After Opioid Overdose, Most Young People Aren’t Getting Addiction Treatment
Posted on by Dr. Francis Collins
Drug overdoses continue to take far too many lives, driven primarily by the opioid crisis (though other drugs, such as methamphetamine and cocaine, are also major concerns). While NIH’s Helping to End Addiction Long-term (HEAL) Initiative is taking steps to address this terrible crisis, new findings serve as another wake-up call that young people battling opioid addiction need a lot more assistance to get back on the right track.
In a study of more than 3,600 individuals, aged 13-22, who survived an opioid overdose, an NIH-funded team found that only about one-third received any kind of follow-up addiction treatment . Even more troubling, less than 2 percent of these young people received the gold standard approach of medication treatment.
The findings reported in JAMA Pediatrics come from Rachel Alinsky, an adolescent medicine and addiction medicine fellow at Johns Hopkins Children’s Center, Baltimore. She saw first-hand the devastating toll that opioids are taking on our youth.
Alinsky also knew that nationally more than 4,000 fatal opioid overdoses occurred in people between the ages of 15 and 24 in 2016 . Likewise, rates of nonfatal opioid overdoses for teens and young adults also have been escalating, leading to more than 7,000 hospitalizations and about 28,000 emergency department visits in 2015 alone .
In the latest study, Alinsky wanted to find out whether young people who overdose receive timely treatment to help prevent another life-threatening emergency. According to our best evidence-based guidelines, timely treatment for youth with an opioid addiction should include medication, ideally along with behavioral interventions.
That’s because opioid addiction rewires the brain—will power alone is simply not sufficient to achieve and sustain recovery. After one overdose, the risk of dying from another one rises dramatically. So, it is critical to get those who survived an overdose into effective treatment right away.
Alinsky and her team dove into the best-available dataset, consisting of data on more than 4 million mostly low-income adolescents and young adults who’d been enrolled in Medicaid for at least six months in 16 states. The sample included 3,606 individuals who’d been seen by a doctor and diagnosed with opioid poisoning. A little over half of them were female; most were non-Hispanic whites.
Heroin accounted for about a quarter of those overdoses. The rest involved other opioids, most often prescription painkillers. However, the researchers note that some overdoses attributed to heroin might have been caused by the powerful synthetic opioid fentanyl. The use of fentanyl, often mixed with heroin, was on the rise in the study’s final years, but it was rarely included in drug tests at the time.
Less than 20 percent of young people in the sample received a diagnosis of opioid use disorder, or a problematic pattern of opioid use resulting in impairment or distress. What’s more, in the month following an overdose, few received the current standard for addiction treatment, which should include behavioral therapy and treatment with one of three drugs: buprenorphine, naltrexone, or methadone.
Drilling a little deeper into the study’s findings:
• 68.9 percent did not receive addiction treatment of any kind.
• 29.3 percent received behavioral health services alone.
• Only 1.9 percent received one of three approved medications for opioid use disorder.
It’s been estimated previously that teens and young adults are one-tenth as likely as adults 25 years and older to get the recommended treatment for opioid use disorder . How can that be? The researchers suggest that one factor might be inexperience among pediatricians in diagnosing and treating opioid addiction. They also note that, even when the problem is recognized, doctors sometimes struggle to take the next step and connect young people with addiction treatment facilities that are equipped to provide the needed treatment to adolescents.
As this new study shows, interventions designed to link teens and young adults with the needed recovery treatment and care are desperately needed. As we continue to move forward in tackling this terrible crisis through the NIH’s HEAL Initiative and other efforts, finding ways to overcome such systemic barriers and best engage our youth in treatment, including medication, will be essential.
 Receipt of addiction treatment after opioid overdose among Medicaid-enrolled adolescents and young adults. Alinsky RH, Zima BT, Rodean J, Matson PA, Larochelle MR, Adger H Jr, Bagley SM, Hadland SE. JAMA Pediatr. 2020 Jan 6:e195183.
 Overdose death rates. National Institute on Drug Abuse, NIH.
 2018 annual surveillance drug-related risks and outcomes—United States: surveillance special report. Centers for Disease Control and Prevention.
 Medication-assisted treatment for adolescents in specialty treatment for opioid use disorder. Feder KA, Krawczyk N, Saloner B. J Adolesc Health. 2017 Jun;60(6):747-750.
Opioid Overdose Crisis (National Institute on Drug Abuse/NIH)
Opioid Overdose (Centers for Disease Control and Prevention, Atlanta)
Decisions in Recovery: Treatment for Opioid Use Disorder (Substance Abuse and Mental Health Services Administration, Rockville, MD)
Rachel Alinsky (Johns Hopkins University Children’s Center, Baltimore)
Helping to End Addiction Long-term (HEAL) Initiative (NIH)
NIH Support: Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Drug Abuse
Yes all addicts need rehabilitation, but how do you get them there and how can they pay when they are not able to hold down a job? these are our children who will be left to defend our country and our beliefs.
Local Health Department is a good place to start. They can help addicts get Medicaid insurance that will pay for treatment. I lost two sons to opiate overdose and have suffered with addiction myself.
I am a nurse practitioner student. What I see is that there are too few resources for addiction treatment (either medication, behavioral, or both). So follow up care is very hard to find and is often not timely. This holds true for mental health services too. Some areas are worse than others. It is a difficult situation that we are slowly addressing. Our graduating class is undertaking the ASAM medication assisted treatment training and hopefully most of us will be licensed to treat addiction. There are some free clinics out there, but finding one is the challenge. We should all try to make a difference in our communities one person at a time.
I am a substance use disorder counselor (we do integrated healthcare – behavioral health, primary care, MAT). My own daughter died of an overdose 18 months ago. She was in hospital for an abscess and MRSA. She was permitted to leave AMA. When I was with her, I tried to get her MAT treatment in hospital. The internal med physicians’ response to her disclosing her OUD was to ACCELERATE detox from narcotic pain management, which, of course, provoked withdrawal symptoms. She had no incentive to remain in hospital for treatment. When I asked for help for her underlying condition (OUD), the internal med folks said (literally) “We don’t do THAT!” We need internal med docs and ED personnel to be educated about OUD and we need seamless referral to MAT tx – hopefully beginning BEFORE the patient is discharged.
Susan, I extend sincerest condolences for your loss. Hoping you will find peace in knowing every effort counts. I admire your courage to stand up and speak about the realities of this immensely difficult situation. Everything you wrote here is true. I’ve witnessed it several times and I’ve gotta say it’s disappointing (a huge understatement). Thankfully there are people in the world for good reasons and I commend you for being a part of the solutions. Thank you!
Seamless referrals. Warm/hot hand offs. Integrated care. Transitional care. These are terms that are still overwhelmingly academic and are not yet proselytized. Especially when it comes to SUD/OUD. That window of time to intercept a person and prevent decompensation is so critical. Locally, more support is needed to ensure ED departments have a way to link and refer as soon as a person is admitted with these concerns. Discharge is tooooo late. Work is happening, just keep up with hard work!!
Wow, I never heard of medication-assisted recovery before but it does look very promising, especially how it’s basically helping a patient have as little chance of relapse as possible. A friend of mine once expressed to me her desire to come clean of marijuana. I should probably suggest this kind of treatment for her.