive addiction recovery outcomes and can substantially reduce one’s risk for overdose, with treatment and behavioral health sevices typically offering care for comorbid mental/physical health conditions and harm-reduction services, in addition to addiction-focused treatment. Although medication treatment by itself is not typically talked about as a behavioral treatment, utilizing these services often comes with patient progress check-ups and a level of clinical care, and progress. Randomized controlled trials have previously revealed the shorter-term benefits of Suboxone on treatment retention among adolescents and young adults, and the current study suggests that these benefits extend across longer periods of time and to methadone and naltrexone. Importantly, this study does not suggest that behavioral treatment is ineffective for opioid use disorder but, rather, that medication may offer benefits above and beyond behavioral health services, specifically with respect to treatment retention. With only about 2 in 5 addiction treatment programs for adolescents offering opioid use disorder medication, increased access to these services might benefit adolescent treatment seekers and program retention. However, it is not clear whether increased access would be accompanied by increased use of medication services, given that other factors like medication attitudes and perceptions could play a role in medication treatment seeking. Furthermore, as the authors mentioned, this study was unable to control for the severity of opioid use disorder, and youth with more severe disorders may have been more likely to have been prescribed pharmacotherapy and more likely to stay in treatment for longer durations, which could account for differences in retention prevalence and duration. More research is needed to help clarify these issues. Randomized controlled investigation will help to confirm the current study’s findings, determine how long these beneficial effects last, and if they translate to retention in other less formal addiction recovery services (e.g., 12-step) and across levels of severity.
Hadland, S. E., Bagley, S. M., Rodean, J., Silverstein, M., Levy, S., Larochelle, M. R., … & Zima, B. T. (2018). Receipt of Timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder. JAMA pediatrics, 172(11), 1029-1037.
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