Search

Background: In the United States, there has been a concerning rise in the prevalence of opioid use disorders (OUD) among transition-age (TA) adults, 18 to 25-years old, with a disproportionate impact on individuals and families covered by Medicaid. Of equal concern, the treatment system continues to underperform for many young people, emphasizing the need to address the treatment challenges faced by this vulnerable population at a pivotal juncture in their life course. Pharmacotherapy is the most effective treatment for OUD, yet notably, observational studies reveal gaps in the receipt of and retention in medications for opioid use disorder (MOUD), resulting in poor outcomes for many TA adults in treatment. Few current studies on OUD treatment quality explicitly consider the influence of individual, organizational, and contextual factors, especially for young people whose social roles and institutional ties remain in flux. Methods: We introduce a retrospective, longitudinal cohort design to study treatment quality practices and outcomes among approximately 65,000 TA adults entering treatment for OUD between 2012 and 2025 in New York. We propose to combine data from multiple sources, including Medicaid claims and encounter data and a state registry of substance use disorder (SUD) treatment episodes, to examine three aspects of OUD treatment quality: 1) MOUD use, including MOUD option (e.g., buprenorphine, methadone, or extended-release [XR] naltrexone); 2) adherence to pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). Using rigorous analytical methods, we will provide insights into how variation in treatment practices and outcomes are structured more broadly by multilevel processes related to communities, treatment programs, and characteristics of the patient, as well as their complex interplay. Discussion: Our findings will inform clinical decision making by patients and providers as well as public health responses to the rising number of young adults seeking treatment for OUD amidst the opioid and polysubstance overdose crisis in the U.S. [ABSTRACT FROM AUTHOR]

Combining historical and ethnographic research, this article analyzes changing logics of control shaping addiction care for sexual minorities at a drug treatment facility in the US. While 30 years ago stigma and exclusion were viewed by staff members as fundamental causes of addiction among sexual minorities, this perspective faded as truth-eliciting confessionals declined and confidence in brain-targeting medicine increased. In this process, paradoxically, sexual stigma was no longer regarded as a barrier to fight and overcome, but instead is redeployed as part of practitioners' toolkits as they work to regulate what they see as patients' "addictive personalities". While a biomedical model may imply that the facility has achieved a post-disciplinary treatment strategy, in that it no longer seeks to produce an identity but fragments it into governable components, staff members in fact continue to target sexual identity by translating this identity into pharmacological pathways and responses. [ABSTRACT FROM AUTHOR]