An Underserved and Vulnerable Population: Interventions for Youth with Opioid Use Disorder
September 7, 2023
Nonfatal and fatal overdoses from opioids have been on the rise for young Americans; a CDC report found that drug overdose deaths increased 100% from 2019 to 2021. Opioid misuse among young people can pose serious health risks and long-term consequences. However, states and localities have been slow to adopt evidence-based strategies for teenagers (aged 12-17) and young adults (aged 18-24)
Treatment with Medication for Opioid Use Disorder and Youth Interventions
Despite the rise of opioid overdoses among young people, teenagers and young adults use various treatment services–both inpatient and outpatient–at much lower rates compared to adults. For example, clinical admissions for teenagers and young adults decreased by 63% and 13% respectively between 2008 and 2017. The use of a medication to treat opioid use disorder among young people is also low, with just 22% of those aged 18-25 and 0% of 12-17 year olds reporting use of one of these medications in the 2019 National Survey of Drug Use and Health. In fact, in contrast to the increasing use of buprenorphine by adults with an opioid use disorder, the use of buprenorphine has been decreasing over the past few years among young people.
A study conducted in British Columbia, Canada sought to understand providers’ perspectives on why traditional services are not reaching younger populations. Participants expressed a need to efficiently and quickly administer care to young people in a timely manner, as well as retain youth in their programs. In particular, providers listed limitations in serving youth with “complex needs”, such as co-occurring chronic pain, or that services are not tailored for racial and sexual minority youth. Other challenges included legal issues, such as navigating provincial and local policies to administer treatment to youth, and institutional barriers, such as a lack of communication and coordination between different agencies and organizations. While they were able to find some work-arounds to the issues, many were still frustrated by the barriers they faced in their work.
What States Should Consider
Principle 3 encourages local and state governments to invest in evidence-based youth prevention programs. Both Blueprints for Health Youth Development and Communities That Care give specific examples of such programs.
Prevention strategies that focus on positive youth development and resilience have proven to be effective at reducing youth exposure, risk, and use of opioids. One study evaluated the effectiveness of three modified strategies at reducing use of opioids among young people. The strategies were inspired by the Strengthening Families Program: For Parents and Youth 10-14, Life Skills Training program, and the Promoting School-community-university Partnerships to Enhance Resilience model. All three prevention strategies were found to significantly reduce use of prescription drugs and opioids during later years of life for young people who participated in the study. Settlement funds could be used by state and local governments to implement positive youth development and resilience training programs in middle schools.
Going beyond prevention, states and jurisdictions could consider funding a continuum of services for young people, including expanding access to medications for opioid use disorder for youth, and screening youth for opioid use disorder to refer them to relevant services. Office-based opioid treatment, which involves outpatient providers using buprenorphine to treat patients with opioid use disorder, has been shown to reduce the frequency of overdose visits to emergency departments (by almost two-thirds).
New York State’s Office of Addiction Services and Supports (OASAS) plans to support youth-oriented opioid education and prevention programs using their share of the opioid settlement funds. One New York State middle school has already implemented an overdose intervention program on their campus. The school’s program includes training for school staff on bystander intervention strategies, such as using naloxone to intervene during an overdose event, and increasing the supply of naloxone available on campus by placing them in emergency cabinets that hold other medical emergency supplies. The strategy recognizes that an overdose may happen anywhere and to anyone, and arms public spaces such as schools with the ability to save a person’s life in case of emergency.