Gallant Kat, Nijjar Preety, DeBeck Kora, Cui Michelle, Kerr Thomas
From the British Columbia Centre on Substance Use, British Columbia, Canada (KG, KD, MC, TK); Department of Medicine, University of British Columbia, British Columbia, Canada (PN, TK); and School of Public Policy, Simon Fraser University, British Columbia, Canada (KD).
J Addict Med. 2025;19(1):105-108. doi: 10.1097/ADM.0000000000001361. Epub 2024 Aug 27.
Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years.
Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021.
A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use.
This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.
阿片类激动剂疗法（OAT）仍然是阿片类物质使用障碍患者的一线治疗方法。尽管青少年和青年（AYA）的过量用药率仍然很高，但对于他们获得OAT治疗的情况却知之甚少。因此，我们试图评估影响14至26岁AYA获得OAT治疗的因素。
数据来自高危青年研究，这是一项前瞻性队列研究，涉及加拿大温哥华街头涉毒的AYA。使用广义估计方程来确定2005年9月至2021年10月期间与OAT登记相关的因素。
共有759名AYA报告至少每周使用阿片类药物或接受OAT治疗，中位年龄为23岁，65.7%自我认定为男性。在基线时，147名参与者（19.4%）正在接受OAT治疗，另外199名（26.2%）在研究随访期间开始接受OAT治疗（随访就诊次数中位数为5次[四分位间距，2.5 - 8次]）。在多变量分析中，年龄<19岁（调整后的优势比[AOR]，0.40；95%置信区间[CI]，0.23 - 0.71）、有原住民血统（OR，0.72；95% CI，0.52 - 1.00）、无家可归（AOR，0.65；95% CI，0.54 - 0.77）、从事毒品交易（AOR，0.73；95% CI，0.61 - 0.87）、每日使用阿片类药物（AOR，0.47；95% CI，0.40 - 0.55）以及非致命性过量用药（AOR，0.73；95% CI，0.60 - 0.89）与使用OAT呈负相关。
本研究发现AYA获得OAT治疗的比例较低。如果青少年和青年年龄<19岁、有原住民血统且具有某些风险标志物，则他们接受OAT治疗的可能性较小。这些发现凸显了需要采取缓解策略以促进该人群获得OAT治疗，以及需要采取额外的减少伤害措施来支持那些不想接受OAT治疗的AYA。
