Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts.
Department of Pediatrics Boston Medical Center, Boston, Massachusetts.
JAMA Pediatr. 2017 Aug 1;171(8):747-755. doi: 10.1001/jamapediatrics.2017.0745.
Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy.
To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt.
Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis.
Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis.
Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001).
In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.
阿片类药物使用障碍（OUD）通常始于青少年和青年时期。主要专业组织建议早期采用药物治疗。以前没有全国性的研究调查过患有 OUD 的青少年和年轻人（统称为青年）接受药物治疗的程度。
确定美国患有 OUD 的青年接受丁丙诺啡和纳曲酮治疗的时间趋势和差异。
设计、设置和参与者：使用来自全国商业保险数据库的匿名数据进行了回顾性队列研究。分析了 970 万 13 至 25 岁的青年的登记和完整健康保险索赔，确定了在 2001 年 1 月 1 日至 2014 年 6 月 30 日期间患有 OUD 的个体，并于 2014 年 12 月 31 日进行了最终随访。分析于 2016 年 4 月 25 日至 12 月 31 日进行。确定了时间趋势，并使用多变量逻辑回归确定与药物使用相关的社会人口统计学因素。
性别、年龄、种族/族裔、邻里教育和贫困水平、地理区域、人口普查区域和诊断年份。
在首次接受 OUD 诊断后 6 个月内开出一种药物（丁丙诺啡或纳曲酮）。
在 20822 名被诊断为 OUD 的青年中（占 970 万样本的 0.2%），13698 名（65.8%）为男性，17119 名（82.2%）为非西班牙裔白人。首次观察到的诊断时的平均（SD）年龄为 21.0（2.5）岁。OUD 的诊断率从 2001 年到 2014 年几乎增加了 6 倍（从每 10 万人每年 0.26 例增加到每 10 万人每年 1.51 例）。总体而言，5580 名青年（26.8%）在诊断后 6 个月内开出了一种药物，在接受药物治疗的青年中，4976 名（89.2%）接受了丁丙诺啡，604 名（10.8%）接受了纳曲酮。药物治疗的比例增加了 10 多倍，从 2002 年（丁丙诺啡推出时）的 3.0%增加到 2009 年的 31.8%，但随后几年有所下降（2014 年为 27.5%）。在多变量分析中，年龄较小的个体接受药物治疗的可能性较小，调整后的年龄为 13 至 15 岁的概率为 1.4%（95%CI，0.4%-2.3%）；16 至 17 岁的概率为 9.7%（95%CI，8.4%-11.1%）；18 至 20 岁的概率为 22.0%（95%CI，21.0%-23.0%）；21 至 25 岁的概率为 30.5%（95%CI，30.0%-31.5%）（P<0.001 差异）。女性（7124[20.3%]）比男性（13698[24.4%]）更不可能接受药物治疗（P<0.001），非西班牙裔黑人和西班牙裔青年（分别为 105[14.8%]和 1165[20.0%]）比非西班牙裔白人青年（17119[23.1%]）更不可能接受药物治疗（P<0.001）。
在这项关于青年丁丙诺啡和纳曲酮使用的首次全国性研究中，配药随着时间的推移而增加。尽管如此，只有 1/4 的有商业保险的患有 OUD 的青年接受了药物治疗，而且观察到了基于性别、年龄和种族/族裔的差异。
