Clinician Perspectives on Barriers and Facilitators to Providing Medications for Opioid Use Disorder for Adolescents.

Abstract

Objectives: Despite rising adolescent opioid overdose deaths, adolescents under the age of 18 years are frequently excluded from the provision of medication for opioid use disorder (MOUD/OUD). As part of preimplementation work to inform the expansion of evidence-based practices to close this service gap, we designed this qualitative study to examine the perspectives of MOUD-providing clinicians on barriers and facilitators to providing MOUD for adolescents younger than 18.

Methods: We recruited clinicians who reported prescribing MOUD at least once per month, purposively sampling to include individuals who varied on training and practice backgrounds, experience prescribing to adolescents younger than 18, and practice settings (urban, suburban, and rural). We performed semistructured interviews and subsequent qualitative thematic analysis of transcripts.

Results: Three major barriers emerged: (1) the overcomplicated, intimidating nature of MOUD training and regulations, (2) poor understanding of MOUD treatment recommendations and consent/confidentiality laws for adolescents younger than 18, and (3) negative, stigmatizing views of adolescents with substance use disorders and the perceived difficulty of treating them. Facilitators identified included: (1) treatment demystification with adolescent-specific OUD implementation protocols/training, (2) clinician-to-clinician peer messaging and encouragement, and (3) formal family and community-level education medicalizing addiction.

Conclusions: Significant barriers to prescribing MOUD to adolescents younger than 18 persist despite the removal of federal training requirements. Comprehensive, multilevel adolescent-specific MOUD education paired with may expand the MOUD-prescribing workforce and improve treatment access. Further research should continue to explore these themes to inform policy and practice reforms aimed at improving outcomes for adolescents affected by OUD.