Few Teens Who Survive Opioid OD Get Recommended Care

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By Amy Norton
HealthDay Reporter

TUESDAY, Jan. 7, 2020 (HealthDay News) — Even after surviving an opioid overdose, few U.S. teenagers receive the recommended treatment for their addiction, a new study shows.

Researchers found that of nearly 3,800 teenagers and young adults who’d suffered an opioid overdose, less than one-third went into addiction treatment within a month. And only one in 54 received the medication recommended for tackling opioid dependence.

“That’s abysmal,” said lead researcher Dr. Rachel Alinsky, of Johns Hopkins School of Medicine in Baltimore. “We wouldn’t tolerate that in any other area of medicine.”

The findings come amid a national opioid epidemic that is claiming a rising number of lives from overdose.

On average, 130 Americans die every day from an opioid overdose, according to the U.S. Centers for Disease Control and Prevention. In 2017, the number of deaths involving opioids — including prescription painkillers, heroin and illicitly made fentanyl — was six times higher than it was in 1999.

It’s well known that people addicted to opioids often go untreated, and teenagers are much less likely than adults to get the recommended medications, Alinsky noted.

The new findings show that even after teens suffer an overdose, that pattern continues.

It’s striking, in part, because people being treated for an overdose are in contact with health care providers who can steer them toward addiction treatment, Alinsky said. And, she pointed out, these individuals are particularly vulnerable.

“They’re at high risk of a recurrent overdose within three months,” Alinsky said.

The “gold standard” treatment for opioid addiction involves counseling and any of three approved medications: methadone, buprenorphine or naltrexone. Methadone and buprenorphine reduce physiological cravings for opioids and withdrawal symptoms, while naltrexone blocks the “high” people get from the drugs (should they relapse while in treatment).

But there are well-known barriers to getting those medications, Alinsky said. Methadone, for example, can only be given through specialty treatment centers. And to prescribe buprenorphine, providers have to go through training, apply for a waiver and agree to limits on the number of patients they will treat.

Beyond that, Alinsky said, there are misunderstandings and “stigma” attached to medication therapy — not only in the general public, but also among providers and policymakers. Some believe “abstinence-based” treatment is the only way, and that using medication is trading one addiction for another.

“We don’t stigmatize people with other medical conditions for needing medication,” Alinsky said. “Why does it happen to people who have an opioid use disorder?”

With young people, the problem appears especially acute. Past studies show that underage patients in treatment for opioid addiction receive medication at one-tenth the rate that adults do, according to Alinsky’s team.

For the study, the researchers combed through data on over 4 million 13- to 22-year-olds covered by Medicaid — the government health insurance program for low-income Americans.

Between April 2018 and March 2019, there were 3,791 deaths from an opioid overdose. The large majority — 69% — received no addiction treatment within a month, while 29% went into behavioral therapy alone. Just under 2% had started any medication, according to the report.

Alinsky pointed to another finding that stood out: Despite suffering an overdose, only 19% of those young people had a diagnosis of opioid use disorder in their medical records. So part of the problem, Alinsky said, may be that some ER providers are not recognizing overdose as part of a chronic disorder.

The findings were published online Jan. 6 in JAMA Pediatrics.

Lindsey Vuolo is director of health law and policy at the nonprofit Center on Addiction, in New York City.

“Unfortunately,” she said, “the results of this study are not surprising.”

Vuolo called stigma the “biggest barrier” to opioid addiction treatment, because it fuels all other obstacles.

“Stigma contributes to lack of addiction training among health care providers and an underinvestment in treatment,” she said. “Stigma underlies federal regulations governing prescribing and administration of methadone and buprenorphine, which contribute to limited access and availability of these medications.”

It also feeds “discriminatory insurance practices” that make addiction treatment unaffordable or burdensome to obtain, Vuolo said.

Better training for health care providers in screening for and treating opioid addiction would help, according to Vuolo. The emergency department — where overdose patients are typically treated — is one important place, she noted. Some hospitals have launched programs to get overdose patients started on buprenorphine in the ER.

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References


SOURCES: Rachel Alinsky, M.D., M.P.H., general pediatrics and adolescent medicine, Johns Hopkins School of Medicine, Baltimore; Lindsey Vuolo, J.D., M.P.H., director, health law and policy, Center on Addiction, New York City; Jan. 6, 2020, JAMA Pediatrics, online

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