The Urban Institute, Washington, DC, USA.
Subst Use Addctn J. 2024 Jul;45(3):434-445. doi: 10.1177/29767342241227791. Epub 2024 Jan 31.
Medications for opioid use disorder (MOUD) in youth can reduce harms but many youths do not receive MOUD. Improving quality metrics of MOUD among youth can advance interventions for youth with opioid use disorder (OUD).
We relied on 2018 Medicaid claims data from California, Colorado, Massachusetts, and New Mexico. We calculated the percentage of youth with OUD included in the quality metric for initiation, and the percentage who initiated by state. We also calculated the percentage excluded from the quality metric for initiation because they have an existing episode of OUD care and their MOUD receipt. We compared the characteristics of those who initiated/received MOUD to those who did not and compared state estimates after adjusting for age and health conditions.
Estimates of initiation exclude about half of the youth with OUD because they were in an existing episode of OUD care and could not be observed initiating. Among youth in a new episode of OUD care, only about 1 in 4 initiated and state estimates varied from 18.9% to 40.1%. Among youth with an existing episode of OUD care, more than half received MOUD and state estimates ranged from 35.2% to 71.3%. Youth who initiated MOUD or received MOUD with an existing OUD had more severe OUD but fewer co-occurring substance use disorders or mental or physical health diagnoses. After adjusting for age and health conditions, MOUD still varied substantially across states.
Most youth with a new OUD diagnosis do not initiate MOUD but more than half of the youth in an existing OUD diagnosis receive MOUD. MOUD quality metrics that are disaggregated, adjusted, and inclusive of youth in an existing episode of care provide additional insight into opportunities to better support youth who might choose MOUD. State differences should be further studied for insight into policies that may affect MOUD.
青少年阿片类药物使用障碍（MOUD）的药物治疗可以减少危害，但许多青少年并未接受 MOUD。提高青少年 MOUD 的质量指标可以促进针对阿片类药物使用障碍（OUD）青少年的干预措施。
我们依赖于来自加利福尼亚州、科罗拉多州、马萨诸塞州和新墨西哥州的 2018 年医疗补助索赔数据。我们计算了纳入启动质量指标的 OUD 青少年的百分比，以及按州启动的百分比。我们还计算了因存在 OUD 护理的现有发作以及他们的 MOUD 接收而被排除在启动质量指标之外的百分比。我们比较了启动/接受 MOUD 的青少年的特征与未启动/接受 MOUD 的青少年的特征，并在调整年龄和健康状况后比较了州估计值。
启动的估计数排除了大约一半的 OUD 青少年，因为他们处于 OUD 护理的现有发作中，无法观察到他们开始接受治疗。在新发作的 OUD 护理中，只有大约 1/4 的人开始接受治疗，州估计值从 18.9%到 40.1%不等。在存在 OUD 护理的现有发作的青少年中，超过一半的人接受了 MOUD，州估计值从 35.2%到 71.3%不等。启动 MOUD 或在现有 OUD 诊断中接受 MOUD 的青少年的 OUD 更为严重，但共病物质使用障碍或精神或身体健康诊断较少。在调整年龄和健康状况后，各州之间的 MOUD 仍存在很大差异。
大多数新诊断出 OUD 的青少年并未开始接受 MOUD，但超过一半的青少年在现有的 OUD 诊断中接受 MOUD。针对现有护理发作中的青少年进行分类、调整和包容的 MOUD 质量指标为更好地支持可能选择 MOUD 的青少年提供了更多的见解。应进一步研究各州之间的差异，以了解可能影响 MOUD 的政策。
