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• W3036325602 abstract "See Related Article on p.33The prevalence, magnitude, and consequences of the current opioid epidemic among adults are well known. Perhaps less widely recognized is the involvement of youth. Between 1999 and 2016, prescription opioid deaths increased by 94.7% and heroin deaths increased by 404.8% among those aged 15–19 years [[1]Gaither J.R. Shabanova V. Leventhal J.M. US national trends in pediatric deaths from prescription and illicit opioids, 1999-2016.JAMA Netw Open. 2018; 1: e186558Crossref PubMed Scopus (119) Google Scholar]. Among a national sample of high school seniors, 12.4% reported lifetime nonmedical opioid use and 1.2% lifetime heroin use [[2]Palamar J.J. Shearston J.A. Dawson E.W. et al.Nonmedical opioid use and heroin use in a nationally representative sample of US high school seniors.Drug Alc Depend. 2016; 158: 132-138Crossref PubMed Scopus (66) Google Scholar]. Young adults (aged 18–25 years) have had the highest per-capita rates of nonmedical prescription opioid use of all age groups at 5.6% past-year use in 2018, while adolescents (aged 12–17 years) were 2.8%. Young adults are also the highest lifespan per-capita users of heroin with 2018 past-year use at .5% [[3]Substance Abuse and Mental Health Services AdministrationKey substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and health. Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration, Rockville, MD2019Google Scholar]. See Related Article on p.33 Adult studies have shown that addiction-related harms, including mortality, can be reduced by treatment with buprenorphine, methadone, or naltrexone. How long these medications should be used is unclear, but they have been safe and effective when used in adults with opioid use disorder (OUD) for months to years, even indefinitely [[4]Sordo L. Barrio G. Bravo M.J. et al.Mortality risk during and after opioid substitution treatment: Systematic review and meta-analysis of cohort studies.BMJ. 2017; 357: 2-14Google Scholar,[5]Nunes E.V. Gordon M. Friedman P.D. et al.Relapse to opioid use disorder after inpatient treatment: Protective effect of injection naltrexone.J Subst Abuse Treat. 2018; 85: 49-55Abstract Full Text Full Text PDF PubMed Scopus (44) Google Scholar]. However, uptake of these medications for OUD (MOUD) has been disproportionately and alarmingly poor for youth [[6]Pecoraro A. Fishman M. Ma M. et al.Pharmacologically assisted treatment of opioid-dependent youth.Ped Drugs. 2013; 15: 449-458Crossref PubMed Scopus (17) Google Scholar,[7]Hadland S.E. Bagley S.M. Rodean J. et al.Receipt of timely addiction treatment and association of early medication treatment with retention in care among youths with opioid use disorder.JAMA Pediatr. 2018; 172: 1029-1037Crossref PubMed Scopus (64) Google Scholar] despite evidence of their effectiveness with this younger population [8Marsch L.A. Bickel W.K. Badger G.J. et al.Comparison of pharmacological treatments for opioid-dependent adolescents: A randomized controlled trial.Arch Gen Psychiatry. 2005; 62: 1157-1164Crossref PubMed Scopus (141) Google Scholar, 9Marsch L.A. Moore S.K. Borodovsky J.T. et al.A randomized controlled trial of buprenorphine taper duration among adolescents and young adults.Addiction. 2016; 111: 1406-1411Crossref PubMed Scopus (41) Google Scholar, 10Woody G.E. Poole S.A. Subramaniam G. et al.Extended vs short-term buprenorphine-naloxone treatment of opioid-addicted youth: A randomized trial.JAMA. 2008; 300: 2003-2011Crossref PubMed Scopus (260) Google Scholar, 11Borodovsky J.T. Levy S. Fishman M. Marsch L.A. Buprenorphine treatment for adolescents and young adults with opioid use disorders: A narrative review.J Addict Med. 2018; 12: 170-183Crossref Scopus (25) Google Scholar, 12Nightingale SL, Wurmser L, Platt PC et al. Adolescents on methadone: Preliminary observations. Presented at: Third Annual Conference on methadone treatment. November 14-16, 1971; New York, New York.Google Scholar, 13Millman RB, Nyswander ME. Slow detoxification of adolescent heroin addicts in New York City. Presented at: Third Annual Conference on methadone treatment. November 14-16, 1971; New York, New York.Google Scholar, 14Fishman M. Winstanley E. Curran E. et al.Treatment of opioid dependence in adolescents and young adults with extended release naltrexone: Preliminary case series and feasibility.Addiction. 2010; 105: 1669-1676Crossref PubMed Scopus (53) Google Scholar, 15Vo H. Robbins E. Westwood M. et al.Relapse prevention medications in Community treatment for young adults with opioid addiction.Substance Abuse. 2016; 37 (PMID: 26820059): 392-397Crossref PubMed Scopus (17) Google Scholar] and endorsement of MOUD treatment for youth by the American Academy of Pediatrics [[16]Committee on Substance Use and PreventionMedication-assisted treatment of adolescents with opioid use disorders policy statement.Pediatrics. 2016; 138: 1-4Crossref Scopus (59) Google Scholar]. Although medication treatment outcomes in youth may be inferior to those in adults [[17]Schuman-Oliver Z. Weiss R.D. Hoeppner B.B. et al.Emerging adult status predicts poor buprenorphine treatment retention.J Subst Abuse Treat. 