Quick Take: Treatment for nicotine use disorder among Medicaid-enrolled adolescents and young adults

1. The receipt of evidence-based treatment for nicotine use disorder is extremely low among adolescents and young adults.

Evidence Rating Level: 2 (Good)

It has now been well established that adolescents and young adults using e-cigarettes are at high risk of transitioning to combustible cigarettes. As such, it is important to determine the extent to which members of this young patient population with nicotine use disorder (NUD) receive evidence-based treatment with counseling and pharmacotherapy. In this retrospective cohort study, researchers used the Truven MarketScan Medicaid database to identify all individuals age 10 to 22 years with NUD and study the proportion of those receiving treatment within 6 months of NUD diagnosis. The receipt of treatment was confirmed using claims for counseling for NUD or pharmacy dispensing of nicotine replacement therapy, varenicline and sustained-release bupropion. Researchers found that among 81,144 youth identified with NUD with 6 months of follow-up after diagnosis, 3364 (4.1%) received counseling for NUD, 1095 (1.3%) received pharmacotherapy, and 110 (0.1%) received both counseling and pharmacotherapy. In assessing factors associated with the receipt of pharmacotherapy, researchers found that older age, white race, asthma (OR 1.26, 95% CI 1.02 to 1.56), depression (OR 1.36, 95% CI 1.02 to 1.81), anxiety disorder (OR 1.44, 95% CI 1.18 to 1.76), attention-deficit/hyperactivity disorder (OR 1.62, 95% CI 1.28 to 2.05), and co-occurring alcohol (OR 1.66, 95% CI 1.07 to 2.55) or marijuana use disorder (OR 1.36, 95% CI 1.02 to 1.81), increased the likelihood of receipt. Bupropion was the most commonly prescribed medication at 46.0%, followed by nicotine replacement therapy (31.2%) and varenicline (22.7%). A major limitation of this study is the fact that individuals not formally diagnosed with NUD would not have been included in this study. As such, the study population may not be reflective of the larger general population of adolescents and young adults with NUD. The sample also only included Medicaid enrollees, who are known to have higher rates of tobacco use than the general population. Patients formally diagnosed with NUD may also be more likely to seek out healthcare services, and therefore, the receipt of treatment for NUD may be inflated in this study population. Nonetheless, the findings of this study show that the receipt of evidence-based treatment for NUD among adolescents and young adults is extremely low. This has important implications for public health initiatives aimed at addressing NUD in this patient population.

Click to read the study in JAMA Pediatrics

Image: PD

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