Opioid Use Disorder Medications Among Youth in Primary Care: Subgroup Analysis of the PROUD Trial

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Objective: Medications for opioid use disorder (OUD) are under-utilized among adolescents and young adults ("youth"). Offering buprenorphine or naltrexone in primary care settings may reduce barriers to their use among youth. We conducted a secondary, patient-level analysis of the PROUD cluster-randomized clinical trial, which tested the implementation of a nurse care management intervention to support prescribing OUD medications. Methods: 12 primary care clinics from 6 health systems were randomized in 2018 and patient-level data was collected from 2 years before to 2 years after randomization. The primary outcome was any OUD medication treatment (i.e., buprenorphine or extended-release injectable naltrexone) during the post-randomization period for youth ages 16-25 years. Results: A total of 20,253 youth ages 16-25 years were seen in intervention and 26,562 in usual care clinics during the study period. Comparing patients by clinic arm, we did not detect a statistically significant difference in the odds of receiving OUD medication treatment after randomization (odds ratio 1.75, 95% CI 0.63-4.89). Among the small number of patients (n=67) who received OUD medication after randomization, median treatment days were 81.5 days (IQR 30-177) and 64 days (IQR 24-206) in intervention or usual care clinics, respectively. Conclusions: We did not find evidence that implementing a primary care nurse care management model meaningfully increased OUD medication treatment among youth. In this special population, youth-centered approaches may be needed to promote prescribing and overcome known barriers to care, such as provider and patient hesitancy to use OUD medications.

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