Opioid Use Disorder Treatment in Teens Should Increase Use of Medication Therapy

Few adolescents receive methadone or buprenorphine for opioid addiction.

Only a small percentage of adolescents undergoing treatment for severe opioid use disorders are receiving medication therapy to manage their condition despite the effectiveness of medication-assisted treatment, found a recent study. In fact, anywhere from 10 to 30 times as many adults as teens received medication as part of their treatment plan for opioid addiction.

Greater access to medication-assisted treatment in teens has reduced rates of misuse and injection drug use and, in adults, has reduced population-level overdoses, noted Kenneth Feder, a doctoral student at Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and his colleagues.

“MAT by a pediatrician without referral would consist primarily of buprenorphine treatment (or long-acting injectable naltrexone, although there is limited evidence for the latter), but few primary care pediatricians have buprenorphine training,” the investigators explained. Further, “federal regulations require methadone clinics to receive a special waiver to treat adolescents,” and teens must have had 2 “failed” attempts without medication before they become eligible for methadone treatment.

The researchers examined data from 139,092 individuals who received first-time specialty treatment for heroin or opioid use in the 2013 Treatment Episode Data Set (TEDS), which covers an estimated two-thirds of public and private substance use treatment admissions in the United States. Teens accounted for 2.2% of all episodes, which included 1.1% of all episodes of heroin use and 3.2% of episodes of opioid use.

Their analysis revealed that only 2.4% of teens (age 15-17) receiving treatment for heroin addiction received methadone or buprenorphine (but not naltrexone) as part of their treatment, whereas 26.3% of adults (age 18+) did. In a similar fashion, 0.4% of teens, compared with 12% of adults, received medication-assisted treatment for addiction to prescription opioids. These raw associations remained similar after statistical adjustment to account for sex, race/ethnicity, referral source, homelessness status, the number of substances reported at admission, and addiction to one or both substance types.

The low rates of medication-assisted treatment in adolescents “may reflect patient, parent, or provider preferences and concerns about the appropriateness of medication-assisted treatment for adolescents,” the researchers suggested. “However, Medicaid and CHIP [Childrens’ Health Insurance Program], which cover the majority of all adolescents, could also help facilitate better access to medication-assisted treatment for adolescents with opioid use disorder.”

The investigators added that medication-assisted treatment could be incorporated into the benefit for screening, detection, and treatment while teens could be wrapped into expansions of medication-assisted treatment under Medicaid.

The study’s findings were limited by the decision to only look at specialty treatment programs, leaving out office-based visits during which doctors might prescribe buprenorphine or naltrexone in teen patients. Yet, primary care providers represent a small percentage of all opioid use disorder treatment. The database the researchers used also did not provide information regarding the severity of the patients’ disorders, which might influence treatment decisions. Further, “the medication-assisted treatment variable does not distinguish between methadone and buprenorphine treatment and may miss youth who were prescribed long-acting naltrexone.”

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Feder K, Krawczyk N, Saloner B. Medication-assisted treatment for adolescents in specialty treatment for opioid use disorder. J Adolesc Health [published online February 28, 2017].  pii: S1054-139X(17)30022-30028. doi:10.1016/j.jadohealth.2016.12.023