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Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults: A Systematic Review.
JAMA Pediatrics ( IF 26.1 ) Pub Date : 2022-03-01 , DOI: 10.1001/jamapediatrics.2021.4606
Andreas Pilarinos 1, 2 , Daniel J Bromberg 3, 4 , Mohammad Karamouzian 1, 5
Affiliation  

IMPORTANCE The ongoing overdose crisis continues to adversely affect adolescents and young adults (AYAs) and has led to numerous preventable deaths. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, have the potential to reduce opioid use and associated harms; however, there are concerns that AYAs lack access to these potentially life-saving medications. OBJECTIVE To systematically review peer-reviewed literature on MOUD access and associated factors to synthesize strategies that can improve MOUD access for AYAs who use opioids. EVIDENCE REVIEW The MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Web of Science, and Global Dissertations & Theses databases were searched from database inception until May 3, 2021. English, French, Russian, or Spanish peer-reviewed studies that evaluated the availability, prescription receipt, or initiation of MOUD were eligible for inclusion. FINDINGS This systematic review identified 37 cohort (n = 17), cross-sectional (n = 15), and qualitative (n = 5) studies that accounted for 179 785 AYAs (mean [SD] age, 24.4 [3.9] years; 148 779 [85%] were female; 67 771 [84%] were White) and examined access to methadone (30 studies), buprenorphine (26 studies), and naltrexone (10 studies). Findings reinforce concerns that AYAs were less likely to access MOUD and suggest that adolescents were more likely to receive naltrexone or buprenorphine-naloxone, which have a lower potential for abuse, in comparison with young adults. This review also identified other factors that were associated with MOUD access, including criminal justice involvement, residing in the US South, living in a limited-income area, Black race, and Hispanic or Latino ethnicity, suggesting ways in which treatment services may be improved to increase MOUD access and meet the treatment goals of AYAs. CONCLUSION AND RELEVANCE This systematic review found gaps in MOUD access between AYAs and non-AYA populations in addition to differences in MOUD access between adolescents and young adults. Considering that existing clinical guidelines recommend the use of MOUD among AYAs, and in light of the increasing number of opioid toxicity deaths, there is a need to improve MOUD access among AYAs by reducing barriers to MOUD and providing AYAs with a continuum of health and social supports alongside MOUD. Future research into ways to encourage MOUD uptake among AYAs may improve the treatment and health outcomes for this population.

中文翻译:

青少年和年轻人获得阿片类药物使用障碍和相关因素的药物:系统评价。

重要性 持续的药物过量危机继续对青少年和年轻成人 (AYA) 产生不利影响,并导致许多本可预防的死亡。用于治疗阿片类药物使用障碍 (MOUD) 的药物,如美沙酮、丁丙诺啡和纳曲酮,有可能减少阿片类药物的使用和相关危害;然而,有人担心 AYA 无法获得这些可能挽救生命的药物。目标 系统地回顾关于 MOUD 访问和相关因素的同行评审文献,以综合可以改善使用阿片类药物的 AYA 的 MOUD 访问的策略。证据审查 MEDLINE、Embase、PsycINFO、CINAHL、Sociological Abstracts、Web of Science 和 Global Dissertations & Theses 数据库从数据库开始到 2021 年 5 月 3 日进行了搜索。英语、法语、俄语、或评估 MOUD 的可用性、处方收据或启动的西班牙同行评审研究符合纳入条件。结果 本系统评价确定了 37 项队列研究 (n = 17)、横断面研究 (n = 15) 和定性研究 (n = 5),涉及 179 785 名 AYA(平均 [SD] 年龄,24.4 [3.9] 岁;148 779 [85%] 为女性;67771 [84%] 为白人)并检查了美沙酮(30 项研究)、丁丙诺啡(26 项研究)和纳曲酮(10 项研究)的使用情况。调查结果强化了人们对 AYA 不太可能获得 MOUD 的担忧,并表明与年轻人相比,青少年更有可能接受纳曲酮或丁丙诺啡-纳洛酮,它们的滥用可能性较低。该审查还确定了与 MOUD 访问相关的其他因素,包括刑事司法参与、居住在美国南部、收入有限的地区、黑人、西班牙裔或拉丁裔,建议可以改善治疗服务以增加 MOUD 访问并实现 AYA 的治疗目标的方法。结论和相关性 该系统评价发现 AYA 和非 AYA 人群之间的 MOUD 获取存在差距,此外青少年和年轻人之间的 MOUD 获取存在差异。考虑到现有的临床指南建议在 AYA 中使用 MOUD,并且鉴于阿片类药物毒性死亡人数的增加,有必要通过减少 MOUD 的障碍并为 AYA 提供连续的健康和社会服务来改善 AYA 中的 MOUD 获取与 MOUD 一起支持。未来研究鼓励 AYA 吸收 MOUD 的方法可能会改善该人群的治疗和健康结果。
更新日期:2021-12-06
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