Buprenorphine rarely available for adolescents at US addiction treatment centers
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Key takeaways:
- Approximately 22% of addiction treatment facilities require adolescents be off buprenorphine prior to admission.
- More treatment facilities offer equine therapy than buprenorphine treatment.
Only one-quarter of residential addiction treatment centers caring for adolescents in the United States offer buprenorphine to patients with opioid use disorder, according to findings published Tuesday in JAMA.
Buprenorphine is the only opioid use disorder treatment approved by the FDA for use in adolescents aged 16 years or older. Although it was first approved in 2002 and has been reported to be safe and effective, studies have noted barriers to its use, including lack of access. Gaps in its use have been linked to increased overdose risks.
“This study grew out of a recognition that opioid use disorder, especially fentanyl use, is increasing among adolescents, as we’ve experienced a marked increase in overdoses between the ages of 14 and 18,” P. Todd Korthuis, MD, MPH, professor of medicine at Oregon Health & Science University School of Medicine and co-author of the study, told Healio. “Rather than submit a survey of programs or interview directors, we wanted to know what families experienced when they tried to find treatment for a loved one.”
Korthuis and colleagues called every residential treatment center in the U.S. listed on the Substance Abuse and Mental Health Services Administration’s online treatment locator page.
“What we found was only 160 programs in the entire country that confirmed they treated adolescents,” Korthuis said.
The researchers posed as the aunt or uncle of a 16-year-old seeking treatment after a recent nonfatal fentanyl overdose and asked what the facilities offered in terms of treatment.
Of the 160 residential treatment facilities, only 39 offered buprenorphine. Twelve offered it to adolescents aged younger than 16 years. Among the remaining 121 facilities that did not offer buprenorphine, 47% indicated that a teenager with their own buprenorphine prescription could stay on it, although 22% of facilities required patients to be off buprenorphine upon admission.
Among the more “jaw-dropping” findings, Korthuis said, was that more treatment facilities — 40 — offered equine therapy than buprenorphine regimens.
“There’s almost no evidence that horse therapy works, whereas there’s overwhelming evidence that buprenorphine saves lives,” Korthuis said.
He said one of the reasons that residential treatment facilities may have difficulty prescribing buprenorphine is a lack of outpatient prescribers in the community.
“We need to redouble our efforts as a medical community to support pediatricians and family medicine doctors in screening for fentanyl use, and being able to start buprenorphine as an outpatient when it’s appropriate,” Korthuis said.
“It is tragic to see that young people with opioid use disorder are unable to access buprenorphine in most treatment facilities, despite this medication being the standard of care for people aged 16 and older,” Nora Volkow, MD, director of the National Institute on Drug Abuse, said in a press release. “Residential treatment facilities provide an opportunity to reach young people with a range of evidence-based supports at a pivotal time in their lives, and it is crucial that buprenorphine is made available as one of those options.”
Korthuis called fentanyl a “very serious public health challenge” among the country’s youth.
“But there’s a lot of hope that buprenorphine can help the brain heal and get back on track with all of the great things that teenagers love to do,” he said.
References:
- Only 1 in 4 adolescent treatment facilities offer buprenorphine for opioid use disorder. https://www.nih.gov/news-events/news-releases/only-1-4-adolescent-treatment-facilities-offer-buprenorphine-opioid-use-disorder. Published June 13, 2023. Accessed June 13, 2023.
- Teens rarely receive addiction medication in U.S. treatment centers. https://www.eurekalert.org/news-releases/991984?. Published June 13, 2023. Accessed June 13, 2023.
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