PMID- 30208470 OWN - NLM STAT- MEDLINE DCOM- 20191004 LR - 20240404 IS - 2168-6211 (Electronic) IS - 2168-6203 (Print) IS - 2168-6203 (Linking) VI - 172 IP - 11 DP - 2018 Nov 1 TI - Receipt of Timely Addiction Treatment and Association of Early Medication Treatment With Retention in Care Among Youths With Opioid Use Disorder. PG - 1029-1037 LID - 10.1001/jamapediatrics.2018.2143 [doi] AB - IMPORTANCE: Retention in addiction treatment is associated with reduced mortality for individuals with opioid use disorder (OUD). Although clinical trials support use of OUD medications among youths (adolescents and young adults), data on timely receipt of buprenorphine hydrochloride, naltrexone hydrochloride, and methadone hydrochloride and its association with retention in care in real-world treatment settings are lacking. OBJECTIVES: To identify the proportion of youths who received treatment for addiction after diagnosis and to determine whether timely receipt of OUD medications is associated with retention in care. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used enrollment data and complete health insurance claims of 2.4 million youths aged 13 to 22 years from 11 states enrolled in Medicaid from January 1, 2014, to December 31, 2015. Data analysis was performed from August 1, 2017, to March 15, 2018. EXPOSURES: Receipt of OUD medication (buprenorphine, naltrexone, or methadone) within 3 months of diagnosis of OUD compared with receipt of behavioral health services alone. MAIN OUTCOMES AND MEASURES: Retention in care, with attrition defined as 60 days or more without any treatment-related claims. RESULTS: Among 4837 youths diagnosed with OUD, 2752 (56.9%) were female and 3677 (76.0%) were non-Hispanic white. Median age was 20 years (interquartile range [IQR], 19-21 years). Overall, 3654 youths (75.5%) received any treatment within 3 months of diagnosis of OUD. Most youths received only behavioral health services (2515 [52.0%]), with fewer receiving OUD medications (1139 [23.5%]). Only 34 of 728 adolescents younger than 18 years (4.7%; 95% CI, 3.1%-6.2%) and 1105 of 4109 young adults age 18 years or older (26.9%; 95% CI, 25.5%-28.2%) received timely OUD medications. Median retention in care among youths who received timely buprenorphine was 123 days (IQR, 33-434 days); naltrexone, 150 days (IQR, 50-670 days); and methadone, 324 days (IQR, 115-670 days) compared with 67 days (IQR, 14-206 days) among youths who received only behavioral health services. Timely receipt of buprenorphine (adjusted hazard ratio, 0.58; 95% CI, 0.52-0.64), naltrexone (adjusted hazard ratio, 0.54; 95% CI, 0.43-0.69), and methadone (adjusted hazard ratio, 0.32; 95% CI, 0.22-0.47) were each independently associated with lower attrition from treatment compared with receipt of behavioral health services alone. CONCLUSIONS AND RELEVANCE: Timely receipt of buprenorphine, naltrexone, or methadone was associated with greater retention in care among youths with OUD compared with behavioral treatment only. Strategies to address the underuse of evidence-based medications for youths with OUD are urgently needed. FAU - Hadland, Scott E AU - Hadland SE AD - Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. AD - Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts. AD - Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. FAU - Bagley, Sarah M AU - Bagley SM AD - Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. AD - Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts. AD - Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. AD - Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. FAU - Rodean, Jonathan AU - Rodean J AD - Children's Hospital Association, Lenexa, Kansas. FAU - Silverstein, Michael AU - Silverstein M AD - Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts. FAU - Levy, Sharon AU - Levy S AD - Adolescent Substance Use and Addictions Program, Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts. FAU - Larochelle, Marc R AU - Larochelle MR AD - Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts. AD - Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. AD - Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. FAU - Samet, Jeffrey H AU - Samet JH AD - Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts. AD - Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. AD - Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts. FAU - Zima, Bonnie T AU - Zima BT AD - Semel Institute for Neuroscience and Human Behavior, UCLA (University of California, Los Angeles), Los Angeles. LA - eng GR - L40 DA042434/DA/NIDA NIH HHS/United States GR - K23 DA045085/DA/NIDA NIH HHS/United States GR - K23 DA042168/DA/NIDA NIH HHS/United States GR - K24 HD081057/HD/NICHD NIH HHS/United States GR - K23 DA044324/DA/NIDA NIH HHS/United States GR - R25 DA013582/DA/NIDA NIH HHS/United States PT - Journal Article PT - Multicenter Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't PL - United States TA - JAMA Pediatr JT - JAMA pediatrics JID - 101589544 RN - 0 (Narcotics) RN - 40D3SCR4GZ (Buprenorphine) RN - 5S6W795CQM (Naltrexone) RN - UC6VBE7V1Z (Methadone) SB - IM CIN - Evid Based Nurs. 2020 Jul;23(3):77. PMID: 31462425 MH - Adolescent MH - Behavior Therapy MH - Buprenorphine/therapeutic use MH - Female MH - Humans MH - Male MH - Methadone/therapeutic use MH - Naltrexone/therapeutic use MH - Narcotics/therapeutic use MH - Opiate Substitution Treatment/*methods MH - Opioid-Related Disorders/*rehabilitation MH - Retention in Care/*statistics & numerical data MH - Retrospective Studies MH - Time Factors MH - United States MH - Young Adult PMC - PMC6218311 MID - NIHMS989582 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2018/09/13 06:00 MHDA- 2019/10/08 06:00 PMCR- 2019/09/10 CRDT- 2018/09/13 06:00 PHST- 2018/09/13 06:00 [pubmed] PHST- 2019/10/08 06:00 [medline] PHST- 2018/09/13 06:00 [entrez] PHST- 2019/09/10 00:00 [pmc-release] AID - 2698965 [pii] AID - poi180052 [pii] AID - 10.1001/jamapediatrics.2018.2143 [doi] PST - ppublish SO - JAMA Pediatr. 2018 Nov 1;172(11):1029-1037. doi: 10.1001/jamapediatrics.2018.2143.