Treatment use and barriers among adolescents with prescription opioid use disorders

Multiple indicators show a substantial increase in nonmedical use of prescription opioids, opioid-related mortality, and admissions to substance abuse treatment (Manchikanti, 2007; Zacny et al., 2003). After cannabinoids, opioids are the second most commonly used illicit/nonmedical drugs, and prescription opioid use disorders (OUD) constitute the second most prevalent drug use disorder in the U.S. (Substance Abuse and Mental Health Services Administration [SAMHSA], 2010; Wu et al., 2011). Approximately 10% of adolescents aged 12–17 years have ever used nonmedical opioids (Wu, Ringwalt, & Patkar, 2008), and many adolescents consider prescription opioids safer than illicit drugs and experience peer pressure to use them (Office of National Drug Control Policy [ONDCP], 2007). Prescription opioids are also seen as easier to get than illicit drugs, and adolescents often endorse reasons other than getting high for using them (relieve pain, anxiety, sleeplessness) (Boyd, Esteban-McCabe, & Teter, 2006). Parents’ medicine cabinets, family members, or friends are reported as primary sources (Schepis & Krishnan-Sarin, 2009). Little is known about use of substance abuse treatment among adolescents with OUD. Recent data showed that 16% of past-year nonmedical opioid users aged 12–17 years met criteria for DSM-IV OUD, and another 20% exhibited subthreshold dependence (Wu, Ringwalt, Mannelli, & Patkar, 2008b). Subthreshold substance users (meeting 1–2 dependence criteria but no abuse criteria) could be good targets for early case identification and interventions because longitudinal data show that they escalate into substance use disorders (SUD) (Shankman et al., 2009). Similarly, adolescent-onset substance use predicts SUD and greater treatment need (Gfroerer & Epstein, 1999). Because substances of abuse act by altering neurotransmission in the brain, substance use may have long-lasting adverse effects on the developing brain (National Institute on Drug Abuse, 2007). Adolescence is hence a critical time for intervention to prevent serious addiction and its consequences. This is particularly applicable to opioids as they have a high abuse potential, are associated with the highest rate of drug-related overdose/mortality, and often require long-term treatment (Paulozzi, Budnitz, & Xi, 2006; Veilleux, Colvin, Anderson, York, & Heinz, 2010). Thus, an understanding of treatment use among subthreshold users relative to threshold groups could provide useful information to guide early screening and intervention. We report treatment use, perceived treatment need, and barriers to treatment use among adolescents who endorsed a pattern of symptoms consistent with DSM-IV criteria for past-year OUD and subthreshold use (endorsing 1–2 prescription opioid dependence criteria and no abuse criteria) using data from the National Survey on Drug Use and Health (NSDUH). We took into consideration Andersen’s behavioral model of health service utilization, which states that treatment use varies by demographic/predisposing characteristics and that enabling/resource and need/health characteristics may promote treatment use (Andersen, 1995; Wu, Pilowsky, Schlenger, & Hasin, 2007). Because adolescents rely on adults to initiate treatment, we examined whether communication with their parents/guardians about substance use increases treatment use. We also explored trends in treatment use, given substantially increased reports of nonmedical opioid use and abuse among adolescents (Manchikanti, 2007). Three main questions were addressed: 1) What is the prevalence of treatment use and perceived need by opioid use status? 2) To what extent are demographic/predisposing (age, gender, race/ethnicity), enabling/resource (income, insurance status, parent-adolescent communication, population density), and need/health characteristics (substance use disorders, self-rated health, major depression, criminal justice involvement) associated with treatment use and perceived need? 3) What are adolescents’ perceived barriers to treatment? No such research has been conducted on adolescents before.