Barriers and Facilitators to Accessing Opioid Agonist Therapy for Street-involved Adolescents and Young Adults in Vancouver.

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-08-27 DOI:10.1097/ADM.0000000000001361
Kat Gallant, Preety Nijjar, Kora DeBeck, Michelle Cui, Thomas Kerr
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Abstract

Objective: Opioid agonist therapy (OAT) remains the first-line therapy for people with opioid use disorder. Whereas overdose rates among adolescents and young adults (AYAs) remain high, little is known about their access to OAT. Therefore, we sought to evaluate factors that shape access to OAT among AYAs aged 14 to 26 years.

Methods: Data were derived from the At-Risk Youth Study, a prospective cohort study that involves street-involved AYAs who use illicit substances in Vancouver, Canada. Generalized estimating equations were used to identify factors associated with OAT enrollment from September 2005 to October 2021.

Results: A total of 759 AYAs reported at least weekly opioid or OAT use, with a median age of 23 years and 65.7% self-identifying as male. At baseline, 147 participants (19.4%) were on OAT, and another 199 (26.2%) initiated OAT during study follow-up (median number of follow-up visits, 5 [Q1-Q3, 2.5-8]). In a multivariable analysis, being <19 years old (adjusted odds ratio [AOR], 0.40; 95% confidence interval [CI], 0.23-0.71), Indigenous ancestry (OR, 0.72; 95% CI, 0.52-1.00), homelessness (AOR, 0.65; 95% CI, 0.54-0.77), drug dealing (AOR, 0.73; 95% CI, 0.61-0.87), daily opioid use (AOR, 0.47; 95% CI, 0.40-0.55), and nonfatal overdose (AOR, 0.73; 95% CI, 0.60-0.89) were negatively associated with OAT use.

Conclusions: This study identified a low rate of OAT access among AYAs. Adolescents and young adults were less likely to be on OAT if they were <19 years old, Indigenous, and possessed certain risk markers. These findings highlight the need for mitigation strategies to facilitate OAT access for this population and for additional harm reduction measures to support AYAs who do not want to use OAT.

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温哥华街头青少年获得阿片类激动剂治疗的障碍和促进因素。
目的:阿片类药物激动剂疗法(OAT)仍然是阿片类药物使用障碍患者的一线疗法。虽然青少年和年轻成年人(AYAs)的用药过量率居高不下,但人们对他们获得 OAT 的情况却知之甚少。因此,我们试图评估影响 14 至 26 岁青少年获得 OAT 的因素:数据来源于 "高危青少年研究"(At-Risk Youth Study),该研究是一项前瞻性队列研究,涉及加拿大温哥华地区使用非法药物的街头青少年。研究采用了广义估计方程来确定与 2005 年 9 月至 2021 年 10 月期间加入 OAT 的相关因素:共有 759 名亚裔报告至少每周使用一次阿片类药物或 OAT,年龄中位数为 23 岁,65.7% 自认为是男性。基线时,147 名参与者(19.4%)服用了 OAT,另有 199 名参与者(26.2%)在研究随访期间开始服用 OAT(随访次数中位数为 5 [Q1-Q3, 2.5-8])。在一项多变量分析中,得出结论:本研究发现,青壮年接受 OAT 的比例较低。如果青少年和年轻成人是以下情况,他们服用 OAT 的可能性较低
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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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