Project Details

Adapting primary care-based treatment for adolescents with opioid use disorder

Scott Hadland, MD, MPH, MS

Summary

8. 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 addiction treatment, adolescents with OUD will be at high risk for early loss to follow-up (<50% retained in care at 3 months; primary 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 Medicaid claims data from 11 states 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 caregivers, 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. RESULTS: Aim 1: Among 4837 youths diagnosed with OUD, 2752 (56.9%) were female and 3677 (76.0%) were non-Hispanic white. Median age was 20 years (interquartile range [IQR], 19-21 years). Overall, 3654 youths (75.5%) received any treatment within 3 months of diagnosis of OUD. Most youths received only behavioral health services (2515 [52.0%]), with fewer receiving OUD medications (1139 [23.5%]). Only 34 of 728 adolescents younger than 18 years (4.7%; 95%CI, 3.1%-6.2%) and 1105 of 4109 young adults age 18 years or older (26.9%; 95% CI, 25.5%-28.2%) received timely OUD medications. Median retention in care among youths who received timely buprenorphine was 123 days (IQR, 33-434 days); naltrexone, 150 days (IQR, 50-670 days); and methadone, 324 days (IQR, 115-670 days) compared with 67 days (IQR, 14-206 days) among youths who received only behavioral health services. Timely receipt of buprenorphine (adjusted hazard ratio, 0.58; 95%CI, 0.52-0.64), naltrexone (adjusted hazard ratio, 0.54; 95%CI, 0.43-0.69), and methadone (adjusted hazard ratio, 0.32; 95%CI, 0.22-0.47) were each independently associated with lower attrition from treatment compared with receipt of behavioral health services alone. 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.

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