Patterns of psychotropic medication use, medication switching, augmentation, and non-persistence in adolescents and young adults with co-occurring psychiatric morbidities and opioid use disorder.

backgroundAdolescents and young adults (AYAs) with opioid use disorder (OUD) frequently experience psychiatric comorbidities, yet little is known about how these conditions are managed pharmacologically in real-world settings. We aimed to describe psychotropic prescribing patterns, polypharmacy, augmentation, therapeutic-class switching, and non-persistence among AYAs with OUD.

methodsWe conducted a retrospective cohort study using electronic medical records from the Substance Use Treatment and Recovery clinic at the Nationwide Children’s Hospital between 2009 and 2022. AYAs aged 10–26 years diagnosed with OUD and at least one co-occurring psychiatric condition were included. Psychotropic prescriptions were grouped into therapeutic classes and evaluated longitudinally for patterns of medication use, medication switching, concurrent prescribing, and non-persistence. Analyses were descriptive and stratified by psychiatric diagnosis, and results are presented as means, standard deviations (SDs), and frequencies.

resultsThe cohort included 101 patients (mean age = 18.5 years; 61.4% male) with anxiety disorders (64.4%) and depressive disorder (56.4%) being the most common diagnoses. Psychotropic polypharmacy occurred in 79.2% of patients. Non-persistence of psychotropic medications was common, affecting 63.2% of patients with depression, 58.5% with anxiety disorders, 44% with ADHD, and 66.7% with bipolar disorder. Medication switches were observed in 91.2% of patients. Medication switching was most frequent for depression (mean = 2.7 switches; SD = 1.6) and anxiety disorders (mean = 1.6; SD = 1.4). The most common switch pathways involved selective serotonin reuptake inhibitors (SSRIs) and second-generation antipsychotics (SGAs), as well as between SSRIs and bupropion. Augmentation strategies were prevalent, including SSRI plus SGA in depression (38.6%) and SSRI plus benzodiazepine in anxiety disorders (33.8%). Attention deficit/hyperactivity disorder (ADHD) treatment was comparatively stable, with fewer switches (mean = 0.5; SD = 0.7) and limited augmentation. Bipolar disorder management commonly involved combinations of SGAs and mood stabilizers.

conclusionsAmong AYAs with OUD, psychotropic treatment was characterized by frequent polypharmacy, augmentation, substantial non-persistence, and common medication class switching, especially for depression and anxiety disorders. These findings demonstrate challenges in achieving pharmacologic stability and support the need for prospective research to optimize psychiatric management in AYAs with OUD. CLINICAL TRIAL NUMBER: Not applicable.