TOPLINE

Among more than 229,000 Medicaid-enrolled individuals aged 13-25 years with opioid use disorder (OUD) in the US, about half began treatment within 2 weeks of diagnosis, about one third engaged in care, about 15% received medications for OUD (MOUD), and about 3% continued medication for at least 180 days, a study showed. Younger adolescents (aged 13-15 years) and youths from racially minoritized groups consistently progressed less often through the stages of care.

METHODOLOGY

• A retrospective cohort study was conducted across the US, including 229,847 Medicaid-enrolled youths aged 13-25 years (median age, 22 years; 51.3% female; 58.8% non-Hispanic White individuals) who had incident-documented OUD diagnoses.
• Researchers analyzed Medicaid claims data from 2016 to 2023 that were drawn from the Transformed Medicaid Statistical Information System Analytic Files and spanned hospital stays, outpatient visits, emergency visits, pharmacy fills, and behavioral health services. 
• Researchers tracked youths' progress through stages of the cascade of care framework aligned with national quality measures: treatment initiation (receipt of any treatment within 14 days of diagnosis), engagement (recording of at least two treatment encounters within 34 days of initiating treatment), receipt of MOUD (receipt of buprenorphine, methadone, or extended-release naltrexone at any point during engagement), and 180-day MOUD retention (continuous receipt of MOUD for ≥ 180 days with no gaps of > 7 days).

TAKEAWAY

• 50.7% of youths with OUD began treatment within 14 days of diagnosis, and 32.9% of youths engaged in care.
• Among youths who engaged in care, 46.3% (representing 15.2% of all youths with diagnoses of OUD) received MOUD. This receipt differed sharply by age, with 6.6% of adolescents younger than 18 years vs 51.2% of adults receiving MOUD. Among all youths with OUD, non-Hispanic White youths were twice as likely to receive MOUD as non-Hispanic Black youths. Female youths were more likely than male youths to receive MOUD.
• Buprenorphine was the most used medication at initiation (68.5%), followed by methadone (25.5%) and extended-release naltrexone (6%). A total of 53.7% of youths engaged in care received behavioral health services but no MOUD.
• Among youths who received MOUD, 20.2% (representing 3.1% of all youths with diagnoses of OUD) stayed on medication for at least 180 days. Among those who received MOUD, 180-day retention was 26.2% with methadone, 19.2% with buprenorphine, and 5.8% with extended-release naltrexone. Retention increased with age, ranging from 0.3% among youths aged 16-17 years to 4.5% among youths aged 24-25 years, and was higher among female (3.6%) than among male (2.5%) youths. It ranged from 4% in non-Hispanic White youths to 1.2% in non-Hispanic Black youths.

IN PRACTICE

"These findings suggest large gaps exist across the OUD cascade of care for adolescents and young adults, highlighting the need for policies and care models that expand medication access and improve treatment retention," the investigators wrote.

SOURCE

The study was led by Scott E. Hadland, MD, MPH, MS, Mass General Brigham for Children, Boston. It was published online on October 2 in JAMA Network Open.

LIMITATIONS

The study was limited by its reliance on administrative claims data, which may be prone to misclassification; the requirement for continuous Medicaid enrollment, which may have introduced selection bias and led to overestimated rates by excluding youths with unstable coverage; and limited generalizability to youths who are uninsured or have commercial insurance.

DISCLOSURES

The study was funded by the National Institute on Drug Abuse of the National Institutes of Health (NIH) and grants received by two investigators from the NIH. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.