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Principal Investigator: CHARLES J NEIGHBORS
Organization: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
Fiscal Year: 2024
Award: $726,809
Funding agency: National Institute on Drug Abuse
Project Summary
Transition-age (TA) adulthood—between ages 18 to 25—is a distinct and critical developmental period where
unique biological, psychological, and social changes are occurring. Brain development continues into the latter
part of this period, with neurological structures associated with reward sensitivity and self-regulation continuing
to form. Social roles are in flux, with reduced parental monitoring and shifts in societal expectations that
presage lifetime functioning at the personal, familial, and community levels. Substance use disorders (SUD)
and mental health conditions are more prevalent in this age group than at other ages, 14.4% and 29.4%
respectively in 2019. Effective treatment at this age has the potential for large long-term payoffs. Over the past
decade, there has been a large rise in the prevalence of opioid use disorders (OUD) among TA adults. Yet, the
treatment system for OUD performs poorly for TA adults: they are less likely to obtain scientifically supported
treatment and more likely to leave treatment early. Although the most efficacious treatment for OUD is
pharmacotherapy, naturalistic studies demonstrate that there are large gaps in receipt of medications for opioid
use disorder (MOUD), low adherence to these medications, and poor outcomes for most TA adults who enter
treatment. Few current studies of quality in OUD treatment programs account for individual, organizational, and
contextual factors that vary over time. In particular, variation in the quality of treatment programs occurs within
the complex interplay of social and ecological factors related to communities, treatment programs, and
characteristics of the patient. Specifically, social determinants of health, such as poverty and racial/ethnic
disparities, create added barriers to obtaining and sustaining scientifically supported treatments. A better
understanding of the program characteristics associated with higher quality care for TA adults with OUD will
inform organizational changes, payer incentives, and government policies to improve treatment for this poorly
served population. Because of rapid organizational changes caused by the COVID-19 public health
emergency, there is an opportunity to explore whether new forms of SUD treatment delivery—telehealth,
liberalization in provision of pharmacotherapy—lead to improved treatment engagement and outcomes for TA
adults. The proposed longitudinal study will combine data from multiple sources, including Medicaid and a
state registry of SUD treatment episodes, to examine three aspects of OUD treatment quality for approximately
65,000 TA adults entering treatment for OUD between 2012 and 2025: 1) access to MOUD; 2) adherence to
pharmacotherapy and retention in treatment; and 3) adverse events (e.g., overdoses). To guide our study, we
propose a conceptual model that draws from the Donabedian quality of care framework (Organizational
Structure>Clinical Process>Outcome) and from social ecology to examine program quality of OUD treatment
for TA adults while accounting for individual and community level factors associated with the ability of these
programs to deliver care.
Terms: <21+ years old><Adanon><Adherence><Adult><Adult Human><Adverse Experience><Adverse event><Age><Althose><Application Context><Biological><Bionomics><Brain><Brain Nervous System><Budgets><Buprenorphine><COVID-19><CV-19><Caring><Characteristics><Client><Clinical><Communities><Complex><Coronavirus Infectious Disease 2019><Counseling><Development><Diagnosis><Dolophine><Dose><Drug Therapy><Drugs><Early treatment><Ecology><Encephalon><Event><Family><Government><Homelessness><Hospitals><Impoverished><Incentives><Individual><Informal Social Control><Lead><Longitudinal Studies><Medicaid><Medication><Mental Health><Mental Hygiene><Methadone><Methadose><Modeling><Nalorex><Naltrexone><Nemexin><Neurologic><Neurological><Organization Charts><Organizational Change><Outcome><Overdose><Patients><Pb element><Pharmaceutical Preparations><Pharmacotherapy><Policies><Population><Poverty><Prevalence><Process><Process Measure><Provider><Psychological Health><Public Health><QOC><Quality of Care><ReVia><Registries><Rewards><Role><Self Regulation><Social Change><Social modification><Social transformation><Structure><Substance Use Disorder><System><Telemedicine><Time><Variant><Variation><Vivitrol><adult youth><adulthood><age group><ages><biologic><clinical care><clinical decision-making><co-morbid><co-morbidity><cohort><community factor><community-level factor><comorbidity><contextual factors><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><critical developmental period><developmental><disparities in race><disparity due to race><disparity in ethnic><drug treatment><drug/agent><early therapy><effective therapy><effective treatment><efficacious therapy><efficacious treatment><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnicity disparity><heavy metal Pb><heavy metal lead><homeless><improved><indexing><inequality due to race><inequity due to race><long-term study><longitudinal outcome studies><longterm study><medication for opioid use disorder><multiple data sources><opiate use disorder><opioid use disorder><organizational structure><parent monitoring><parental monitoring><peer><programs><psychologic><psychological><public health emergency><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racially unequal><response><social><social expectations><social health determinants><social role><social vulnerability><societal expectations><structural determinants><structural factors><substance use and disorder><telehealth><treatment program><unhoused><young adult><young adulthood>