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In youths with opioid use disorder (OUD), treatment with buprenorphine, naltrexone, or methadone within 3 months of diagnosis was associated with greater care retention compared with behavioral therapy alone, according to a study published in JAMA Pediatrics.
Investigators retrospectively reviewed enrollment data and health insurance claims of 2,483,250 Medicaid recipients age 13 to 22, of whom 4837 had been diagnosed with opioid use disorder. The investigators examined retention in care with attrition (ie, ≥60 days with no treatment-related claims) in youth who received OUD medication (ie, buprenorphine, naltrexone, or methadone) within 3 months of OUD diagnosis vs patients who received behavioral therapy only.
Patient median age was 20 (interquartile range [IQR], 19-21). The majority of patients (75.5%) included in the analysis received any addiction treatment within 3 months of OUD diagnosis, with 52.0% of youth (n=2515) receiving behavioral health treatment only, and 23.5% (n=1139) receiving OUD medications. In this cohort, only 4.7% (n=34) of youths age <18 (95% CI, 3.1%-6.2%) and 26.9% (n=1105) of youths age ≥18 (26.9%; 95% CI, 25.5%-28.2%) received timely OUD medication (ie, within 3 months of diagnosis).
The median care retention was 123 days (IQR, 33 to 434 days), 150 days (IQR, 50 to 670 days), and 324 days (IQR, 115 to 670 days) in patients who received timely buprenorphine, naltrexone, and methadone, respectively vs 67 days (IQR, 14 to 206 days) in patients who received behavioral therapy only. An independent association was established between lower attrition from treatment and timely treatment with buprenorphine (adjusted hazard ratio [aHR], 0.58; 95% CI, 0.52-0.64), naltrexone (aHR, 0.54; 95% CI, 0.43-0.69), and methadone (aHR, 0.32; 95% CI, 0.22-0.47) compared with behavioral therapy only.
Study limitations include its observational design, precluding establishment of a causal relationship between higher retention rates and OUD medications vs clinical setting.
“The finding that medications were provided to only approximately 1 in 4 youths presenting for care overall, including only 1 in 21 adolescents, highlights a crucial potential opportunity to improve OUD care and enhance retention in treatment,” concluded the study authors.
Reference
Hadland SE, Bagley SM, 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 [published online September 10, 2018]. JAMA Pediatr. doi:10.1001/jamapediatrics.2018.2143
