Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1821 Clifton Road, NE, Atlanta, GA 30329, USA.
Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1821 Clifton Road, NE, Atlanta, GA 30329, USA.
Drug Alcohol Depend. 2023 May 1;246:109850. doi: 10.1016/j.drugalcdep.2023.109850. Epub 2023 Mar 23.
Medication for opioid use disorder (MOUD) is vastly underutilized in adolescents. Existing treatment guidelines for OUD largely focus on adults, providing limited guidance for pediatric populations. Limited information is known about use of MOUD in adolescents based on substance use severity.
This secondary data analysis examined how patient-level variables influenced the receipt of MOUD in adolescents aged 12-17 (n = 1866) using the Treatment Episode Data Set (TEDS) 2019 Discharge data set. A crosstabulation and chi-square statistic evaluated the relationship between a proxy for clinical need based on high-risk opioid use (either reporting daily opioid use within the past 30 days and/or history of injection opioid use) for MOUD in states with and without adolescents receiving MOUD (n = 1071). A two-step logistic regression analysis in states with any adolescents receiving MOUD examined the explanatory power of demographic, treatment intake, and substance use characteristics.
Completion of 12th grade, a GED, or beyond, decreased the likelihood of receiving MOUD (odds ratio [OR]= 0.38, p = 0.017), as did being female (OR = 0.47, p = .006). None of the remaining clinical criteria were significantly associated with MOUD, although a history of one or more arrests increased the likelihood of MOUD (OR = 6.98, p = 0.06). Only 13% of individuals who met criteria for clinical need received MOUD.
Lower education could serve as a proxy for substance use severity. Guidelines and best practices are needed to ensure the proper distribution of MOUD to adolescents based on clinical need.
阿片类药物使用障碍（MOUD）的药物治疗在青少年中未得到广泛应用。现有的 OUD 治疗指南主要针对成年人，为儿科人群提供的指导有限。根据物质使用的严重程度，青少年使用 MOUD 的信息有限。
本二次数据分析使用 2019 年 TEDS 出院数据集，考察了患者水平变量如何影响 12-17 岁青少年（n=1866）接受 MOUD 的情况。通过交叉表和卡方检验，评估了在有和没有青少年接受 MOUD 的州，基于高风险阿片类药物使用（在过去 30 天内报告每日使用阿片类药物和/或注射阿片类药物使用史）的临床需要代理变量与青少年接受 MOUD 之间的关系（n=1071）。在有任何青少年接受 MOUD 的州，进行了二步逻辑回归分析，以考察人口统计学、治疗摄入和物质使用特征的解释力。
完成 12 年级、GED 或更高学历，降低了接受 MOUD 的可能性（优势比[OR]=0.38，p=0.017），女性（OR=0.47，p=0.006）也是如此。其余的临床标准与 MOUD 均无显著相关性，尽管有一次或多次被捕记录会增加 MOUD 的可能性（OR=6.98，p=0.06）。仅有 13%符合临床需要标准的人接受了 MOUD。
较低的教育程度可能是物质使用严重程度的一个指标。需要制定指南和最佳实践，以确保根据临床需要向青少年适当分配 MOUD。
