Younger people, females, black or Hispanic less likely to have medication.
While there is still a great debate about how opioid use disorder (OUD) should be treated, more experts are coming to the conclusion that pharmacotherapy access must be expanded. However, there remain several disparities in race, sex, and age that dictate who receives medication.
This is according to a new study from JAMA pediatrics, “Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder among Adolescents and Young Adults, 2001-2014.” The national retrospective cohort study looked at 20,822 young people aged 13 to 25 years with OUD.
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OUD is characterized by a problematic pattern of opioid use. It encompasses opioid addiction and dependency and often begins in adolescence or young adulthood, with 7.8% of high schoolers reporting lifetime opioid misuse. Two-thirds of OUD patients used before the age of 25, and a third used before age 18. Many experts advocate for early pharmacological intervention. Overall, only about 1 in 12 young adults receive treatment for any kind of addiction.
The study looked at the rates of buprenorphine and naltrexone prescription, since both can be offered in primary care and subspecialty settings. There have been issues surrounding naltrexone, and it is less commonly prescribed than buprenorphine. However, only 1% of pediatricians have the certification to prescribe buprenorphine.
About one in four youth, 26.8%, received either buprenorphine or naltrexone within 6 months of diagnosis. From 2002 to 2009, respectively the lowest (3%) and highest years (31.8%) of youth OUD medication rates, rates increased over 10 times. In 2014, the most recent year studied, the rate was 27.5%.
The younger the patient, the less likely he or she was to receive medication for OUD. For patients under 16, the group with the lowest rates (1.4%), this can be explained by the fact that buprenorphine is not approved for patients under 16. However, patients 16 to 17 were the next lowest group (9.7%). Patients 18 to 20 years had a 22% rate and patients 21 to 25 had a rate of 30.5%.
Females, blacks, and Hispanics were less likely to receive medication than non-Hispanic white males. 24.4% of males received medication while only 20.3% of females did and23.1% of non-Hispanic whites received medication, compared to 14.8% of non-Hispanic blacks and 20% of Hispanics.
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To help fix these problems, the authors recommend exploring strategies to increase access to evidence-based treatments. One of these strategies is to increase the number of addiction subspecialists, since pediatricians and family physicians have new opportunities to become certified. But because rates of OUD are so high among youth, the study also recommends using pharmacotherapy in pediatric primary care settings.
“In the face of a worsening opioid crisis in the United States,” the authors say, “strategies to expand the use of pharmacotherapy for adolescents and young adults are greatly needed, and special care is warranted to ensure equitable access for all affected youth to avoid exacerbating health disparities.”