TY - JOUR
T1 - Young Adults Have Worse Outcomes Than Older Adults
T2 - Secondary Analysis of a Medication Trial for Opioid Use Disorder
AU - Fishman, Marc
AU - Wenzel, Kevin
AU - Scodes, Jennifer
AU - Pavlicova, Martina
AU - Lee, Joshua D.
AU - Rotrosen, John
AU - Nunes, Edward
N1 - Funding Information:
This work (the original parent study) was supported by grants from the National Institute on Drug Abuse (NIDA) Clinical Trials Network ( U10DA013046 , UG1/ U10DA013035 , UG1/U10DA013034 , U10DA013045 , UG1/U10DA013720 , UG1/U10DA013732 , UG1/U10DA013714 , UG1/U10DA015831 , U10DA015833 ), as well as NCCIH ( AT010614 ) to M.F. and K.W. (salary support during the secondary analysis).
Publisher Copyright:
© 2020 Society for Adolescent Health and Medicine
PY - 2020/12
Y1 - 2020/12
N2 - Purpose: Young adults are disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. Methods: This secondary analysis compared young adults (aged 18–25 years) with older adults (aged ≥26 years) in a large comparative effectiveness trial (“XBOT”) that randomized subjects to extended-release naltrexone or sublingual buprenorphine–naloxone for 6 months. Opioid relapse was defined by opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. Results: Among subjects in the intention-to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%) compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08–2.70), p = .02. In the per-protocol sample (n = 474, only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds ratio of 1.91 (95% confidence interval = 1.19–3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected. Conclusions: Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults.
AB - Purpose: Young adults are disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. Methods: This secondary analysis compared young adults (aged 18–25 years) with older adults (aged ≥26 years) in a large comparative effectiveness trial (“XBOT”) that randomized subjects to extended-release naltrexone or sublingual buprenorphine–naloxone for 6 months. Opioid relapse was defined by opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. Results: Among subjects in the intention-to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%) compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08–2.70), p = .02. In the per-protocol sample (n = 474, only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds ratio of 1.91 (95% confidence interval = 1.19–3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected. Conclusions: Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults.
KW - Addiction treatment
KW - Buprenorphine
KW - Naltrexone
KW - Opioid use disorder
KW - Young adults
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U2 - 10.1016/j.jadohealth.2020.07.038
DO - 10.1016/j.jadohealth.2020.07.038
M3 - Article
C2 - 32873500
AN - SCOPUS:85089971531
SN - 1054-139X
VL - 67
SP - 778
EP - 785
JO - Journal of Adolescent Health
JF - Journal of Adolescent Health
IS - 6
ER -