Adolescents and young adults are less likely to be prescribed medications for opioid use disorder (MOUD) compared with older adults, with access barriers linked to Black race, Hispanic and Latino ethnicity, living in the South, and involvement in the criminal justice system, according to findings reported in JAMA Pediatrics.
“As someone who has worked on the frontlines of the overdose crisis, I believe that urgent action is needed to address these critical access gaps,” said lead author Andreas Pilarinos, MPP, a PhD Candidate at the University of British Columbia. The authors emphasized the need to address prescriber reluctance and broaden the range of medications available to young people with opioid use disorder.
Although MOUD are linked to positive outcomes in teens and young adults and are recommended by the American Academy of Pediatrics, experts have raised concerns about access to these medications in these age groups. The present study was designed to investigate barriers to access and factors that may improve access to treatment for opioid use disorder in this population.
Large, Systematic Review
The study authors reviewed 37 studies examining access to MOUD among nearly 180,000 adolescents and young adults; a majority of the studies (65%) were conducted in the United States. The study participants were mainly White (84%) and women (85%) and the research involved methadone (30 studies), buprenorphine (26 studies), and naltrexone (10 studies).
In addition to examining MOUD access among young people, the researchers identified 3 studies that examined access to MOUD within treatment facilities, all of which were conducted in the US. One of these studies showed that access to MOUD was lower in adolescents (13.2%) versus adults (41.5%) in cash-only treatment facilities, and another that found higher levels of buprenorphine-naloxone (11.8%) and naltrexone (16.3%) prescription versus methadone (1.3%) prescription across adolescent-specific facilities.
The following are a summary of key clinical findings:
- Adolescents and young adults were less likely to be provided with any medication for opioid use disorder compared with adults
- In a US-based study, older age was linked to a 3.29 greater likelihood of buprenorphine prescription compared with younger age
- Adolescents were more likely to be provided with naltrexone and/or buprenorphine than methadone, despite the heightened overdose risk during induction with the former agents due to required abstinence from opioids (18.1% buprenorphine, 2.3% naltrexone, 1.2% methadone in 1 study)
- This finding may be related to concerns regarding diversion of methadone in the younger population, the study authors noted
- Access to buprenorphine and naltrexone in adolescents and young adults increased from 2% in 2002 to 32% in 2009 and then decreased to 28% in 2014
- Lack of access in adolescents and young adults was associated with residing in the US South, Black race, and Hispanic or Latino ethnicity, and criminal justice system involvement
- In some studies, individuals in lower socioeconomic neighborhoods were more likely to have access to medications, which is likely due to the concentration of treatment services in these neighborhoods, according to the researchers
- Among pregnant patients, being referred through the criminal justice system was negatively associated with access to medications for opioid use disorder
- Not having custodial rights over one’s children and child abuse charges were negatively associated with access to these medications
The study authors recommended expanding the range of medications available to young people; continuing to educate and train prescribers to provide patient-centered, trauma-informed, and culturally-safe care; and working to address and reduce barriers to accessing these medications.
“What we have to remember is that the cost of a young person overdosing from the illicit drugs supply far outweighs any risk from prescribing these proven, life-saving medications to young people, and so it is important that prescribers work collaboratively with youth to support them in identifying and realizing their care goals,” Pilarinos said.
Study limitations included potentially missed studies during the screening phase, difficulty calculating pooled effect measures given the heterogeneity of the studies, and the lack of generalizability of the findings to middle- or low-income countries because most of the studies were conducted in high-income countries.
Pilarinos A, Bromberg DJ, Karamouzian M. Access to medications for opioid use disorder and associated factors among adolescents and young adults: a systematic review. JAMA Pediatrics. Published online December 6, 2021. doi:10.1001/jamapediatrics.2021.4606