Comment; We need to do better. I have an admitted bias for buprenorphine. This study shows unacceptable delay in getting these folks on medication, more Naltrexone use in younger populations. If the patient’s are unwilling to get into treatment, we need a “carrot & stick” automatic program to funnel them into at least Medication-Assisted Treatment, ideally more broad-based education about recovery and treatment. To many years of life are being lost!
Sarah M. Bagley, MD, MSca,b,c,∗,Correspondence information about the author MD, MSc Sarah M. Bagley
, Marc R. Larochelle, MD, MPHa,c, Ziming Xuan, ScD, SMd, Na Wang, BAe, Aneesh Patel, BAf, Dana Bernson, MPHg, Michael Silverstein, MD, MPHb, Scott E. Hadland, MD, MPHb,c, Thomas Land, PhDh, Jeffrey H. Samet, MD, MPHa,c,d, Alexander Y. Walley, MD, MSca,c,gPlumX MetricsDOI: https://doi.org/10.1016/j.annemergmed.2019.07.030
Article Info
Study objective
Nonfatal opioid overdose represents an opportunity to engage young adults into using medication for opioid use disorder. We seek to describe characteristics of young adults who experience nonfatal overdose and estimate rates of and time to medication for opioid use disorder for young adults relative to those aged 26 to 45 years.
Methods
We conducted a cohort study using retrospective administrative data of 15,281 individuals aged 18 to 45 years who survived an opioid-related overdose in Massachusetts between 2012 and 2014, using deidentified, individual-level, linked data sets from Massachusetts government agencies. We described patient characteristics stratified by age (18 to 21, 22 to 25, and 26 to 45 years) and evaluated multivariable Cox proportional hazards models to compare rates of medication for opioid use disorder receipt, controlling for age, sex, history of mental health disorders, and addiction treatment.
Results
Among 4,268 young adults in the year after nonfatal overdose, 28% (n=336/1,209) of those aged 18 to 21, 36% (n=1,097/3,059) of those aged 22 to 25 years, and 36% (n=3,916/11,013) of those aged 26 to 45 years received medication for opioid use disorder. For individuals aged 18 to 21 and 22 to 25 years, median time to buprenorphine treatment was 4 months (interquartile range 1.7 to 1.8 months); to methadone treatment, 4 months (interquartile range 2.8 to 2.9 months); and to naltrexone treatment, 1 month (interquartile range 1 to 1 month). Individuals aged 18 to 21 years were less likely (adjusted hazard ratio 0.60 [95% confidence interval 0.45 to 0.70]) to receive methadone than those aged 22 to 25 and 26 to 45 years. Individuals aged 18 to 21 years and those aged 22 to 25 years were more likely to receive naltrexone (adjusted hazard ratio 1.65 [95% confidence interval 1.36 to 2.00] and 1.41 [95% confidence interval 1.23 to 1.61], respectively) than those aged 26 to 45 years.
Conclusion
One in 3 young adults received medication for opioid use disorder in the 12 months after surviving an overdose. Type of medication for opioid use disorder received appeared to be age associated. Future research should focus on how medication choice is made and how to optimize the emergency department for medication for opioid use disorder initiation after nonfatal overdose.
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