Mintz Carrie M, Presnall Ned J, Sahrmann John M, Borodovsky Jacob T, Glaser Paul E A, Bierut Laura J, Grucza Richard A
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
Drug Alcohol Depend. 2020 Aug 1;213:108130. doi: 10.1016/j.drugalcdep.2020.108130. Epub 2020 Jun 18.
Adolescents with opioid use disorder (OUD) are an understudied and vulnerable population. We examined the association between age and six-month treatment retention, and whether any such association was moderated by medication treatment.
In this retrospective cohort study, we used an insurance database with OUD treatment claims from 2006-2016. We examined 261,356 OUD treatment episodes in three age groups: adolescents (ages 12-17), young adults (18-25) and older adults (26-64). We used logistic regression to estimate prevalence of six-month retention before and after stratification by treatment type (buprenorphine, naltrexone, or psychosocial only). Insurance differences (commercial vs Medicaid) in medication treatment prevalence were also assessed.
Adolescents were less likely to be retained compared to adults (17.6 %; 95 % CI 16.5-18.7 % for adolescents; 25.1 %; 95 % CI 24.7-25.4 % for young adults; 33.3 %; 95 % CI 33.0-33.5 % for older adults). This disparity was reduced after adjusting for treatment type. For all ages, buprenorphine was more strongly associated with retention than naltrexone or psychosocial treatment. Adolescents who received buprenorphine were more than four times as likely to be retained in treatment (44.8 %; 95 % CI 40.6-49.0) compared to those who received psychosocial services (9.7 %; 95 % CI 8.8-10.8). Persons with commercial insurance were more likely to receive medication than those with Medicaid (73 % vs 36 %, (χ = 38,042.6, p < .001).
Age disparities in six-month treatment retention are strongly related to age disparities in medication treatment. Results point to need for improved implementation of medication treatment for persons with OUD, regardless of age or insurance status.
患有阿片类物质使用障碍（OUD）的青少年是一个研究不足且易受伤害的群体。我们研究了年龄与六个月治疗留存率之间的关联，以及这种关联是否会受到药物治疗的调节。
在这项回顾性队列研究中，我们使用了一个包含2006年至2016年OUD治疗索赔的保险数据库。我们研究了三个年龄组的261,356次OUD治疗事件：青少年（12至17岁）、年轻成年人（18至25岁）和老年人（26至64岁）。我们使用逻辑回归来估计按治疗类型（丁丙诺啡、纳曲酮或仅心理社会治疗）分层前后六个月留存率的患病率。还评估了药物治疗患病率方面的保险差异（商业保险与医疗补助）。
与成年人相比，青少年治疗留存的可能性较小（青少年为17.6%；95%置信区间为16.5 - 18.7%；年轻成年人为25.1%；95%置信区间为24.7 - 25.4%；老年人为33.3%；95%置信区间为33.0 - 33.5%）。在调整治疗类型后，这种差异有所减小。对于所有年龄段，丁丙诺啡与留存率的关联比纳曲酮或心理社会治疗更强。与接受心理社会服务的青少年（9.7%；95%置信区间为8.8 - 10.8）相比，接受丁丙诺啡治疗的青少年在治疗中留存的可能性高出四倍多（44.8%；95%置信区间为40.6 - 49.0）。拥有商业保险的人比拥有医疗补助的人更有可能接受药物治疗（73%对36%，（χ = 38,042.6，p <.001）。
六个月治疗留存率的年龄差异与药物治疗的年龄差异密切相关。结果表明，无论年龄或保险状况如何，都需要改进对患有OUD者的药物治疗实施情况。