2014; 47: 202-2012Abstract Full Text Full Text PDF Scopus (67) Google Scholar], there is no evidence to suggest that they confer substantial safety risk based on age. Prior work from multistate Medicaid claims data has shown that only 25% of young adults and <5% of adolescents receive timely MOUD after documentation of an OUD diagnosis, even after a nonfatal overdose [[18]Alinsky R.H. Zima B.T. Rodean J. et al.Receipt of addiction treatment after opioid overdose among Medicaid-enrolled adolescents and young adults.JAMA Pediatr. 2020; 174: e195183Crossref PubMed Scopus (23) Google Scholar]. The article in this issue by Chavez et al. [[19]Chavez L.J. Bonny A.E. Bradley K.A. et al.Medication treatment and health care Use among adolescents with opioid Use disorder in Ohio.J Adolesc Health. 2020; 67: 30043-30044Google Scholar] highlights this youth treatment gap in Ohio. Utilizing Medicaid claims data, the authors reviewed cases of adolescents with an index diagnosis of OUD. The first striking finding was that only .3% of adolescents had documentation of an OUD diagnosis, 6–7 times lower than known population prevalence rates for past-month nonmedical opioid use in this age group. The second finding was that less than 5% of those who were identified as having an OUD received MOUD. This article also adds to our understanding by showing that poor engagement in treatment services does not explain the underutilization of opioid treatment medication, since half received outpatient general medical visits and almost a third received behavioral health visits during the same period. It also cannot fully be explained by a reluctance to use a pharmacotherapy, since 9.8% of the study population received an opioid analgesic, 30% received antidepressants, 20% received attention deficit hyperactivity disorder medication, and almost 18% received an antipsychotic. The study is also particularly important for showing that the youth treatment gap persists in a state at the epicenter of the opioid crisis, where attention and considerable investment of resources has focused on improving access to OUD treatment in general and medications in particular. We should also add that as vital as treatment is, especially for the critical youth target population, we will not be able to treat our way out of this crisis as long as new cases continue to emerge with anywhere near current rates. While initiation of opioid use through medical sources has been an important pathway for youth, the majority of initiations are through nonmedical sources, and adolescents and young adults who develop an OUD often do so in the context of non-opioid substance use [[20]Cicero T.J. Ellis M.S. Kasper Z.A. Polysubstance use: A broader understanding of substance use during the opioid crisis.Am J Pub Health. 2020; 110: 244-250Crossref Scopus (44) Google Scholar]. Thus, OUD is best seen as a particularly advanced, more malignant disorder that occurs within a broader family of substance use disorders (SUDs) where the reinforcing properties of nonopioid substances such as alcohol, cannabis, nicotine, stimulants, and others can foster behavioral patterns that are a substrate on which opioid addiction takes hold. In that context, identification and treatment of nonopioid SUDs may help prevent the emergence of OUDs and successive waves of whatever comes next. In conclusion, it is very important to embrace the conceptualization of OUD as a health problem with a high mortality rate that can be markedly improved by MOUD. How long MOUD should be used is unclear, but using months to years clearly works better than days to weeks. The nonopioid SUDs that often accompany or can set the stage for development of OUD's can respond to psychosocial interventions that are currently available and should be part of a comprehensive approach to reducing the harm that opioid and other SUDs can cause [[21]Woodcock E. Lundahl Stoltman J. Greenwald M. Progression to regular heroin use: Examination of patterns, predictors, and consequences.Addict Behav. 2015; 45: 287-293Crossref PubMed Scopus (31) Google Scholar]. For OUD, effective medications are available but vastly underutilized. Meaningful progress can be made by mobilizing youth-serving care settings, such as pediatric, family practice, and adolescent medicine clinical settings, to make addressing this crisis central to their mission. Engaging youth, families, health-care practitioners, and policy makers in prevention and evidence-based medication treatment for opioid-addicted youth is a top public health priority. We cannot afford to wait any longer; if not now, then when? Medication Treatment and Health Care Use Among Adolescents With Opioid Use Disorder in OhioJournal of Adolescent HealthVol. 67Issue 1PreviewThe opioid epidemic impacts both adolescents and adults, and overdose deaths continue to rise. Two medication treatments (buprenorphine and naltrexone) are effective for treating opioid use disorder (OUD) in office-based settings but are seldom prescribed to adolescents. The present study describes medication treatment for OUD and other care received by adolescents with OUD in a state at the center of the opioid epidemic. Full-Text PDF" @default.
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• W3036325602 title "Medication Treatment for Opioid-Addicted Youth—What Are We Waiting for?" @default.
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