9.19.24 MACS Webinar on Approaches to Treatment of OUD in the Pediatric Population-Resources from Dr. Fishman

Resources from Dr. Fishman

Pdf Summary

The narrative review led by Marc Fishman and colleagues critically examines the challenges and opportunities in medication treatment for opioid use disorder (OUD) among young adults (YAs) aged 18-25. Opioid misuse in this demographic is disproportionately high, contributing to severe health and social consequences. Medications for OUD (MOUD), including Buprenorphine, Methadone, and Naltrexone, are proven effective but underutilized in young adults.<br /><br />**Barriers to Treatment:**<br /><br />1. **Engagement:** YAs have markedly lower engagement rates in treatment programs compared to other adults.<br />2. **MOUD Initiation:** Only a small fraction of young adults with OUD initiate MOUD, as seen in several studies. Common reasons include stigma, logistical difficulties, and a lack of awareness or negative perceptions about MOUD.<br />3. **Retention:** Retention rates for YAs on MOUD are poor. Younger age is consistently a predictor of shorter treatment duration and higher dropout rates.<br /><br />**Explanations for Barriers:**<br /><br />- **Developmental Factors:** Adolescents may overestimate their ability to manage substance use without treatment.<br />- **Logistical Issues:** Long waitlists, financial barriers, and lack of specialized services impede access.<br />- **Stigma:** Extensive stigma from both within and outside the healthcare system affects participation. <br />- **Family Influence:** Negative family perceptions about MOUD can deter YAs from seeking or adhering to treatment.<br /><br />**Strategies for Improvement:**<br /><br />1. **Family Involvement:** Integration of family support, modeled after Community Reinforcement Approach and Family Training (CRAFT), has shown promise in improving treatment engagement and retention.<br />2. **Primary Care Integration:** Placing MOUD services in pediatric or primary care settings might enhance accessibility and early intervention.<br />3. **Assertive Outreach:** Persistent and proactive engagement methods, such as frequent follow-ups and use of multiple communication channels, can help retain young adults in treatment.<br />4. **Policy Interventions:** Recent legislative changes, like expanding MOUD prescribing authority and revoking specialized training requirements, aim to increase provider capacity.<br />5. **Upstream Interventions:** Using educational settings and social media to reach young adults early in their substance misuse trajectory can be effective in preemptive intervention.<br /><br />The study concludes by advocating for a multi-faceted, developmentally informed approach that includes family involvement, policy support, and innovative outreach strategies tailored for YAs to effectively combat the opioid crisis.

Keywords

Opioid Use Disorder

Young Adults

Medication Treatment

Buprenorphine

Methadone

Naltrexone

Treatment Barriers

Family Involvement

Primary Care Integration

Policy Interventions