Opioid use disorders in adolescents: predictors of treatment and outcomes

青少年阿片类药物使用障碍：治疗和结果的预测因素

• 批准号: 10064619
• 负责人: DOUGLAS L. LESLIE
• 金额: $ 57万
• 依托单位: PENNSYLVANIA STATE UNIV HERSHEY MED CTR
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-15 至 2023-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10064619
• 关键词: Accident and Emergency department; Address; Adolescence; Adolescent; Adult; Affect; Age; American; Characteristics; Chronic; Climacteric; Clinical; Cognitive; Counseling; Dangerous Behavior; Dangerousness; Data; Databases; Development; Diagnosis; Differential Diagnosis; Drug Prescriptions; Drug abuse; Emergency department visit; Emotional; Epidemic; Event; Evidence based practice; Exposure to; Family; Family Characteristics; Geographic Locations; Geography; Health Expenditures; Healthcare Systems; Heroin; Hospitalization; Hospitals; Impairment; Individual; Insurance Carriers; Investigation; Length; Mental Health; Mental disorders; National Institute of Drug Abuse; Opioid; Opioid Analgesics; Outcome; Overdose; Pain; Parents; Patients; Pattern; Pharmacotherapy; Policies; Prevalence; Process; Public Health; Relapse; Reporting; Research; Risk; Services; Societies; Strategic Planning; Substance Use Disorder; Surveys; Time; Treatment outcome; United States; Use Effectiveness; Youth; adolescent drug abuse; adolescent substance use; aged; comorbidity; cost; design; geographic difference; implementation strategy; mortality; opioid use disorder; opioid user; opioid withdrawal; physical conditioning; prescription opioid; prescription stimulants; service providers; sex; social; sociodemographics; substance abuse treatment; twelfth grade; young adult

Project Summary/Abstract Substance use disorders (SUDs) among adolescents have risen to epidemic rates in the U.S., with more than half of American adolescents abusing drugs at least once before entering 12th grade. This staggering number of affected youth suffer cognitive and social impairment and increased risk for other dangerous behaviors. Substance use disorders are one of the largest preventable public health challenges in the United States and present costly consequences to the individual, the health care system, and society as a whole, with a large proportion of adults with SUDs reporting drug abuse beginning in adolescence. Opioid use disorders (OUDs) are a particularly dangerous component of youth SUD, resulting in increasing rates of mortality from overdoses; a range of clinical, emotional, and social negative sequelae; and potentially life-changing impacts from impairment during this critical developmental and educational period. In 2014, there were 467,000 adolescents aged 12 to 17 and 978,000 young adults aged 18 to 25 who were non-medical opioid analgesic users in the U.S. Of the intentional adolescent exposures to prescription drugs between 2007 and 2009, 68% were exposures to opioids. Furthermore, many adolescent non-medical users of opioid analgesics later switch to heroin. According to NSDUH data from 2002 to 2011, 79.5% of heroin initiates (52.7% of whom were aged 18 to 25) reported prior non-medical opioid analgesic use. While previous studies have investigated OUD service use and effectiveness in adults, very little is known about how adolescents with OUD are treated or whether these treatments are effective. We propose to use several large, national claims and survey databases to explore factors associated with the incident diagnosis of OUD in adolescents, as well as treatment patterns and outcomes. In addition to exploring patient socio-demographic and clinical characteristics associated with OUD treatment and outcomes, we will also explore family characteristics, such as parental opioid analgesic use. This proposal, responsive to the call for research to “understand the barriers to successful and sustainable implementation of evidence-based practices and to develop implementation strategies” in the 2016-2020 NIDA Strategic Plan, will address the following aims: 1) Examine geographic variation in, and other factors associated with, incident diagnosis of OUD in adolescents; 2) Examine the patterns of substance abuse treatment in adolescents with incident OUD diagnosis; and 3) Examine the risk of and time to subsequent service use indicative of relapse among adolescents with incident OUD diagnosis. This study would take advantage of a unique set of databases that allows for the investigation of family and clinical characteristics on patterns of opioid use disorder treatment and outcomes in adolescents. By better understanding how adolescents with OUD are treated and how such treatments affect risk of subsequent ED, hospital and detox services, providers, insurers and policymakers will be better able to design developmentally appropriate treatment processes and policies to help mitigate this public health crisis.

项目摘要/摘要 青少年中的药物使用障碍（SUD）在美国的流行病率上升，超过 一半的美国青少年在进入12年级之前至少滥用药物一次。这个惊人的数量 受影响的年轻人遭受认知和社会障碍，并增加了其他危险行为的风险。 药物使用障碍是美国最大的可预防公共卫生挑战之一， 当前对个人，医疗保健系统和整个社会的昂贵后果，很大 在青少年开始报告药物滥用的成年人的比例。阿片类药物使用障碍（OUDS） 是青年SUD的特别危险组成部分，导致死亡率提高 服药过量；一系列临床，情感和社会负性后遗症；并可能改变生活的影响 从这个关键发展和教育时期的损害。 2014年有467,000 年龄在12至17岁和978,000名18至25岁的青少年，他们是非医疗阿片类镇痛药 在2007年至2009年之间，美国有意接触处方药的用户，有68％ 暴露于卵虫类药物。此外，许多青少年的非医学用户后来切换 致海洛因。根据2002年至2011年的NSDUH数据，有79.5％的海洛因发起（其中52.7％的18岁 至25）报道了先前的非医疗阿片类镇痛药。虽然先前的研究调查了Oud服务 在成年人中使用和有效性，对如何对待OUD的青少年或是否了解 这些治疗是有效的。我们建议使用几个大型国家主张和调查数据库探索 与青少年中OUD的事件诊断以及治疗模式和治疗模式相关的因素 结果。除了探索与OUD相关的患者社会人口统计学和临床​​特征 治疗和结果，我们还将探索家庭特征，例如父母阿片类镇痛药。 提案，响应呼吁进行研究的呼吁“了解成功和可持续的障碍 在2016 - 2020年NIDA中实施基于证据的实践并制定实施策略” 战略计划将解决以下目的：1）检查地理差异以及其他因素 与青少年中OUD的事件诊断相关； 2）检查药物滥用的模式 在有事件Oud诊断的青少年进行治疗； 3）检查随后的风险和时间 服务使用指示有事件OUD诊断的青少年退休。这项研究将采取 一组独特的数据库的优势，该数据库允许家庭和临床特征投资 阿片类药物使用障碍治疗和青少年结果的模式。通过更好地了解如何 患有OUD的青少年以及此类治疗如何影响随后的ED，医院和排毒的风险 服务，提供商，确保和政策制定者将更好地设计合适的设计 治疗过程和政策，以帮助减轻这种公共卫生危机。