Patient and provider medication preferences affect treatment outcomes among adolescents and young adults with opioid use disorder

Laura B Monico; Jesse B Fletcher; Tyler Ross; Robert P Schwartz; Marc J Fishman; Jan Gryczynski; Shannon Gwin Mitchell

doi:10.1016/j.josat.2024.209334

Patient and provider medication preferences affect treatment outcomes among adolescents and young adults with opioid use disorder

J Subst Use Addict Treat. 2024 Mar 24:162:209334. doi: 10.1016/j.josat.2024.209334. Online ahead of print.

Authors

Laura B Monico¹, Jesse B Fletcher², Tyler Ross³, Robert P Schwartz², Marc J Fishman⁴, Jan Gryczynski², Shannon Gwin Mitchell²

Affiliations

¹ Friends Research Institute Inc, United States of America. Electronic address: lmonico@friendsresearch.org.
² Friends Research Institute Inc, United States of America.
³ Memorial University of Newfoundland, United States of America.
⁴ Maryland Treatment Centers Inc, United States of America.

PMID: 38531508
DOI: 10.1016/j.josat.2024.209334

Abstract

Background: The opioid epidemic in the United States has not spared youth or young adults, as evidenced by a six-fold increase in opioid use disorder (OUD) diagnoses in the last two decades. Given this dramatic rise, a call for greater uptake and accessibility of medications for opioid use disorder (MOUDs) among youth and young adults has ensued, resulting in an increasing number of MOUD treatment pathways for this vulnerable population.

Methods: This secondary data analysis seeks to characterize patient and provider preferences for MOUD treatment pathways, and test for associations between baseline MOUD treatment preferences and opioid use and treatment adherence outcomes. Participants included 288 youth and young adults (age 15-21 years), recruited from a residential treatment program in Maryland. The study assessed patient preferences at baseline (n = 253) and provider preferences at patient treatment discharge (n = 224). Mixed-effects negative binomial regression models were conducted for opioid use outcomes, and logistic regressions were conducted for treatment adherence outcomes.

Results: Results indicate that congruence of treatment with patients' (Incidence Rate Ratio [IRR] = 0.65) and providers' (IRR = 0.66) preferences was significantly associated with reduced self-reported days of opioid use in the past 90 days, but only for patients receiving extended-release naltrexone (XR-NTX). Results also indicated that patients were less likely to switch medication treatment pathways (e.g., from XR-NTX to buprenorphine, or vice versa) during follow-up if they received their preferred treatment at baseline, a finding which held true for both XR-NTX (Odds Ratio [OR] = 0.32) and buprenorphine (OR = 0.22).

Conclusions: Receipt of MOUD congruent with patient and provider preferences was associated with reduced opioid use and greater treatment adherence in this sample of youth and young adults with OUD.

Keywords: Adolescent; Buprenorphine; Extended-release naltrexone (XR-NTX); MOUD; Opioid use disorder; Young adult.