Medications for Opioid Use Disorder Among Transition Age Youth Compared to Adults 26 or Older in Rural Settings

Abstract

Objective

Transition age youth (TAY), aged 18 to 25 years, face barriers to medication treatment for opioid use disorder (MOUD), resulting in lower retention. We evaluated OUD prevalence and MOUD receipt comparing TAY to adults aged 26 or older residing in rural settings.

Method

Electronic health records (October 2019 to January 2021) for 36,762 patients across 6 primary care clinics involved in a large feasibility trial in US rural communities were analyzed. All clinics implemented a standardized intervention. Mixed effects logistic/linear regression estimated the odds of OUD diagnosis among all patients, and, among those with OUD, the odds of receiving MOUD and days prescribed MOUD during the 15-month study period, comparing age categories (TAY aged 18-25 years vs adults 26 years or older). Covariates included gender, race, ethnicity, mental health comorbidities, and insurance status.

Results

OUD prevalence was 2.82% among TAY (n = 3,122) and 3.24% among adults aged 26 or older (n = 33,208). After adjusting for covariates and clustering, TAY had significantly lower odds of OUD diagnosis compared to adults 26 years or older (odds ratio = 0.58, 95% CI 0.45-0.73). There were no significant differences in MOUD receipt between age groups. Compared to adults aged 26 or older, TAY with OUD had significantly fewer MOUD days during the study, −43.81 days (−76.85 to −10.77).

Conclusion

Although no differences were observed in MOUD prescription receipt between TAY and adults aged 26 or older, TAY with OUD had fewer total days prescribed MOUD, indicating lower retention. Further research generalizable to rural communities is needed to assess retention among rural TAY with OUD.

Plain language summary

This study used data from the electronic health records of 6 rural primary care clinics across three states to compare the diagnostic rates of opioid use disorder (OUD) and the prescription of medications for opioid use disorder (MOUD) between 3,122 transition age youths (aged 18-25) and 33,208 adults aged 26 or older. The study found that the rates of OUD were lower in youths under age 25 compared to adults 26 or older. However, among participants diagnosed with OUD, youths under age 25 received 43 to 63 fewer days of prescribed MOUD compared to adults 26 years or older. These findings indicate possible inconsistencies in care such as lower retention or lower adherence affecting transition age youths compared to adults 26 or older. These findings highlight the need for age-appropriate interventions to improve treatment among youths with opioid use disorder in rural settings.

Clinical trial registration information

Rural MOUD Telemedicine in Primary Care Phase 1 (Feasibility); https://clinicaltrials.gov/; NCT04418453.