Date Published: May 7, 2018
Publisher: BioMed Central
Author(s): Scott E. Hadland, Tae Woo Park, Sarah M. Bagley.
Opioid-related overdose deaths have risen sharply among young adults. Despite this increase, access to evidence-based medication for opioid agonist treatment (OAT) for youth remains low. Among older adults, barriers to OAT include the paucity of buprenorphine-waivered prescribers and low rates of prescribing among waivered physicians. We have increasingly found in our clinical practice significant stigma related to using OAT to treat addiction for young adults. In this series, we describe three cases of young adults who faced significant stigma related to their treatment.
The first case is a young male with a history of significant trauma and a severe opioid use disorder. He started buprenorphine and has found a job, stayed abstinent, and began a healthy relationship. At each step in his recovery, he has faced resistance to taking medication from other treatment providers, directors of sober houses, and his parents. The second case is a young woman who presented to a substance use treatment program after a relapse. She was unable to restart buprenorphine despite our calling to ask that it be restarted. Ultimately, she left against medical advice and was stabilized as an outpatient on buprenorphine. The final case is a young woman who stopped buprenorphine after being told she was “not sober” while attending 12-step group but restarted after conversations with her clinical team. In each case, the patient has continued their medication treatment and are stable.
Opioid-related deaths continue to rise among all age groups, including young adults. Stigma related to medication treatment can be a substantial barrier for many young adult patients but there are concrete steps that providers and communities can take to address this stigma.
Opioid-related overdose deaths have risen sharply among 18–25 year olds (young adults). From 2014 to 2015, there was a 72% increase in young adult deaths related to synthetic opioids (including fentanyl) and 15% increase in heroin-related deaths . There is consensus that opioid agonist treatment (OAT)—including use of buprenorphine, methadone, or naltrexone—should be offered to people of all ages with an opioid use disorder (OUD) . This consensus is shared among federal and state authorities, public health experts, and professional medical societies.
#1 We first met MH, a male in his early 20s, in the fall of 2016. We diagnosed him with severe OUD and started buprenorphine. He was adherent with his early visits but the treatment team felt his underlying mental disorders which included depression and post-traumatic stress disorder (PTSD), would be a barrier to his recovery unless his co-occurring addiction and mental disorders were concurrently addressed. Despite our efforts to provide patient-centered care, his co-occurring mental disorders resulted in an inpatient hospitalization. He was discharged to a residential treatment program. At that point, he contacted us with a request to restart buprenorphine. Over the following few months, he engaged in psychotherapy including for PTSD, found a job, started a relationship with a supportive girlfriend, and has remained abstinent. However, he has repeatedly faced resistance in continuing buprenorphine treatment. At the residential treatment program, staff asked repeatedly about the need for medication and questioned whether he could really be abstinent while taking buprenorphine, despite his voiced desire to stay on the medication. When he transitioned to a sober house, the director questioned the dose of buprenorphine and shared concerns with his parents about being on buprenorphine. His parents also questioned the need for medication. To respond to the resistance to buprenorphine treatment, we saw this patient regularly and provided a consistent message that it is was clear that buprenorphine was helping him achieve his recovery goals. Although he has remained on buprenorphine, he has been clear with us that this resistance (from other caregivers?) to staying on buprenorphine has been difficult to manage.
Opioid-related deaths continue to rise among all age groups, including young adults. Medication treatment is a key response to address overdose deaths but there have been barriers expanding access to OAT. Stigma related to medication treatment can be a substantial barrier for many young adult patients.