Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014.
Trends in Receipt of Buprenorphine and Naltrexone for Opioid Use Disorder Among Adolescents and Young Adults, 2001-2014.
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DOI：
10.1001/jamapediatrics.2017.0745
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发表时间：
2017-08-01
期刊：
影响因子：
26.1
通讯作者：
Larochelle MR
中科院分区：
文献类型：
--
作者：
Hadland SE;Wharam JF;Schuster MA;Zhang F;Samet JH;Larochelle MR
阿片类药物使用障碍(OUD)通常始于青春期和青春期。主要专业组织建议及早进行药物治疗。以前的国家研究都没有研究过患有艾滋病的青少年和青壮年(统称为“青年”)接受药物治疗的程度。目的：确定丁丙诺啡和纳曲酮在美国患有OUD的青少年中接受治疗的时间趋势和差异。回溯性队列。970万青年的参保和完整的健康保险索赔，使用的是来自国家商业保险数据库Optom的去身份数据。在2001年1月1日至2014年6月30日期间被诊断为多发性硬化症的13-25岁青年。性别、年龄、种族/民族、邻里教育和贫困程度、大都市地区、人口普查地区和诊断年份。在首次接受OUD诊断后6个月内分发药物(丁丙诺啡或纳曲酮)。我们确定了时间趋势，并使用多变量Logistic回归来确定与药物接收相关的社会人口学因素。在20,822名确诊为OUD的年轻人(占样本的0.2%)中，13,698名(65.8%)为男性，17,119名(82.4%)为非西班牙裔白人。首次诊断时平均年龄为21.0岁(2.5岁)。从2001年到2014年，OUD的诊断率增加了近6倍。总体而言，5580名(26.8%)青年在确诊后6个月内服用了药物，其中4976名(89.2%)接受药物治疗的青年接受丁丙诺啡治疗，604名(10.8%)接受纳曲酮治疗。药物收入从2002年(丁丙诺啡引入时)的3.0%增长到2009年的31.8%，增长了10倍以上，但在随后的几年中有所下降。在多变量分析中，年轻人接受药物治疗的可能性较小(调整后的年龄13-15岁的概率为1.4%；16-17岁的调整概率为9.7%；18-20岁的调整概率为22.0%；21-25岁的调整概率为30.5%；P<；差异为0.001)。女性(20.3%)比男性(24.4%)更少接受药物治疗(p<；0.001)，非西班牙裔黑人(14.8%)和西班牙裔青年(20.0%)与非西班牙裔白人青年(23.1%；p<；0.001)相比也是如此。在这项关于在年轻人中接受丁丙诺啡和纳曲酮的首次全国性研究中，处方随着时间的推移而增加。尽管如此，只有四分之一的有商业保险的患有OUD的年轻人接受了药物治疗，并且观察到了基于性别、年龄和种族/民族的差异。
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, “youth”) with OUD receive pharmacotherapy. To identify time trends and disparities in receipt of buprenorphine and naltrexone among youth with OUD in the US. Retrospective cohort. Enrollment and complete health insurance claims of 9.7 million youth using de-identified data from Optum, a national commercial insurance database. Youth aged 13–25 years who received a diagnosis of OUD between January 1, 2001 and June 30, 2014. Sex, age, race/ethnicity, neighborhood education and poverty levels, metropolitan area, census region, and year of diagnosis. Dispensing of a medication (buprenorphine or naltrexone) within 6 months of first receiving an OUD diagnosis. We identified time trends and used multivariable logistic regression to determine sociodemographic factors associated with medication receipt. Among 20,822 youth diagnosed with OUD (0.2% of the sample), 13,698 (65.8%) were male and 17,119 (82.4%) were non-Hispanic white. Mean age (SD) was 21.0 (2.5) years at first observed diagnosis. The diagnosis rate of OUD increased nearly 6-fold from 2001 to 2014. Overall, 5,580 (26.8%) youth were dispensed a medication within 6 months of diagnosis, with 4,976 (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. In multivariable analyses, younger individuals were less likely to receive medications (adjusted probability for age 13–15 years, 1.4%; 16–17 years, 9.7%; 18–20 years, 22.0%; 21–25 years, 30.5%; p<0.001 for difference). Females (20.3%) were less likely than males (24.4%) to receive medications (p<0.001), as were non-Hispanic black (14.8%) and Hispanic (20.0%) youth compared to non-Hispanic white youth (23.1%; p<0.001). 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.
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