Aadolescents who seek treatment for opioid addiction in an inpatient setting are more likely to receive the offer of horseback riding rather than full access to a highly effective common addiction drug.
According to a new research paper, only one in eight residential facilities open to patients aged 16 to 17 offer full access to buprenorphine. In contrast, nearly two-thirds of adult treatment facilities offer the drug.
The new research, published Tuesday in the Journal of the American Medical Association, comes as opioid overdose deaths in the United States hover at an all-time high. Overdose deaths among teenagers more than doubled between 2019 and 2021.
The findings are particularly ominous because if adolescents cannot access buprenorphine in residential treatment centers, they are unlikely to access it elsewhere, said Caroline King, a physician-researcher who conducted the research while studying for her medical degree at Oregon Health and Science University.
You expect the sickest kids, the kids with the least access, will be the kids in these residential care centers, he said. And if they can’t access bupe there, it might be a red flag that they really can’t access it in communities and outpatients as well. We won’t be able to treat children who use fentanyl if they don’t have access to buprenorphine.
In general, few Americans have convenient access to the drugs used to treat opioid addiction. Buprenorphine is one of only two drugs approved by the Food and Drug Administration to treat opioid cravings and withdrawal. The other, methadone, is available only through specialist clinics whose patient restrictions often make access to the drug virtually impossible.
In recent years, some advocates have called for significant deregulation of methadone, particularly by allowing doctors to prescribe it directly to patients and by allowing pharmacists to dispense it.
Separately, lawmakers last year scrapped a long-standing requirement that doctors must undergo mandatory eight-hour training and receive a special license just to prescribe buprenorphine (the X-waiver). In the midst of the Covid-19 pandemic, the federal government has also made it easier for patients to receive buprenorphine via telehealth.
While the changes have largely been welcomed, some detractors have expressed fears that increased access to methadone and buprenorphine, which are themselves opioids, could have unintended consequences, namely an increase in overdoses involving the drugs.
A new research paper released in January, however, showed that the rate of overdose deaths involving buprenorphine has not increased despite increased access.
While access to medicines is a crisis for all age groups, findings from new studies show it is particularly acute among 16- to 17-year-olds.
It is tragic to see that young people with opioid use disorder are unable to access buprenorphine in most treatment settings, despite this drug being the standard of care for people 16 years of age and older Nora Volkow, director of the National Institute on Drug Abuse, he said in a statement. Residential treatment facilities provide an opportunity to reach young people with a range of evidence-based supports at a crucial time in their lives, and it is vital that buprenorphine is made available as one of these options.
The study used a secret buy approach, in which researchers called residential treatment facilities and asked if buprenorphine was offered as a treatment.
Only 24.4 percent of the facilities contacted by the researchers offered buprenorphine even in limited settings, according to the paper. Some offered to start adolescents on buprenorphine but stopped treatment before discharge, while a select few allowed people already on the drug to continue taking it but did not provide new buprenorphine prescriptions.
Only 10.6% offered buprenorphine initiation and continued treatment.
In contrast, 25% of all facilities surveyed offered equinotherapy, a form of treatment that relies on horse riding or other horse-related activities and is not supported by evidence. More than a third have offered access to 12-step programs like Narcotics Anonymous, a group known to oppose the use of addiction drugs.
The facilities were really all over the place, King said. In reality, it was the lack of standardization and programs [being] everywhere, which surprised us the most.
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