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Transition Age Youth and Adults 26+ in Rural Communities: Differences in MOUD Access, Retention, and Consistency of Care

March 4, 2024
Meg Brunner, MLIS
Flores JM, et al. Medications for opioid use disorder among transition age youth compared to adults 26 or older in rural settings. JAACAP Open 2024 (in press). doi: 10.1016/j.jaacop.2024.02.001.
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Happy smiling nurse consoling female patient after surgery at hospital
Happy smiling nurse consoling female patient after surgery at hospital

What’s the Question?

Studies conducted in rural communities have underscored the severity of the opioid crisis among rural youth and young adults. According to research, rural adolescents with OUD are more likely to have past-year prescription opioid use, start using opioids at a younger age, start injecting opioids at a younger age, and become infected with HCV. They also have major challenges in access to and availability of MOUD and mental health services. Plus, patients in rural settings also frequently confront time, travel, and cost-related barriers – factors typically even harder for youth to overcome than adults.

Given all this, researchers for this study wanted to know: what’s the actual prevalence of OUD for youth vs. adults in rural communities? And what kind of care are they receiving?

This study looks at these two questions, comparing the prevalence of OUD and rates of prescription MOUD between transition age youths (TAY) aged 18-25 and adults aged 26 years or older in rural settings, as well as differences in MOUD treatment adherence, retention, and care.

How Was This Study Conducted?

Researchers used electronic health records from a large multisite study conducted in the NIDA National Drug Abuse Treatment Clinical Trials Network (CTN-0102). Data from 36,762 patients across 6 primary care clinics in rural communities were analyzed.

What Did Researchers Find Out?

In this sample, OUD prevalence was lower among TAY compared to adults aged 26+. Notably, OUD prevalence was higher for both age groups in this study compared to the national average, though this may be due to the fact this sample was taken from CTN-0102 participants, rather than general patient data.

Among those diagnosed with OUD, 72.73% of TAY and 64.52% of adults aged 26+ were prescribed MOUD in the study – this was actually the opposite of what researchers were expecting to see (they hypothesized that older adults would be more likely to be prescribed medications). This was again higher than the national average, which again may be because of the samples’ research involvement (this time because clinic staff may have had access to more resources and training). Still, almost one-third of patients still did not receive MOUD, a significant number.

Despite similar rates of MOUD receipt between the two age groups, TAY had significantly were prescribed MOUD for significantly fewer days compared to the adults aged 26+ sample, suggesting inconsistences in care, like lower MOUD adherence or retention in treatment for younger adults.

What Are the Implications for the Workforce?

This study highlights findings that underscore the need for age-specific interventions to improve diagnosis and MOUD initiation, retention, and consistency of care for youth and young adults in rural communities. Opioid use disorder and deaths from overdose continue to be a major problem across the U.S., with rural areas facing additional barriers to care – strategies to address those barriers need to be adaptable to serve the needs of young people from rural communities.

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