Addiction Medicine Treatment Increased Among Adolescents During COVID-19

The rise of telehealth during the COVID-19 pandemic facilitated increased initiation of addiction treatment among insured adolescents, according to study results published in the Journal of Adolescent Health. However, racial and ethnic disparities in treatment continue to persist.

In response to the COVID-19 pandemic, federal regulations allowed for increased flexibility in the treatment of opioid and substance use disorders. As a result, the expansion of telemedicine increased access to care and led to a stabilization — and potentially a decrease — of substance use among adolescents during the pandemic. However, recent studies indicate that racial/ethnic disparities in substance use-related hospitalizations and overdoses remained unchanged during the pandemic and now substance use levels are rising to pre-pandemic levels. Yet, little is known about the temporal changes in addiction medicine treatment utilization by adolescents during the pandemic. To this aim, investigators evaluated addiction treatment initiation, engagement, and retention among adolescents 13 to 17 years of age with substance use disorders.

The investigators conducted a retrospective analysis using electronic health record data from Kaiser Permanente Northern California during pre-pandemic (March 1, 2019 to December 31, 2019) and pandemic (March 1, 2020 to December 31, 2020) time periods. Substance use disorders and diagnoses were verified using International Statistical Classification of Diseases (ICD) codes. The primary measures were addiction treatment initiation, treatment engagement (2 or more additional treatment-related services or buprenorphine dispensations within 34 days of initiation), and treatment retention at 12 weeks.

The investigators identified a total of 2795 adolescents with substance use problems, with 1770 participants in the pre-pandemic cohort and 1177 in the pandemic cohort. On average, participants were 16 (SD, 1) years of age and the pre-pandemic and pandemic cohorts were 58.0% and 51.6% boys, 42.9% and 44.8% White, 32.4% and 28.5% Latino/Hispanic, 9.8% and 10.5% Black, and 9.7% and 8.8% Asian or Pacific Islander (API), respectively.

The investigators found that addiction treatment initiation among adolescents was higher during the COVID-19 pandemic (41.3%) than pre-pandemic levels (33.3%), and the odds of initiation remained significantly elevated for the pandemic cohort (adjusted odds ratio [aOR], 1.42; 95% CI, 1.21-1.67), even after adjusting for covariates. Furthermore, telehealth treatment initiation significantly expanded from 4.8% pre-pandemic to 22.4% during the pandemic (aOR, 5.98; 95% CI, 4.59-7.80). However, treatment engagement and retention did not significantly differ between the cohorts.

When stratified by race/ethnicity across time periods, Latino/Hispanic adolescents had lower odds of initiation (aOR, 0.78; 95% CI, 0.64-0.96) while Black adolescents had lower odds of engagement (aOR, 0.52; 95% CI, 0.30-0.88) relative to White adolescents.

Additionally, treatment retention was shorter among adolescents who identified as API (adjusted mean difference [aMD], -5.7; 95% CI, -10.4 to -0.9), Black (aMD, -4.9; 95% CI, -9.6 to -0.1), and other/unknown (aMD, -7.4; 95% CI, -13.0 to -1.8), compared with White adolescents.

The observed increase in telemedicine during the pandemic emphasizes the utility of addiction treatment availability in increasing treatment initiation among adolescents with substance us problems. Study authors concluded, “Telehealth may have facilitated higher treatment initiation during COVID-19 for adolescents across all racial/ethnic subgroups and helped prevent widening treatment gaps.”

Study limitations include a lack of data on uninsured patient populations, the small sample size, and the inability to examine differences by type of substance use.

This article originally appeared on Psychiatry Advisor