(106) Trauma, Resiliency, and Longitudinal Treatment Outcomes in a Pediatric MAT Clinic

Background:
The prevalence of nonmedical opioid use and opioid use disorder (OUD) among adolescents and young adults (AYA) has increased in the United States. Buprenorphine is frequently used in the management of pain in pediatrics, but very few AYA with OUD receive medication-assisted treatment (MAT). Adverse childhood experiences (ACEs) and the absence of their counterpart, childhood protective factors (i.e., resiliency), have been associated with risk for negative health outcomes. It has not been established if trauma and resiliency predict treatment outcomes in AYA being treated with MAT for OUD. The objective of this study was to examine the relationships between ACEs, resiliency, and treatment outcomes over six months in AYA receiving MAT for OUD.

Methods:
ACEs and resiliency were assessed in AYA ages 15-24 receiving buprenorphine MAT for OUD in an outpatient clinic. ACEs were measured with the Modified Adverse Childhood Experience Questionnaire, and resiliency with the Southern Kennebec Healthy Start Resilience survey. Both instruments generate a total score ranging from 0-14. ACEs and resiliency scores were examined continuously and dichotomized using established cutoffs with demonstrated associations with risk of adult chronic health disease (ACEs ≥4, resiliency <9). Outcome measures over the first 6 months of treatment included (1) treatment retention, defined as time from first to last visit (allowing for gaps of up to 8 weeks), (2) compliance, defined as time to first buprenorphine negative urine, and (3) relapse, defined as time to first opioid positive urine drug screen. Cox proportional hazard models were fit for all 3 outcomes using ACEs and resiliency as univariate predictors. Potential impacts of covariates (sex, age, insurance, mental health comorbidities, prior substance use treatment, and history of injection drug use) were examined for relationships of interest that were significant in bivariate analysis.

Results:
Of 43 participants enrolled, mean age was 18.7 (1.9), 25 (58.1%) were female, 40 (93%) white non-Hispanic, and 14 (37.6%) privately insured. 11 (25.6%) had prior substance use treatment, 25 (58.1%) history of injection drug use, and 29 (67.4%) mental health comorbidities. 3 respondents had no ACE score and 1 had no resiliency score. 32/40 (80.0%) reported >4 ACEs and 12/42 (28.6%) <9 resiliency factors. 31 (72.1%) participants were retained in treatment for the duration of the study. Total ACE score was significantly (p-value=0.014) associated with buprenorphine compliance (hazard ratio 1.317 [1.056, 1.643]); no relationship was found with treatment retention or opioid relapse. Total resiliency score was not significantly associated with any outcome.

Conclusions:
ACE score was associated with improved buprenorphine compliance for youth receiving MAT for OUD while resiliency scores were not associated with treatment outcomes explored. MAT compliance is known to reduce relapse and mortality in those with OUD. Underlying mechanisms for these relationships are not clear but perhaps consistent with prior research investigating the link between anxiety and MAT treatment outcomes. Patients with higher trauma burdens are more likely to report higher anxiety at baseline than the general population and past research demonstrates that anxiety is associated with MAT outcomes for patients with OUD. Further information is needed to clarify the complex interaction between trauma burden, resiliency, anxiety, and OUD treatment outcomes.

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Diversity, Equity, and Inclusion: Among adolescents and young adults with opioid use disorder, access to medication treatment for addiction is limited creating a health disparity. The study site’s clinic treats patients regardless of insurance status and ability to pay to provide greater patient access and treatment engagement. Current study findings provide greater clarity in understanding this vulnerable patient population and support work towards optimizing patient outcomes.