The vast majority of younger patients struggling with opioid addiction are not receiving medications that have been recommended to treat their affliction, according to a new study. Only one in four patients received a treatment medication approved by the U.S. Food and Drug Administration – methadone, buprenorphine, or naltrexone – within three months of their diagnosis. And, for those under the age of 18, only one in 21 was prescribed a guideline-recommended medication.
“This study shows that the great majority of youth are not receiving treatment recommended in evidence-based guidelines,” said the study’s lead author, Dr. Scott Hadland, a pediatrician and addiction specialist at the Grayken Center for Addiction at the Boston Medical Center. “That’s really concerning because the data suggest that when people do receive medication they are much more likely to remain in treatment.”
Hadland said the three recommended medications help by reducing withdrawal symptoms. “That allows people to really focus on recovery,” he added. “An additional benefit is that people are less likely to overdose because of the pharmacological properties of these medications.”
While some people may need to take the medications indefinitely, those in the younger generation are likely to opt not to. “They often don’t want to be on a medication for the rest of their lives,” Hadland said. “Many go on a medication for a period of one to several years and ultimately make the decision to come off the medication. We do that in a very patient-centered way, where we help keep them safe.”
Hadland and his colleagues analyzed two years of health insurance claims for 2.4 million young people ages 13 to 22. During that period, 4,837 young people were diagnosed with opioid use disorder. 76 percent received treatment within three months of diagnosis. But most, 69 percent, received only behavioral therapy. Among adolescents younger than 18, only 4.7 percent received medication. Of those in the18 and older category, 27 percent received medication. Among youth who got no medication, half had dropped out of treatment after 67 days. Half remained in treatment for more than 123 days with buprenorphine, more than 150 days with naltrexone, and more than 324 days with methadone.
“The medication provides pharmacological support to help them stop using or to at least reduce substance use,” Hadland said. “It also provides them with confidence knowing that they are getting the best treatments available.”
The problem, Hadland said, is that many treatment programs don’t offer methadone, buprenorphine, or naltrexone. “And not only do they not offer evidence-based treatment, but also, if someone comes in taking one of these medications, they will deny entrance or insist on discontinuation,” he said. He suspects the biggest issue is stigma.
Dr. Jody Glance agrees. The new study “spotlights the backwards state of affairs in addiction treatment,” said Glance. “There’s a real harm occurring by not offering these medications.”
She said that there has been more interest in learning about addiction treatments as of late, however. “I do see the tide turning,” she said.
And, that’s a very good thing, because urgent treatment is needed. “Time is of the essence,” Hadland explained. “People are dying.”