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 The proportion of Americans aged 13 to 25 diagnosed with opioid use
disorders surged almost six-fold from 2001 to 2014, researchers
report in JAMA Pediatrics. During that period, the average annual
rate of opioid use disorder among teens and young adults climbed
from 0.26 cases to 1.51 cases for every 100,000 people.
Overall, just 27 percent of these young patients diagnosed with
opioid use disorder were prescribed buprenorphine and naltrexone,
two medicines to treat addiction, within six months of their
diagnosis.
“Medications have been shown to treat withdrawal and cravings, and
reduce relapse, and are an extremely effective component of
treatment for opioid use disorder,” said lead study author Dr. Scott
Hadland, a pediatrician and addiction specialist at Boston Medical
Center.
“Offering medications early in the life course of addiction –
particularly to patients with severe addiction – is critical to
prevent downstream harm from addiction,” Hadland said by email.
To assess how often addicted youth receive medication for opioid use
disorders, Hadland and colleagues examined health insurance claims
data for 9.7 million young people, for the years 2001 to 2014.
Overall, almost 21,000 teens and young adults in the study, or about
0.2 percent, were diagnosed with opioid use disorder. About 5,600 of
these young people received medications to treat their addiction.
The majority of those who got medicine received buprenorphine, an
opioid that helps reduce cravings by targeting the same places in
the brain that are impacted by addictive opioids like heroin,
morphine, and codeine. A minority, about 11 percent, received
naltrexone, a medicine for alcohol and drug addiction.
The early years of the study coincided with the 2002 introduction of
buprenorphine, and prescriptions of anti-addiction drugs for opioid
use disorder in teens and young adults jumped more than 10-fold from
3 percent in 2002 to almost 32 percent in 2009. But after that,
prescriptions declined even as addiction rates rose.
Younger teens, females, and black and Hispanic youth were less
likely to get medication for opioid use disorder than older youth,
males and white people, the study also found.
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One limitation of the study is that
researchers lacked data on the severity of addiction, which may have
influenced whether patients received medications, the authors note.
Because the study only included people with private health
insurance, it’s also possible that results would look different for
young people with other benefits like Medicaid or who were
uninsured.
Even so, the results underscore the importance of 2016
recommendations from the American Academy of Pediatrics advising
pediatricians to consider medication for adolescents with opioid
addiction, said Brendan Saloner of Johns Hopkins Bloomberg School of
Public Health in Baltimore in an accompanying editorial.
“Every patient should have access to a
treatment program that provides access to these medications, whether
or not they end up using them,” Saloner told Reuters Health by
email.
The cost of the medication can be a barrier, Saloner noted, because
even with private insurance the drugs can cost $20 to $50 a month or
more. But it should always be offered, he stressed.
“There is clear evidence that just as with smoking and other
addictive substances, treatment with medication may be necessary due
to the neurologic changes that occur in the reward center of the
brain,” said Dr. Constance Houck, a researcher at Harvard Medical
School in Boston who wasn’t involved in the study.
“This may be particularly true for adolescents who are especially
thrill seeking and impulsive and may be even more susceptible to
addiction,” Houck said by email.
SOURCE: http://bit.ly/2rNNdm3 JAMA Pediatrics, online June 19, 2017.
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