“I Just Knew That I Needed Help”: Primarily Latine Adolescents and Young Adults Speak About Medication Treatment for Opioid Use Disorder in the Fentanyl Era

BACKGROUND: Medications for opioid use disorder (MOUD) are evidence-based, lifesaving treatments for adolescents and young adults (AYAs) with opioid use disorder (OUD). However, AYAs access MOUD at alarmingly low rates. Therefore, this study investigated facilitators, barriers, and health services preferences for accessing MOUD among AYAs desiring treatment for OUD within a safety-net health system. METHODS: We conducted 11 semi-structured interviews with AYAs aged 16 to 21 who initiated MOUD in a county safety-net health system. Patients started MOUD (primarily buprenorphine) in inpatient, outpatient, and/or emergency department settings. We employed combined inductive and deductive coding and thematic analysis. RESULTS: Ten of 11 (91%) AYAs identified as Latine, and 9 (82%) were publicly insured. We identified 4 themes: (1) AYAs weighed the consequences of ongoing non-prescribed opioid use when deciding to engage in treatment; (2) perceived therapeutic and adverse effects of MOUD influenced AYAs' desire to start and continue MOUD; (3) Relationships with peers, caregivers, parole officers, and healthcare providers enabled AYAs to start and continue OUD treatment; (4) Inpatient MOUD initiation experiences were largely positive, though a few had negative experiences. CONCLUSION: This predominantly publicly insured, Latine sample of AYAs with OUD identified relationships, perceived risks of opioids, and perceived effectiveness of MOUD as key facilitators to engage in MOUD. Also, AYAs largely appreciated starting MOUD inpatient, though many identified barriers to continuing MOUD long-term. These perspectives provide essential input into future research, clinical, and public health interventions.