1. Non-Fatal Opioid-Related Overdoses Among Adolescents in Massachusetts 2012-2014
Avik Chatterjee, Marc R. LaRochelle, Ziming Xuan, Na Wang, Dana Bernson, Michael Silverstein, Scott E. Hadland, Thomas Land, Jeffrey H. Samet, Sarah M. Bagley

2. Disclosures
Dr. Bagley would like to acknowledge the 1K23 DA award that supports her time, and Dr. Larochelle and Dr. Walley would like to acknowledge support from the 1UL1TR grant from the National Center for Advancing Translational Sciences of the National Institutes of Health.
No conflicts of interest

3. Opioid Epidemic Has Not Spared Adolescents
In 2015: 772 Adolescent Overdose Deaths

4. Opioid Use Disorder (OUD) Remains Undertreated in Adolescents
Medications for OUD (MOUD)—naltrexone, methadone, or buprenorphine—are life-saving
Yet in a cohort of 27,677 youth aged with OUD, <10% of adolescents got medications
1/8th the rate of young adults
In 2016, the American Academy of Pediatrics released a statement encouraging MOUD in adolescents

5. Why Aren’t Adolescents Receiving MOUD?
Providers
Federal restrictions on MOUD in adolescents
Methadone age
Buprenorphine 16+
Stigma
Lack of preparation among adolescent providers
Patients
Low access to relevant providers
Reluctance to engage in outpatient care

6. Non-Fatal Opioid-Related Overdose (NFOD)
NFOD is a high-risk event (100-fold increased mortality)
Could NFOD be a chance to intervene/start medications?
But little is known about adolescents who experience NFOD
Are they different from adults?
Are adolescents receiving MOUD after NFOD?

7. Objectives
What are the characteristics of adolescents who experience NFOD, compared to adults?
Do adolescents who experience NFOD subsequently receive MOUD?

8. Methods
Massachusetts Chapter 55 Dataset—mandated merging of individual-level data across multiple state agencies
Deterministic match protocol—requiring exact matches for several identifiers
Subsequently de-identified for research purposes

9. Chapter 55 Dataset All-Payer Claims Database
Prescription Monitoring Program
Ambulance Trip Record Information System
Acute Care Hospital Mix
Registry of Vital Records and Statistics
Bureau of Substance Addiction Services

10. Methods The cohort Aged 11 and older
Experienced a non-fatal, opioid-related overdose between 1/1/2012 and 12/31/2014
Outcome: receipt of MOUD in subsequent year
Co-variates: prior MOUD, Opioid, BZD prescription, anxiety, depression, location, MassHealth
High missingness for race variable
Excluded those who died within 30 days
Co-variate data available 1/1/2011 til 12/31/2015

11. Methods Descriptive statistics
Chi-square test for comparisons between those and those 18+

12. Results 22,525 NFODs among adults in MA between 2012 and 2014
195 of those among adolescents (0.9%)

13. % (n) for Those 18 and older P-Value for Bivariate Chi-Square Test
Results
Characteristic
% (n) for Those 11-17
N=214
% (n) for Those 18 and older
N=22,311
P-Value for Bivariate Chi-Square Test
Female
52 (102)
38 (8461)
<0.001
Rural zip code
14 (27)
7 (1525)
Enrolled in MassHealth
57 (111)
73 (16202)
Diagnosis of Anxiety
13 (25)
19 (4251)
0.03
Diagnosis of Depression
16 (32)
23 (5196)
0.02
Prescription for Opioids Prior 12 months
11 (21)
43 (9544)
Prescription for Benzodiazepines Prior 12 months
5 (10)
29 (6454)

14. % (n) for Those 18 and older P-Value for Bivariate Chi-Square Test
Results
Characteristic
% (n) for Those 11-17
N=214
% (n) for Those 18 and older
N=22,311
P-Value for Bivariate Chi-Square Test
Any Medication for OUD Prior 12 months
<5 (<10)
23 (5077)
<0.001
Prescription for Buprenorphine Prior 12 months
11 (2548)
Prescription for Naltrexone Prior 12 months
4 (1002)
Methadone Maintenance Prior 12 months
0 (0)
10 (2195)
Any Medication for OUD1 in the 12 months following NFOD
8 (15)
29 (6472)

15. Discussion
Adolescents who experienced NFOD in MA between 2012 and 2014 were different from adults in important ways
Gender
Prior receipt of opioids
NFOD is a missed opportunity for prescription of MOUD

16. Discussion Gender Lack of prescription opioids
Consistent with prior findings that younger girls are taught to use opioids by older man, as part of sexual, often violent, relationships: UFO study
Lack of prescription opioids
Consistent with other data that adolescents get prescription opioids from friends/family members

17. Discussion Why did so few adolescents receive MOUD?
This mirrors trend among adults (29% after NFOD in the same Chapter 55 dataset among adults)
Broader stigma about meds (“replacing one addiction for another”)
Stigma and lack of preparedness among pediatric providers
Federal restrictions on buprenorphine and methadone among adolescents
MOUD not available where adolescents interact with the treatment system (e.g., residential treatment)

18. Discussion Future directions
ED and hospital based interventions to start MOUD and connect to outpatient care
Gender-appropriate and trauma-informed approaches
Integrating MOUD into residential treatment programs, corrections, other institutions with which adolescents may interact after NFOD
Trainings specific to adolescent providers

19. Discussion Limitations
This is likely an undercount
1 year of ambulance data not present
Some NFODs may not have gone in ambulance/to ER
The epidemic has changed since 2014 (fentanyl)
Still, the need for increased MOUD access for adolescents very likely persists

20. Questions?

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