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    Why are teens not being treated for opioid use disorders?

    As the prevalence of opioid use disorders among teenagers and young adults increases, the amount of medications dispensed to treat those disorders is dropping, according to a new report published in JAMA Pediatrics.

    Only about a quarter of teenagers and young adults are treated with pharmacotherapy, and there are significant disparities across gender, age, and ethnicities in regard to trends in dispensing.

    Deaths from drug overdoses tripled from 2000 to 2014, with the majority rooted in prescription opioid and heroin use. Opioid use disorder (OUD) often starts in adolescence and young adulthood, and early intervention is key to heading off a cascade into lifelong addiction. No previous studies have examined to what extent adolescents and young adults struggling with OUDs receive pharmacologic support including medications such as buprenorphine and naltrexone.

    The study was conducted using data on 9.7 million teenagers and young adults aged 13 to 25 years collected from a national commercial insurance database from 2001 through 2014. Researchers identified which individuals in the study group received either buprenorphine or naltrexone in the first 6 months following diagnosis of an OUD.

    Of the 20,882 teenagers and adolescents in the study identified with an OUD, 65.8% were male; 82.2% were non-Hispanic white; and the mean age was 21 years at first diagnosis.

    Researchers found that the diagnosis rate of OUDs among adolescents and young adults increased 6-fold over the study period, and medication receipt increased 10-fold, from 3% in 2002 to 31.8% in 2009, then dropping to 27.5% by 2014. A little more than a quarter—26.8%—of the teenagers and young adults studied were dispensed a pharmacologic treatment within 6 months of diagnosis, according to the report. Most—89.2%—were prescribed buprenorphine, while 10.8% were given naltrexone. Age played a role, too, and researchers found that younger patients were less likely to receive medication to treat OUD, with just 1.4% of 13- to 15-year-olds receiving medication compared with 9.7% of 16- to 17-year-olds; 22% of 18- to 20-year-olds; and 30.5% of 21- to 25-year-olds.

    The study found that teenagers aged younger than 16 years were the least likely to be prescribed medication to treat OUD, or receive treatment in general. Researchers note that fewer than 1 in 3 specialty drug treatment programs in the country enroll adolescents, and pediatricians who prescribe buprenorphine are rare.

    Females were also less likely to receive medications, with 20.3% of females receiving medication compared with 24.4% of males. Racial disparities were identified as well, with 14.8% of non-Hispanic blacks receiving medication compared with 20% of Hispanic adolescents and young adults and 23.1% of non-Hispanic whites.

    The treatment gap among Hispanic and black teenagers and young adults is significant. Researchers found that even with appropriate insurance coverage, Hispanic and black adolescents and young adults are less likely than their white counterparts to receive medications for OUDs, and treatment rates in general were significantly lower, with 6.9% of blacks and 8.5% of Hispanics receiving treatment compared with 10.7% of whites. When treatment is offered, these populations also have barriers to completion, with only half of black and Hispanic teenagers and young adults completing treatment programs.



    Recommended: Looking at the opioid epidemic in pediatrics

    The report also brings attention to the disturbing trend of a decrease in pharmacotherapy to treat OUD at the same time that opioid use diagnoses and health insurance coverage under the Affordable Care Act (ACA) were increasing.

    “Both of these forces likely resulted in an expansion in the number of youth in OUD care, which may not have been accompanied by improved access to medications,” the study notes. “National data preceding the ACA suggest that those with commercial insurance are less likely to receive addiction treatment (with or without pharmacotherapy) than are those with public insurance. In the face of changing national health insurance policies, further studies are needed to understand differences in diagnosis and treatment between commercially and publicly insured adolescents and young adults with OUD.”

    NEXT: Improving the treatment

    Rachael Zimlich, RN
    Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare ...


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