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 Researchers examined data on more than 4 million youths aged 13 to
22 with coverage through Medicaid, the government insurance program
for the poor, between 2009 and 2015. During that period, 3,791 young
people had nonfatal opioid overdoses.
In the month after overdoses, 69% of these teens and young adults
didn't receive any addiction treatment, researchers report in JAMA
Pediatrics. While 29% did get help, nearly all of them received only
behavioral health services. Just 2% received anti-addiction
medications that are considered the gold standard for combatting
opioid abuse.
"It is unacceptable that so few youths are receiving the recommended
treatment after opioid overdose," said lead study author Dr. Rachel
Alinsky of Johns Hopkins University School of Medicine in Baltimore.
"In pediatrics, we would not accept it if only 1 in 50 youth with
asthma got the standard treatment when they came into the emergency
department, or if 1 in 50 youth with diabetes got the standard
treatment if they were hospitalized," Alinsky said by email.
Roughly one in four overdoses involved heroin. The remainder were
caused by misuse of other forms of prescription or illegal opioids.
Youth who used heroin were more than twice as likely to have repeat
overdoses during the study.
Within 30 days of a heroin overdose, 4.1% of young people had
another overdose, and within three months, 8.1% of them had a repeat
overdose, the study found.
Among youth whose initial overdose involved other types of opioids,
1.2% had a repeat overdose within 30 days and 2% had a recurrence
within 90 days.
Despite higher rates of repeat overdose, youth with heroin overdoses
were 35% less likely to receive any addiction treatment than youth
who overdosed on other types of opioids.
Less than 10% of the youths who had overdoses were diagnosed with
opioid use disorder, the study also found. Even among those with
heroin overdoses, less than half got this diagnosis.
A combination of factors may make it hard for young people to
receive opioid addiction drugs, Alinsky said.
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Pediatricians may not be familiar with treatments for opioid use
disorder, and many clinicians who treat this condition may not
accept younger patients, Alinsky said. Some providers may also be
resistant to treating drug addiction with prescription medications.
"There is widespread stigma against medication for opioid use
disorder within the healthcare and recovery communities, who
sometimes inaccurately view medication for opioid use disorder as
replacing one drug with another," Alinsky said. "This stigma may be
even stronger when it comes to prescribing medication to
adolescents, where a common view is that medications should be used
as a last resort despite the evidence-based guidelines from the
American Academy of Pediatrics that recommend its use."
All of this can put parents in a position where they have to push
hard to get their children needed care, said Lucas Hill of the
University of Texas at Austin College of Pharmacy.
"Given the increasing prevalence of ultra-potent synthetics in the
illegal opioid supply, initiating medications immediately after a
non-fatal overdose should be the top priority for any family,"
Lucas, who wasn't involved in the study, said by email. "Available
evidence indicates these medications are far more effective than
other treatment approaches, such as medically-supervised withdrawal
(i.e. detox)."
When patients don't get medications in the hospital where they
receive overdose treatment, Hill advised, parents should seek out
further care. In the U.S., they can search on the Department of
Health and Human Services website findtreatment.gov for local
providers who can prescribe buprenorphine.
"I would call until I found an active prescriber who accepted my
insurance, would consider initiating medication on the day of our
first visit, and could schedule that first visit within a few days,"
Hill said.
SOURCE: https://bit.ly/2s6l541 JAMA Pediatrics, online January 6,
2019.
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