Adapting primary care-based treatment for adolescents with opioid use disorder
Scott Hadland, MD, MPH, MS
BACKGROUND: Amidst the escalating incidence of opioid overdose, only one in 13 adolescents identified as needing addiction treatment ultimately receive it, and once in treatment, younger age is associated with poor retention in care. Office-Based Opioid Treatment (OBOT), which teams primary care physicians with nurse care managers and behavioral health specialists, is effective for treating adults with opioid use disorder (OUD) but has not yet been modified to be developmentally appropriate or family-centered for adolescents.
GAP: It is currently unknown how OBOT should be modified to meet the needs of adolescents and their caretakers in order to maximize retention in care and treatment outcomes.
HYPOTHESIS: (1) Once in outpatient treatment, adolescents with OUD will be at high risk for early loss to follow-up (<50% retained in care at 3 months; primary outcome) and drug use relapse (>25% with a positive urine drug screen by 3 months; secondary outcome).
(2) Adolescents, caretakers, and key informants will identify modifications to OBOT that, once implemented, can be used to optimize the model for treating adolescents with OUD.
METHODS: Aim 1: Secondary data analysis of state-wide Massachusetts All Payer Claims Database (APCD) to identify times of high risk for loss to follow-up and drug use relapse among adolescents <18 years-old diagnosed with OUD in outpatient addiction treatment.
Aim 2: Semi-structured interviews with adolescents with OUD, their caretakers, and key informants (experienced OBOT providers caring for adults and primary care physicians of adolescents in areas of high prevalence of OUD) to identify recommended modifications of OBOT for adolescents, and development of an optimized OBOT clinical model.
IMPACT: Data will allow us to optimize OBOT for adolescents at BMC within 1-2 years, provide preliminary data for my K23 career development award application in which I will conduct a trial of enhanced OBOT within 3-4 years, and potentially result in dissemination of OBOT to other sites within 5-10 years. In sum, this work has the potential to durably reshape systems of care for adolescents and their families.