(15) Characterization of Young Adults Accessing Buprenorphine Telehealth in Philadelphia, PA

Background & Introduction: Medications for opioid use disorder (MOUD) are under-prescribed to adolescents and young adults (AYA) despite distinct developmental differences that predispose this population to risk-taking and the neurobiological underpinnings of addiction. Evidence that maturation of the brain’s pre-frontal cortex is not complete until the mid-to-late 20s can render AYA vulnerable to behaviors that lead to increased risk of substance use disorders (SUD). Also, because of their developmental stage, stigma or general beliefs about treatment held by peers and family members may have an important and distinct impact on them. Clinically, young adults have been shown to respond to treatment interventions for SUD differently than older adults. This study seeks to compare characteristics of young adults to older adults seeking buprenorphine treatment via telehealth and examine retention in treatment among the young adult cohort. We chose to examine this population in particular because youth may require different types of low threshold treatment models than adults due to their experience of unique barriers and the added social complexities that make access and retention in traditional treatment models challenging.

Methods: This retrospective analysis compares young adults (ages 18-29 years) to older callers who were prescribed buprenorphine via a health system-based telehealth urgent care program, CareConnect, in Philadelphia, Pennsylvania from 2021-2023. CareConnect was developed during the COVID-19 pandemic to leverage telehealth to provide same-day access to buprenorphine prescriptions and substance use services navigation for individuals who struggle to access care. CareConnect is embedded within a virtual urgent care practice and is staffed by advanced practice providers and substance use navigators (SUNs).

To evaluate outcomes, we extracted data for all CareConnect callers from clinical documentation and encounter records. We measured linkage to treatment defined as a buprenorphine prescription after the telehealth visit, and retention in treatment using the state Prescription Drug Monitoring Program (PDMP) and whether patient filled >1 buprenorphine prescription and had an active buprenorphine prescription at 30 days following their initial engagement with the buprenorphine telehealth program. We compared patient and treatment characteristics between young adults and other callers using Chi-Square tests. Multivariable logistic regression models were used to evaluate factors associated with linkage to treatment and retention in care among all callers, and separately, among young adults adjusting for age, gender, race, ethnicity, housing, recent incarceration, and insurance.

Results: Of the 693 telehealth callers, 101 (15%) were young adults. The majority identified as male (62%), were enrolled in Medicaid (82%), and had permanent housing (70%). Almost half of the sample identified as White (45%) and over a third identified as Black (37%) with most individuals identifying as non-Hispanic (75%). Preliminary results show that the young adults accessing CareConnect were more likely to have no insurance (14%) or private insurance (10%) than the adult callers (7%, 5% respectively, p< 0.02). There were no baseline differences in other characteristics, including gender (67% male young adults vs 61% male adults, p=0.2), race (37% Black, 42% white, 7% other, 15% unknown among young adults vs. 46% Black, 37% white, 5% other, 12% unknown among adults, p=0.69), ethnicity (22% Hispanic, 67% Non-Hispanic, 11% unknown among young adults vs. 14% Hispanic, 76% Non-Hispanic, 10% unknown among adults, p=0.1), and housing (70% permanent housing, 18% unstable, 12% unknown among young adults vs. 70% permanent housing, 22%,unstable,9% unknown among adults, p=0.48.) A slightly higher proportion of young adults reported release from incarceration within last month (16%) than adult callers (10%, p=0.1.) Most callers were not in withdrawal (83% of young adults vs. 78% of adults, p=0.21) and less than a half of callers reported having naloxone on hand (41% of young adults vs. 49% of adults, p=0.24.) There were also no differences between young adults and all-comers in terms of retention in care (47% of young adults and 53% of adults, p< 0.21) Lack of insurance among young adults was associated with lower odds of linkage to care than adults with Medicaid or Medicare (aOR=0.5, 95% CL=0.27, 0.86). In addition, there was a significant interaction between age of caller and race; young age was associated with lower odds of linkage to care among Black callers (aOR=0.35, 95%CL=0.16, 0.73.) Among young adult callers, Black patients had lower odds of linkage to care than Whites (aOR=0.37, 95%L=0.14, 0.97.) Among adult callers, no insurance and unknown housing were associated with lower odds of linkage to care (aOR=0.37, 95%CL=0.18, 0.73, and aOR=0.51, 95%CL=0.28, 0.94, respectively.)

Conclusion & Discussion: Young adults continue to die from preventable overdoses, and telehealth may be a safety net to ensure this population accesses buprenorphine, naloxone and appropriate linkage to OUD care. Our study highlights the critical need to decrease potential disruptions in insurance to support young adults’ continued engagement in care. This analysis also underscores the importance of designing targeted interventions to ensure minoritized young adults do not face further disparities in access to OUD treatment. Our data is limited as we cannot ascertain adherence from the evidence of an active prescription. Larger studies examining the role of telehealth on MOUD linkage and adherence are needed to ascertain the long-term impact on clinical outcomes for young adults.

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