Opioid use disorder: a neglected human immunodeficiency virus risk in American adolescents

Abstract

In 2017 alone, 783 000 children aged 12-17 years misused opioids with 14 000 using heroin. Opioid misuse and opioid use disorder (OUD) in adolescents and young adults are significant barriers to ending the HIV epidemic. To address these synergistic scourges requires dedicated practitioners and improved access to life-saving evidence-based treatment. Adolescents and young adults make up over one in five new HIV diagnoses even though they are less likely to be tested or know they are infected. Adolescents and young adults living with HIV are less likely to be retained in care or achieve virological suppression. OUD further leads to increased rates of risky behaviours (like sex without condoms), deceased retention in HIV care and decreased rates of viral suppression in this vulnerable population. Medications for opioid use disorder (MOUD) are recommended for adolescents and young adults with severe OUD and help retain youth in HIV treatment and decrease risk of death. However, due to stigma and lack of experience prescribing MOUD in adolescents, MOUD is often perceived as a last line option. MOUD remains difficult to access for adolescents with a shortage of providers and decreased options for treatment as compared to adults. Addiction treatment is infection prevention, and integrated addiction and HIV services are recommended to improve health outcomes. A multipronged approach including patient education, provider training and policy changes to improve access to treatment and harm reduction are urgently needed confront the drug use epidemic in youth.

Opioid use disorder (OUD) and treatment for opioid problems among OUD symptom subtypes in individuals misusing opioids

“…Eighteen- to 49-year-old participants were more likely to receive treatment for OUD than adolescents (12–17 years old), after adjustment for class membership. This age-related gap in care has been described previously ( Mauro et al, 2022 , Welsh et al, 2022a ) and highlights the need for treatment initiation in younger populations to prevent development of OUD-related problems such as HIV infection and opioid overdose ( Curtin et al, 2017 , Lloyd et al, 2021 , Yule et al, 2018 ). However, treatment initiation is only one barrier, as adolescents are also less likely to remain in treatment than are adults ( Mintz et al, 2020 ).…”

Pre-existing Opioid Use Worsens Outcomes in Patients With Diverticulitis

“…This study has a few limitations, including the fact that patients with a history of opioid abuse are more likely to be immunocompromised than the general population, as this population is at increased risk for HIV infection, endocarditis, and other severe infections [ 24 , 25 ]. Therefore, patients with a history of opioid use have other risk factors that may predispose them to serious infections, sepsis, and abscess formation.…”