Characteristics and Receipt of Medication Treatment Among Young Adults Who Experience a Nonfatal Opioid-Related Overdose - 21/12/19
, Marc R. Larochelle, MD, MPH a, c, Ziming Xuan, ScD, SM d, Na Wang, BA e, Aneesh Patel, BA f, Dana Bernson, MPH g, Michael Silverstein, MD, MPH b, Scott E. Hadland, MD, MPH b, c, Thomas Land, PhD h, Jeffrey H. Samet, MD, MPH a, c, d, Alexander Y. Walley, MD, MSc a, c, gAbstract |
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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| Please see page 30 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors. |
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| Author contributions: SMB conceived of the study and wrote the first draft of the article. MRL, ZX, DB, and TL contributed to the development of the analytic plan. MRL, ZX, DB, MS, SEH, TL, and AYW provided feedback on the article. NW conducted the analysis. NW, MS, and SEH reviewed the final draft of the article. MS and SEH conceived the results. SMB, MRL, MS, SEH, JHS, and AYW interpreted the results. MRL, JHS, and AYW reviewed the article. SMB takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Dr. Bagley reports receiving salary support through a Career Development Award (NIDA 1K23DA044324). |
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Vol 75 - N° 1
P. 29-38 - janvier 2020 Retour au numéro
Article précédent
- One-Year Mortality After Emergency Department Visit for Nonfatal Opioid Poisoning: A Population-Based Analysis
- Pamela Leece, Cynthia Chen, Heather Manson, Aaron M. Orkin, Brian Schwartz, David N. Juurlink, Tara Gomes
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- Andrew Farkas, Michael J. Lynch, Rachael Westover, Joseph Giles, Nalyn Siripong, Akanksha Nalatwad, Anthony F. Pizon, Christian Martin-Gill
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