Importance:Opioid use disorder (OUD) frequently begins in adolescence and young adulthood. Intervening early with pharmacotherapy is recommended by major professional organizations. No prior national studies have examined the extent to which adolescents and young adults (collectively termed youth) with OUD receive pharmacotherapy. Objective:To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the United States. Design, Setting, and Participants:A retrospective cohort study was conducted using deidentified data from a national commercial insurance database. Enrollment and complete health insurance claims of 9.7 million youth, aged 13 to 25 years were analyzed, identifying individuals who received a diagnosis of OUD between January 1, 2001, and June 30, 2014, with final follow-up date December 31, 2014. Analysis was conducted from April 25 to December 31, 2016. Time trends were identified and multivariable logistic regression was used to determine sociodemographic factors associated with medication receipt. Exposures:Sex, age, race/ethnicity, neighborhood education and poverty levels, geographic region, census region, and year of diagnosis. Main Outcomes and Measures:Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis. Results:Among 20 822 youth diagnosed with OUD (0.2% of the 9.7 million sample), 13 698 (65.8%) were male and 17 119 (82.2%) were non-Hispanic white. Mean (SD) age was 21.0 (2.5) years at the first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014 (from 0.26 per 100 000 person-years to 1.51 per 100 000 person-years). Overall, 5580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4976 (89.2%) of medication-treated youth receiving buprenorphine and 604 (10.8%) receiving naltrexone. Medication receipt increased more than 10-fold, from 3.0% in 2002 (when buprenorphine was introduced) to 31.8% in 2009, but declined in subsequent years (27.5% in 2014). In multivariable analyses, younger individuals were less likely to receive medications, with adjusted probability for age 13 to 15 years, 1.4% (95% CI, 0.4%-2.3%); 16 to 17 years, 9.7% (95% CI, 8.4%-11.1%); 18 to 20 years, 22.0% (95% CI, 21.0%-23.0%); and 21 to 25 years, 30.5% (95% CI, 30.0%-31.5%) (P < .001 for difference). Females (7124 [20.3%]) were less likely than males (13 698 [24.4%]) to receive medications (P < .001), as were non-Hispanic black (105 [14.8%]) and Hispanic (1165 [20.0%]) youth compared with non-Hispanic white (17 119 [23.1%]) youth (P < .001). Conclusions and Relevance:In this first national study of buprenorphine and naltrexone receipt among youth, dispensing increased over time. Nonetheless, only 1 in 4 commercially insured youth with OUD received pharmacotherapy, and disparities based on sex, age, and race/ethnicity were observed.

译文

重要性:阿片类药物使用障碍(OUD)经常在青春期和成年期开始。主要专业组织建议尽早进行药物治疗。以前的国家研究都没有研究OUD的青少年和年轻人(统称为青年)接受药物治疗的程度。
目的:确定美国OUD青年中丁丙诺啡和纳曲酮的接受时间趋势和差异。
设计,地点和参与者:使用来自国家商业保险数据库的身份不明数据进行回顾性队列研究。分析了970万年龄在13至25岁之间的970万青年的入学和完全健康保险理赔,确定了在2001年1月1日至2014年6月30日期间被诊断为OUD的个人,最终随访日期为2014年12月31日。分析于2016年4月25日至12月31日进行。确定了时间趋势,并使用多变量logistic回归确定与用药相关的社会人口统计学因素。
暴露:性别,年龄,种族/民族,邻里教育和贫困程度,地理区域,人口普查区域和诊断年份。
主要结果和措施:在首次接受OUD诊断后的6个月内分发药物(丁丙诺啡或纳曲酮)。
结果:在20822名被诊断为OUD的青年中(占970万样本的0.2%),男性中有13698名(65.8%),非西班牙裔白人中有17119名(82.2%)。在首次观察到的诊断中,平均(SD)年龄为21.0(2.5)岁。从2001年到2014年,OUD的诊断率增长了近6倍(从每100000人年0.26增至每100000人年1.51)。总体而言,在诊断后的6个月内分配了5580(26.8%)名年轻人用药,其中接受丁丙诺啡的4976(89.2%)名接受药物治疗的青年人和接受纳曲酮的604名(10.8%)。药物治疗的收入增加了十倍以上,从2002年的3.0%(引入丁丙诺啡时)到2009年的31.8%,但随后几年却下降了(2014年为27.5%)。在多变量分析中,年龄较小的个体接受药物治疗的可能性较小,年龄调整为13至15岁的概率为1.4%(95%CI,0.4%-2.3%); 16至17年,9.7%(95%CI,8.4%-11.1%); 18至20年,22.0%(95%CI,21.0%-23.0%);和21至25年,分别为30.5%(95%CI,30.0%-31.5%)(差异P <<。001)。与非西班牙裔黑人(105名[14.8%])和西班牙裔(1165名[20.0])相比,女性(7124名[20.3%])与男性(13698名[24.4%])接受药物治疗的可能性较小(P <.001)。 %]的年轻人与非西班牙裔白人(17119 [23.1%])的年轻人相比(P <)。001)。
结论和相关性:在这项关于丁丙诺啡和纳曲酮的年轻人接受的首次国家研究中,随着时间的流逝,配药量增加。尽管如此,只有四分之一的有OUD的商业保险青年接受了药物治疗,并且观察到了基于性别,年龄和种族/民族的差异。

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