About a quarter of U.S. residents ages 13 to 25 with an opioid misuse disorder and commercial insurance received medication-assisted treatment within six months of their diagnosis, according to a retrospective study published Monday in JAMA Pediatrics.
3 imperatives for addressing the opioid crisis
For the study, researchers sought to identify the percentage of U.S. youth ages 13 to 25 who had received a medication to treat an opioid misuse disorder. The researchers focused on two opioid misuse medications—buprenorphine and naltrexone—which can be provided in primary care and specialty settings.
The researchers reviewed national commercial insurance data on more than 9.7 million youth who had prescription drug coverage from 2001 to 2014.
Overall, the researchers identified 20,822 youth ages 13 to 25 who were diagnosed with an opioid misuse disorder. Of those patients, the researchers found more than 80 percent were non-Hispanic white, and 65.8 percent were male. The researchers said the diagnosis rate for opioid misuse disorders rose almost sixfold from 2001 to 2014, during which the average age of diagnosis was 21.
The researchers found 26.8 percent of patients ages 13 to 25 with an opioid misuse disorder received either buprenorphine or naltrexone within six months of their diagnoses. The percentage of youth receiving prescriptions for those treatments increased by more than tenfold from 2002 to 2009, when it reached 31.8 percent. However, prescriptions have declined in more recent years, falling to 27.5 percent in 2014, according to the study.
The researchers found several disparities in prescriptions for opioid misuse treatments among youth. For example, the researchers found younger patients ages 13 to 17 were less likely to receive medication-assisted treatment for an opioid misuse disorder, compared with young adults. Girls, non-Hispanic black youth, and Hispanic youth also were less likely to receive medication-assisted treatment.
Scott Hadland, an assistant professor of pediatrics at Boston University School of Medicine and the study's lead author, attributed the disparity in prescription rates for buprenorphine and naltrexone among youth in part to the fact that few clinicians are certified to prescribe buprenorphine, and even fewer—1 percent—are pediatricians. Providers do not need a special certification to prescribe Naltrexone, according to the study.
Brendan Saloner, who authored an accompanying editorial with his Johns Hopkins University colleagues, called for a clinical and "cultural" shift toward medication-assisted treatment for opioid misuse disorders to reduce the associated "stigma." They added, "There is a need for research on how physicians, patients, and families communicate about (medication-assisted treatments) and how youth-specific concerns about buprenorphine use could be addressed in office-based settings," adding that the gender and racial disparities in medication-assisted treatments are "troubling" (Walker, MedPage Today, 6/19; Cancryn, "Pulse," Politico,
Reduce opioid misuse and abuse with our new report
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties, and providers typically intervene only after the patient has shown signs of misuse and addiction.
This research report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.