Organizational Predictors and Use of Evidence-Based Practices in Adolescent Substance Abuse Treatment

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults: A Systematic Review

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.

Exploring recovery capital among adolescents in an alternative peer group

BACKGROUND

Recovery support models (RSMs) integrate peer supports and continuing care to promote sustained recovery for adolescents with substance use disorder. RSMs aim to build recovery capital (RC), the personal, social, and environmental resources required to sustain recovery. The Alternative Peer Group (APG) is an RSM that integrates pro-recovery peers and social activities into clinical practice. APGs aim to build adolescents' RC and help them establish pro-recovery social networks. The Recovery Capital for Adolescents Model (RCAM) is a proposed framework for identifying assets to enhance and barriers to address in supporting adolescents' recovery. The RCAM has never been directly applied in APG research so little is known about the process of building RC while participating in an APG.

METHODS

This study is a secondary analysis of semi-structured interviews with APG participants. Using a deductive analytic approach, the RCAM was systematically applied to participants' narratives to examine the model's utility for identifying recovery barriers and resources that promote adolescent recovery.

FINDINGS

This study's findings confirmed the RCAM's utility for identifying specific recovery assets and barriers to recovery faced by adolescents. APG participants' narratives generally reflected the RCAMs RC domains (financial, human, social and community) as proposed and added details to refine the model. Specific strategies employed by the APG to enhance RC and address recovery barriers are presented and illustrated with qualitative exemplars.

CONCLUSIONS

The RCAM is a useful model for identifying the multiple, interrelated factors inherent to adolescents' recovery experience and potential pathways of RC resource-building.