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Original Investigation
January 6, 2020

Receipt of Addiction Treatment After Opioid Overdose Among Medicaid-Enrolled Adolescents and Young Adults

Author Affiliations
  • 1Division of General Pediatrics and Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
  • 2Semel Institute for Neuroscience and Human Behavior, UCLA (University of California, Los Angeles), Los Angeles
  • 3Children’s Hospital Association, Lenexa, Kansas
  • 4Grayken Center for Addiction, Boston Medical Center, Boston, Massachusetts
  • 5Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
  • 6Department of Pediatrics, Boston Medicine Center, Boston, Massachusetts
  • 7Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts
JAMA Pediatr. Published online January 6, 2020. doi:10.1001/jamapediatrics.2019.5183
Key Points

Question  What are the characteristics of youths (adolescents and young adults) who experience nonfatal opioid overdose with heroin or other opioid, and do these youths receive timely evidence-based treatment?

Findings  In this cohort study of 4 039 216 Medicaid-enrolled youths 13 to 22 years of age, among 3606 individuals who experienced opioid-related overdose and had continuous enrollment for at least 30 days after overdose, less than one-third received timely addiction treatment after overdose, and only 1 in 54 youths received pharmacotherapy with buprenorphine, naltrexone, or methadone.

Meaning  Interventions are needed to link youths to treatment after overdose, with priority placed on improving access to evidence-based pharmacotherapy.


Importance  Nonfatal opioid overdose may be a critical touch point when youths who have never received a diagnosis of opioid use disorder can be engaged in treatment. However, the extent to which youths (adolescents and young adults) receive timely evidence-based treatment following opioid overdose is unknown.

Objective  To identify characteristics of youths who experience nonfatal overdose with heroin or other opioids and to assess the percentage of youths receiving timely evidence-based treatment.

Design, Setting, and Participants  This retrospective cohort study used the 2009-2015 Truven–IBM Watson Health MarketScan Medicaid claims database from 16 deidentified states representing all US census regions. Data from 4 039 216 Medicaid-enrolled youths aged 13 to 22 years were included and were analyzed from April 20, 2018, to March 21, 2019.

Exposures  Nonfatal incident and recurrent opioid overdoses involving heroin or other opioids.

Main Outcomes and Measures  Receipt of timely addiction treatment (defined as a claim for behavioral health services, for buprenorphine, methadone, or naltrexone prescription or administration, or for both behavioral health services and pharmacotherapy within 30 days of incident overdose). Sociodemographic and clinical characteristics associated with receipt of timely treatment as well as with incident and recurrent overdoses were also identified.

Results  Among 3791 youths with nonfatal opioid overdose, 2234 (58.9%) were female, and 2491 (65.7%) were non-Hispanic white. The median age was 18 years (interquartile range, 16-20 years). The crude incident opioid overdose rate was 44.1 per 100 000 person-years. Of these 3791 youths, 1001 (26.4%) experienced a heroin overdose; the 2790 (73.6%) remaining youths experienced an overdose involving other opioids. The risk of recurrent overdose among youths with incident heroin involvement was significantly higher than that among youths with other opioid overdose (adjusted hazard ratio, 2.62; 95% CI, 2.14-3.22), and youths with incident heroin overdose experienced recurrent overdose at a crude rate of 20 700 per 100 000 person-years. Of 3606 youths with opioid-related overdose and continuous enrollment for at least 30 days after overdose, 2483 (68.9%) received no addiction treatment within 30 days after incident opioid overdose, whereas only 1056 youths (29.3%) received behavioral health services alone, and 67 youths (1.9%) received pharmacotherapy. Youths with heroin overdose were significantly less likely than youths with other opioid overdose to receive any treatment after their overdose (adjusted odds ratio, 0.64; 95% CI, 0.49-0.83).

Conclusions and Relevance  After opioid overdose, less than one-third of youths received timely addiction treatment, and only 1 in 54 youths received recommended evidence-based pharmacotherapy. Interventions are urgently needed to link youths to treatment after overdose, with priority placed on improving access to pharmacotherapy.

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