Examination of emerging adults with opioid use disorders

Background.

Patterns of health behaviors established in adolescence and continuing into adulthood can affect individuals across their life. Park et al. (2014) examined substance use patterns in two age groups (12-17 and 18-25); the analysis concluded that past-month substance use increases ‘dramatically between adolescence and young adulthood’ (Park et al., 2014, pg. 11). Overall, young adulthood entails ‘greater risk and worse outcomes than adolescence’ (Park et al., 2014; pg. 3). One million US citizens, 18-25, are estimated to be nonmedical users of prescription opioids. This investigation sought to examine the experience of ‘emerging adults’ (aged 18-24) related to care engagement, integration, and quality.

Methods.

Data from administrative databases in the State of Florida (US) were analyzed related to care received for substance use disorder (SUD) diagnoses from July 1, 2014 to December 31, 2016. Additionally, individual structured interviews with ‘emerging adults’ (18-24) were conducted at medication-assisted treatment sites throughout Florida (n = 42). Content analysis of interview questions was conducted utilizing Atlas.ti V5.0 (Muhr, 2004).

Results.

Emerging adults, 18-24, made up 13.6% (n=9,373) of the population of Medicaid enrollees who received at least one substance use treatment service in Florida from July 1, 2014 to December 31, 2016. Of this group (21%) (n=1,938) had a primary diagnosis of ‘Opioid type Dependence’: only 8.1% these (n=758) were found to have engaged in related treatment during the period evaluated.

The interview sample was majority female (52%), Caucasian (71%), and averaged 23 years. Average age of first use was 15; 32% reported, however, beginning at a very young age (9-12 yoa). Only 17% of received any SUD treatment prior to 18. Thirty-six percent (36%) indicated current treatment for a (nonsubstance) mental health disorder; 93% reported receiving medication and 33% reported receiving counseling.

Analysis of interview responses revealed multiple pathways to the initiation of drug use and eventual addiction. Although there was no, one “typical” pathway, multiple interviewees reported family history of domestic violence, death, and unplanned pregnancies. Depression and/or anxiety, from an early age led to trouble in school, hanging with the “wrong crowd”, and discord with parents. The use of, initially prescribed, opiate medication was identified as a pathway to addiction.

Conclusions.

Though opioid use disorders are highly prevalent in emerging adult (EA) population, few received any treatment immediately following their diagnosis and retention times were substantially lower in the EA group. Engaging and retaining young adults in integrated care must be a priority. Per the US Surgeon General’s Report (2016), the most effective practice is to intervene early, ‘before the condition can progress’, relatedly, this urgency suggests further resources may need to be directed toward expansion of prevention and early intervention efforts.

Findings from the qualitatively-analyzed interviews revealed that many of the ‘emerging adults’ began using illicit substances at very early ages (as early as 9) and had struggled with their substance use for many years prior to engaging in care; often in difficult family situations. These findings further emphasize the need to provide early intervention to this vulnerable population.