Section of Adolescent Medicine, Department of Pediatrics, Yale School of Medicine, 100 Church Street South, Suite A222, New Haven, CT, 06520, USA.
Division of Adolescent Medicine, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
Harm Reduct J. 2024 Nov 25;21(1):210. doi: 10.1186/s12954-024-01113-8.
Medications for opioid use disorder (MOUD) are under-prescribed to adolescents and young adults (AYA). Few published studies have explored challenges to and opportunities to enhance continuous provision of MOUD for AYA. Our report focuses on this emergent theme that was identified as part of a larger qualitative study.
We purposively sampled and enrolled medical providers who prescribed MOUD to AYA. Semi-structured individual interviews using chart-stimulated recall explored barriers and facilitators to MOUD retention. We used modified grounded theory in our qualitative analysis, with double coding of interviews.
Barriers to retention on MOUD included patient-level (i.e., return to substance use) and system-level factors (i.e., cost, delayed receipt, pharmacy challenges, and in-person visit requirements). Facilitators included patient-level (i.e., motivation, support networks) and system-level factors (i.e., telehealth access, availability of certified recovery specialists).
Our study is the first to look at retention for this key age group, setting it apart from the existing body of literature that looks at medication initiation. Our findings confirm that significant systemic barriers exist to AYA patients' retention on MOUD. Further research is needed to develop interventions that facilitate continuous delivery of high-quality care among this key population.
阿片类药物使用障碍（MOUD）的药物治疗在青少年和年轻人（AYA）中开得不足。很少有已发表的研究探讨过为 AYA 持续提供 MOUD 的挑战和机会。我们的报告侧重于这一新兴主题，这是作为一项更大的定性研究的一部分确定的。
我们有目的地选择和招募为 AYA 开具 MOUD 的医疗服务提供者。使用图表激发回忆的半结构式个体访谈探讨了 MOUD 保留的障碍和促进因素。我们在定性分析中使用了改良的扎根理论，并对访谈进行了双重编码。
MOUD 保留的障碍包括患者层面（即，恢复物质使用）和系统层面的因素（即，成本、延迟获得、药房挑战和面对面就诊要求）。促进因素包括患者层面（即，动机、支持网络）和系统层面的因素（即，远程医疗访问、认证康复专家的可用性）。
我们的研究是首次针对这一年龄关键群体的保留问题进行的研究，与现有的关注药物起始的文献有所不同。我们的发现证实，AYA 患者在 MOUD 上的保留存在重大的系统障碍。需要进一步研究以制定干预措施，为这一关键人群提供高质量的连续护理。
