title: Access to substance use treatment among young adults who use prescription opioids non-medically.
abstract: Non-medical prescription opioid (NMPO) use is a substantial public health problem in the United States, with 1.5 million new initiates annually. Only 746,000 people received treatment for NMPO use in 2013, demonstrating substantial disparities in access to treatment. This study aimed to assess correlates of accessing substance use treatment among young adult NMPO users in Rhode Island, a state heavily impacted by NMPO use and opioid overdose.
  
  
  
  This analysis uses data from a study of 200 Rhode Island residents aged 18 to 29 who reported NMPO use in the past 30 days. We compared individuals who had ever successfully enrolled in a substance use treatment program without ever facing barriers, individuals who had ever attempted to enroll but were unable, and individuals who never attempted to enroll. We used multinomial logistic regression to determine the independent correlates of never attempting and unsuccessfully attempting to access substance use treatment.
  
  
  
  Among 200 participants, the mean age was 24.5, 65.5% were male, and 61.5% were white. Nearly half (45.5%) had never attempted to enroll in substance use treatment, while 35.0% had successfully enrolled without ever facing barriers and 19.5% were unsuccessful in at least one attempt to enroll. In multivariable models, non-white participants were more likely to never have attempted to enroll compared to white participants. Previous incarceration, experiencing drug-related discrimination by the medical community, and a monthly income of $501 - $1500 were associated with a decreased likelihood of never attempting to enroll. A history of overdose and a monthly income of $501 - $1500 were associated with an increased likelihood of unsuccessfully accessing treatment. The most commonly reported barriers to accessing treatment were waiting lists (n = 23), health insurance not approving enrollment (n = 20), and inability to pay (n = 16).
  
  
  
  This study demonstrates significant disparities in access to treatment among young adults who report NMPO use. A history of overdose was shown to correlate with experiencing barriers to substance use treatment utilization. Interventions are needed to reduce drug-related discrimination in clinical settings and to provide mechanisms that link young adults (particularly with a history of overdose) to evidence-based treatment.
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.
authors.forename: Elliott J
authors.initials: EJ
authors.lastname: Liebling
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.
authors.forename: Jesse L
authors.initials: JL
authors.lastname: Yedinak
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.|Department of Emergency Medicine, Boston University School of Medicine, 771 Albany Street, Room 1208, Boston, MA, 02118, USA.|The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, 55 Claverick Street, Providence, RI, 02903, USA.
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Vose Hall Room 322, Boston, MA, 02118, USA.|Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.|Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Hadland
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA.|Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01605, USA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Clark
authors.affiliation: Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4, Providence, RI, 02912, USA. brandon_marshall@brown.edu.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D063487:Prescription Drug Misuse / Q000523:psychology / Q000706:statistics & numerical data*; D012237:Rhode Island / Q000453:epidemiology; D055815:Young Adult
keywords: Access; Barriers; Non-medical use; Prescription opioids; Substance use; Treatment; Utilization; Young adults