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Most youth with nicotine use disorder are not treated
Nearly all Medicaid-insured adolescents and young adults with diagnosed nicotine use disorder, or NUD, do not receive counseling or pharmacologic treatment for their condition, according to research published in JAMA Pediatrics.
“We have treatments that are proven to work for older people and are very likely to work for young people as well. Not using these treatments is a missed opportunity,” Nicholas Chadi, MD, MPH, a pediatrician at Boston Children’s Hospital, said in a news release.
Chadi and colleagues assessed information collected from a national Medicaid database to detect patients aged 10 to 22 years diagnosed with NUD. Patients who were enrolled in Medicaid for at least 6 months and diagnosed between Jan. 1, 2014, and June 30, 2015, from 11 states were included.
The researchers identified nearly 3.5 million patients, 3.8% of whom had NUD. Of these patients, 81,144 were youths.
Few adolescents and young adults received counseling for NUD (4.1%), and just 1.3% received nicotine replacement therapy or other pharmacologic therapies. Only 0.1% (n = 110) received both counseling and medications to treat NUD.
According to Chadi and colleagues, patients were more likely to be treated with medications if they were older, white, had a second diagnosis of asthma, depression, anxiety, ADHD and co-occurring alcohol or marijuana use disorder. When medications were given, most patients received bupropion (46%), nicotine replacement therapy (31.2%) or varenicline (22.7%).
“As providers, we have a tremendous opportunity here to intervene and help prevent future generations of people dealing with the long-term health consequences of nicotine use disorder,” Scott Hadland, MD, MPH, MS, a pediatrician and addiction specialist at Boston Medical Center’s Grayken Center for Addiction, said in the release. “We have tools that we know are effective in helping curb nicotine addiction, and we need to get these tools into the appropriate hands.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.
Perspective
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There are times in medicine when we are forced to face the dogmatic assumptions that limit our effectiveness in heading off illness. When juxtaposed to the recent reports of over 800 confirmed cases of vaping-associated pulmonary injury in the U.S. leading to 12 deaths, the observation that only 4% of adolescent and young adult patients with nicotine dependence received counseling — and only 1% received pharmacotherapy — represents one of those times.
Which assumptions limit our understanding of best ways to meet our patient’s treatment needs? Which assumptions make workflow adjustments seem infeasible? How can we do better? If 0.1% of patients in this age group received standard of care for their tobacco dependence, we’ve just been offered a 99.9% chance to make a significant improvement in our patients’ lives.
