Intermediate
Workshop Session
Marc Fishman, MD, DFASAM
Medical Director
Maryland Treatment Centers
Johns Hopkins University School of Medicine
Young people are disproportionately affected by the current opioid epidemic, with catastrophic consequences for youth and their families. But adolescents and young adults with OUD generally have poor engagement in care, and worse treatment outcomes than older adults. Fewer than 25% of adolescents with OUD receive any relapse prevention medication. Despite the clear and urgent need, there is still a lack of research and clinical consensus on youth-specific treatment models. In particular, while we have evidence for effectiveness of medications, we have little evidence for the most effective delivery models for these medications. We have a long way to go in optimizing engagement and retention.
Assertive interventions, including home delivery of medication,s have had a role in overcoming barriers to retention and adherence in numerous chronic relapsing-remitting illnesses, including Assertive Community Treatment (ACT) for severe and persistent mental illness. This session will feature an innovative approach to treatment for high-severity OUD in youth, including assertive outreach, family engagement and home delivery of relapse prevention medications.
The session will begin with a description of the intervention. Family engagement empowers families, providing guidance for monitoring and improving adherence for youth in treatment. Confidentiality is sometimes seen as a barrier, and young adults may have developmentally normative resistance to involving their families. But respecting the emerging autonomy of youth and including families are not incompatible with one another. In fact, treatment of youth proceeds best as a collaboration among youth, parents and the treatment team. Additionally, clinic-based treatment can present barriers to treatment access. Home-based services, including monthly administration of extended release naltrexone or extended release buprenorphine, have the potential to overcome many of these barriers. By literally meeting youth and families where they are, in their homes, we may be able to engage and retain youth that are not be likely to succeed in clinic-based settings.
The workshop will continue with an interactive discussion of cases vignettes that illustrate the non-linear clinical courses characteristic of this patient population, the decision points in clinical trajectories, and the conundrums in management. There will be a particular focus on practical clinical strategies in leveraging family involvement.
Finally, the session will summarize results to date in evaluating the model. Our small published case series (Vo et al , 2017) showed promising results with an increase in retention and number of doses received, compared to a historical comparison group of clinic-based treatment as usual. In an interim analysis of the first 25 subjects in a randomized trial currently underway, preliminary results show that the intervention group had a significantly greater mean number of doses over the first 3 months (2.5 doses) compared to the usual care control (0.3 doses). The intervention group also had a lower rate of OUD relapse (27%) than the control group (91%).
There will also be ample opportunity throughout for Q&A and discussion.