Barriers to medication access for opioid use disorder in adolescents and young adults

1. In this systematic review of 37 studies, multiple barriers were identified in accessing medication for opioid use disorder for adolescents and young adults, including age, sex, race and ethnicity, geographic location, health and social system factors.

2. Adolescents and young adults may be more likely to be prescribed opioid medication deemed to have a lower abuse potential, such as opioid antagonists and partial agonists.

Evidence Rating Level: 3 (Average)

Study Rundown: Medications for opioid use disorders have been demonstrated to reduce deaths from opioid toxicity. Currently, a gap exists in understanding barriers to accessing medications for opioid use disorder in adolescents and young adults. This systematic review aimed to assess factors associated with access to medications for opioid use disorders among adolescents and adults between 10-30 years. 37 studies involving 179,785 adolescents and young adults were included (85% female, 84% white). Overall, adolescents and young adults were less likely than other age groups to access medications for opioid use disorder. In particular, adolescents were more likely to receive antagonist or partial agonist treatment instead of full agonist treatment. Decreased access was reported for individuals living in the southern United States. Low-income areas had overall better access to medications for opioid use disorders, however those in high-income areas were more likely to be prescribed medication. Health and social system factors such as long wait times, delayed prescriptions, and difficulty finding a prescriber were negatively associated with opioid medication access. Black and non-White race and Latino ethnicity were associated with decreased access to medications. Women were more likely to be prescribed medication for opioid use than men. Although study heterogeneity and predominantly white and female study population limits widespread applicability of the findings,  this review is helpful in identifying barriers to medication for opioid use disorder in adolescents and young adults that can be target for future interventions to improve treatment.

Click to read the study in JAMA Pediatrics  

Relevant Reading: Medication for adolescents and young adults with opioid use disorder

In-Depth [systematic review]: This systematic review included all empirical study designs, excluding case series/studies and reviews, from inception until May 2021. Medications for opioid use disorder were categorized as opioid agonists (e.g. methadone and buprenorphine), partial agonists (e.g. buprenorphine-naloxone), or antagonists (e.g. naltrexone). Access to opioid use medications included any assessment of availability, prescription or initiation of treatment. In total, 37 studies (17 cohort, 15 cross-sectional and 5 qualitative) published between 1992-2021 from multiple countries, primarily from the United States (n = 24), were included. A total of 179,785 adolescents and young adults were included, who were predominantly white (84%) and female (85%), with a mean age of 24.4. The majority of studies assessed access to methadone (n = 30), followed by buprenorphine (n = 26) and naltrexone (n = 10). Categories of variables assessed included age, involvement in the criminal justice system, geography, health and social system factors, personal health and social networks, race and ethnicity, sex, socioeconomic factors, and substance use type and behaviors.

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