Adolescents’ and Young Adults’ Access to Medications for Opioid Use Disorder

Most adolescents and young adults (AYAs) reporting opioid use disorder (OUD) have limited access to medications for opioid use disorder (MOUD), according to a systematic review and meta-analysis published in JAMA Pediatrics.

Researchers searched CINAHL, Embase, Global Dissertations & Theses, MEDLINE, PsychINFO, Sociological Abstracts, and Web of Science from inception through May 3, 2021, for peer-reviewed studies in English, French, Russian, or Spanish that reviewed the use of MOUD.

They included 37 studies in the review that were conducted between 1992 and 2021. Those studies included 179,785 AYAs (24.4±3.9 years, 85% females, 84% White) and 3,243 adolescent treatment facilities. Studies included a median of 404 participants. There were 17 cohort studies, 15 cross-sectional studies, and 5 qualitative studies. Most (n=24) were completed in the United States, followed by Canada (n=4), and Australia (n=3).

Studies evaluated participants with OUD (n=14), heroin and other opioid use (n=9), any opioid use (n=7), primary opioid use (n=2), nonmedical prescription opioid use (n=1), and injection drug use (n=1).

Access for AYAs to MOUD ranged from 0.4% to 80.7% overall. Methadone access ranged from 1.2% to 80.7%. Buprenorphine ranged from 3% to 30% while naltrexone ranged from 0.8% to 37%.

Age was linked with MOUD access according to 18 studies. Buprenorphine-naloxone was more likely to be provided compared with methadone at their last treatment episode, adolescents (60.1 vs 38%) and young adults (49.5% vs 48.3%) reported in one particular study.

Studies indicated MOUD were more commonly provided in youth-tailored treatment facilities and in counties with more residents aged 45 to 64 years than residents under 20 years compared with counties that had a greater proportion of residents aged 25 to 44 years vs aged 0 to 19 years.

Studies of MOUD access over time indicated a greater amount of AYA had access to MOUD in 2009 (31.8%) compared with 2002 (2%) before dropping to 27.5% in 2014, with an increase in odds of receiving naltrexone. Pregnant women gained increased access to buprenorphine but experienced decreased access to methadone from 2009 to 2015. MOUD receipt through individual and referral rose 1992 to 2017. Those who received MOUD within 1 month of a nonfatal overdose were more likely to have previously used MOUD and have an OUD diagnosis.

According to 2 studies, referral from the criminal justice system was inversely linked with MOUD access among pregnant women. In US Medicaid expansion states, receiving a criminal justice referral for MOUD was linked with receiving it in prison. Those who lived in states where child abuse charges can be filed against pregnant women who use drugs were less likely to have MOUD access.

Four studies indicated residents of the South in the US have less access to MOUD than residents in the Northeast, Midwest, and Western regions of the US.

Three studies found Black, Latino, and non-White individuals were less likely to have access to MOUD. Four found that women were more likely to access MOUD compared with men. Four studies reported that income or employment was associated with MOUD access.

The study has several limitations. For example, some records may have been missed in the search and screening process. Also, the heterogeneity between the included studies made it difficult to calculate the pooled effect measures. In addition, the studies came from high income nations, thus the findings may not be generalizable to low- and middle-income countries.

“Findings suggest there is an urgent need to address barriers to MOUD access, including prescriber reluctance, which may be accomplished by providing AYAs with access to a continuum of health and social supports alongside MOUD,” the investigators said.

“Similarly, determining ways to both encourage and reduce barriers to the prescription of MOUD may be helpful in improving MOUD access among this hard-to-reach population.”

Reference

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