- Experts say teens and young adults need better access to medications as the opioid crisis continues to worsen.
- But just a fraction of teens in treatment for opioid use disorder have access to medications that could help them.
- There are three main medications to treat opioid addiction: methadone, buprenorphine, and naltrexone.
Medications to treat opioid use disorder (OUD) save lives. So why aren’t more doctors prescribing them?
There are three medications approved by the Food and Drug Administration (FDA) to treat OUD in the United States: methadone, buprenorphine, and naltrexone. However, doctors consistently underutilize all of them.
Just 11 percent of patients who qualify actually get FDA-recommended medication to treat OUD, according to a recent Mayo Clinic Proceedings review.
And among certain groups, like teenagers, the use of these medications is even less frequent, down to as low as 2.4 percent.
Now in response to apparent underprescribing, members of the medical establishment are hoping to give doctors the information they need to confidently prescribe these medications and start saving lives.
And the ongoing opioid epidemic has helped public health officials push for more access to treatment. But issues remain with getting physicians trained and ready to provide these medications.
Additionally, some federal restrictions can make it particularly hard for underage patients to get access to these medications.
Opioid use among teens has hit epidemic proportions, according to a new study published in the Journal of Studies on Alcohol and Drugs.
In 2017, 900 adolescents began misusing opioids each day. Out of more than 750,000 adolescents who misused opioids in the past year, 12.8 percent, or roughly 99,000 teens, reported symptoms of OUD.
But prescribing and usage statistics on medication to treat OUD are abysmal. And for teenagers, that rate is even worse.
Only 2.4 percent of adolescents receiving treatment for heroin use received medications compared to more than 26 percent of adults.
Additionally, only 4 percent of adolescents getting treatment for prescription opioid misuse received medication. Comparatively, about 12 percent of adults received the medication.
“Access is challenging for teens and families who are interested in medications for the treatment of opioid use disorder,” said Dr. Deepa Camenga, MHS, assistant professor of emergency medicine in pediatrics at Yale School of Medicine.
Camenga is the first author of the new study, which reviews medication-assisted therapy (MAT) for OUD in adolescents.
Camenga points out there are multiple challenges faced by teens who have OUD, including the fact that it’s difficult to find physicians who have had special training to treat substance use disorders in teenagers.
“One is that we have a great deal of work to do as a profession in training professionals to feel comfortable treating adolescents with OUD,” Camenga said. “So, many communities don’t have healthcare professionals who feel comfortable treating substance use disorders in teens, even if they have people who treat adults.”
While teens may have difficulty accessing these approved medications, it can be difficult for adults, too.
In the recent Mayo Clinic Proceedings review, researchers point out that there’s a general need for physicians to have better access to high-quality information about these medications used to stop OUD.
“Our primary goal was to provide information and to improve comfort so the average physician’s comfortable with these medications,” said Dr. Tyler Oesterle, first author of that research and medical director of the Mayo Clinic Health System Fountain Centers Chemical Dependency Treatment Center.
According to Oesterle’s research, only 11 percent of patients with OUD are prescribed an FDA-approved medication.
The review was put together to encourage physicians to feel empowered to actually prescribe the medications that can help turn the tide of the
Currently, the three drugs
Even the American Academy of Pediatrics has pushed to get teenage patients more access to medications for opioid misuse. They issued a policy statement in 2016 that stated:
“The American Academy of Pediatrics (AAP) advocates for increasing resources to improve access to medication-assisted treatment of opioid-addicted adolescents and young adults. This recommendation includes both increasing resources for medication-assisted treatment within primary care and access to developmentally appropriate substance use disorder counseling in community settings.”
Here’s a brief overview of those drugs and some of the challenges teens face in terms of prescribing and access.
Methadone is an opioid with demonstrated efficacy in decreasing opioid use in adults. It’s been used to this effect since the mid-1960s. However, because the Drug Enforcement Administration (DEA) classifies it as a Schedule I substance, it’s heavily regulated.
Methadone is available only through federally regulated clinics certified by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Only in rare circumstances is methadone used to treat individuals under the age of 18. Adolescents also require written parental consent and documentation to obtain methadone treatment.
Methadone clinics remain controversial for many communities. This can affect access.
“Even as bad as the opioid crisis is, I don’t know that there are a lot of communities clamoring to have a methadone clinic put in down the street. There is still tremendous stigma involved,” said Dr. Bradley Stein, MD, PhD, senior policy researcher at the RAND Corporation and its director of Opioid Policy Tools and Information Center.
Buprenorphine (Subutex) and buprenorphine with naloxone (Suboxone) were both approved to treat OUD in the United States in 2002.
The DEA classifies it as a Schedule III substance. On account of this classification, doctors who wish to prescribe it must undergo additional training and receive a waiver through the DEA.
“Right now, about 7 percent of physicians in the United States have been waivered to provide buprenorphine… for a physician to be waivered, it takes about 8 hours of training,” Stein said. “Buprenorphine has been approved since 2002, but we’re only up to 7 percent.”
Naltrexone is an oral formulation of naltrexone. It was first approved to treat OUD in the United States in 1984. More recently, an intramuscular injection was approved, under the brand name Vivitrol, in 2010.
“It’s a full blocker, so it completely blocks opioids. So, if you are actively using opioids and you are looking to get sober, if you want to go to naltrexone, you have to completely stop your opioid use. And that’s a challenge for folks, because that means withdrawal,” Oesterle said.
The introduction of a monthly injection has improved compliance. But keeping patients on the drug to maintain its efficacy remains a challenge.
There are no large-scale clinical trials testing naltrexone in adolescents. But, according to Camenga’s research, there’s evidence to suggest that injectable naltrexone would be a “feasible and effective treatment for OUD in adolescents.”
According to every expert interviewed for this story, it’s clear that prescribing practices for OUD medication need to increase and barriers for access need to lower, especially for adolescents and young adults.
The question doctors and policymakers raise is how to effectively take on this challenge of getting more teenagers with OUD on the right medication.
Some say that stigma around OUD remains a serious detriment to appropriate treatment.
“Until we get a better handle on stigma, we are fighting this battle with one hand tied behind our back,” Stein said.
Others, like Camenga, firmly emphasize the importance of educating physicians.
“Training healthcare professionals is the first step, because these decisions are made on a case-by-case basis between the healthcare provider and the patient, and ideally their family is involved as well,” Camenga said.
“It’s really a situation where you’re weighing the risks and benefits of not receiving medication with receiving medication, given the information that we do have available,” she said.