Department of Population Health, New York University Grossman School of Medicine, New York, New York, United States of America.
New York State Office of Addiction Services and Supports (OASAS), Albany, New York, United States of America.
PLoS One. 2024 Aug 14;19(8):e0297567. doi: 10.1371/journal.pone.0297567. eCollection 2024.
In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux.
We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay.
Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.
在美国，18 至 25 岁的过渡年龄段（TA）成年人中阿片类药物使用障碍（OUD）的患病率令人担忧，这对接受医疗补助的个人和家庭造成了不成比例的影响。同样令人担忧的是，许多年轻人的治疗系统仍然表现不佳，这强调了在他们生命历程的关键时期，需要解决这个弱势群体所面临的治疗挑战。药物治疗是治疗 OUD 的最有效方法，但值得注意的是，观察性研究显示，阿片类药物使用障碍（MOUD）药物的接受和保留方面存在差距，导致许多 TA 成年人在治疗中出现不良结果。目前很少有关于 OUD 治疗质量的研究明确考虑个体、组织和环境因素的影响，特别是对于那些社会角色和机构关系仍在变化的年轻人。
我们引入了回顾性、纵向队列设计，以研究 2012 年至 2025 年间在纽约接受 OUD 治疗的约 65000 名 TA 成年人的治疗质量实践和结果。我们建议结合多个来源的数据，包括医疗补助索赔和就诊数据以及州物质使用障碍（SUD）治疗记录，以检查 OUD 治疗质量的三个方面：1）MOUD 使用，包括 MOUD 选择（例如丁丙诺啡、美沙酮或延长释放[XR]纳曲酮）；2）药物治疗的依从性和治疗保留率；3）不良事件（例如，过量）。我们将使用严格的分析方法，深入了解治疗实践和结果的变化如何更广泛地由与社区、治疗计划以及患者特征相关的多层次过程以及它们的复杂相互作用来构建。
我们的研究结果将为患者和提供者的临床决策提供信息，也将为美国阿片类药物和多药物过量危机中寻求 OUD 治疗的年轻成年人数量不断增加的公共卫生应对措施提供信息。
