PDF(Pubmed)
Abstract：
BACKGROUND: In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux.
METHODS: We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay.
CONCLUSIONS: Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.
METHODS: We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay.
CONCLUSIONS: Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S.
摘要：
背景：在美国，在过渡年龄（TA）成年人中，阿片类药物使用障碍（OUD）的患病率有所增加，18到25岁,对医疗补助覆盖的个人和家庭产生不成比例的影响。同样值得关注的是，对于许多年轻人来说，治疗系统仍然表现不佳，强调需要解决这一弱势群体在其生命历程中的关键时刻所面临的治疗挑战。药物治疗是OUD最有效的治疗方法,然而值得注意的是，观察性研究揭示了阿片类药物使用障碍（MOUD）的药物接收和保留方面的差距，导致许多TA成人在治疗中的不良结局。目前很少有关于OUD治疗质量的研究明确考虑个体的影响，组织，和上下文因素，特别是对于那些社会角色和机构关系仍在变化的年轻人。
方法：我们介绍了一个回顾性的，纵向队列设计,旨在研究2012年至2025年间在纽约接受OUD治疗的约65,000名TA成人的治疗质量实践和结局.我们建议合并来自多个来源的数据，包括医疗补助索赔和遭遇数据以及物质使用障碍（SUD）治疗发作的州注册表，检查OUD治疗质量的三个方面：1)MOUD使用，包括MOUD选项(例如，丁丙诺啡,美沙酮,或缓释[XR]纳曲酮)；2)坚持药物治疗和治疗保留；3)不良事件(例如，过量）。使用严格的分析方法，我们将提供有关如何通过与社区相关的多层次过程更广泛地构建治疗实践和结果的变化的见解，治疗方案,和病人的特征，以及它们复杂的相互作用。
结论：我们的发现将为患者和提供者的临床决策以及公共卫生应对越来越多的年轻人在美国阿片类药物和多物质过量危机中寻求OUD治疗提供信息
方法：我们介绍了一个回顾性的，纵向队列设计,旨在研究2012年至2025年间在纽约接受OUD治疗的约65,000名TA成人的治疗质量实践和结局.我们建议合并来自多个来源的数据，包括医疗补助索赔和遭遇数据以及物质使用障碍（SUD）治疗发作的州注册表，检查OUD治疗质量的三个方面：1)MOUD使用，包括MOUD选项(例如，丁丙诺啡,美沙酮,或缓释[XR]纳曲酮)；2)坚持药物治疗和治疗保留；3)不良事件(例如，过量）。使用严格的分析方法，我们将提供有关如何通过与社区相关的多层次过程更广泛地构建治疗实践和结果的变化的见解，治疗方案,和病人的特征，以及它们复杂的相互作用。
结论：我们的发现将为患者和提供者的临床决策以及公共卫生应对越来越多的年轻人在美国阿片类药物和多物质过量危机中寻求OUD治疗提供信息
