Access to addiction meds for young people has improved — but retention hasn’t
In 2016, the American Academy of Pediatrics issued a policy statement urging doctors to offer medications for opioid use disorder to adolescent and young adult patients who needed them. New national data indicate that more young people with an opioid use disorder diagnosis did start receiving addiction medications like buprenorphine and methadone, but the increase was small — and the number who stayed on medication for six months, already quite low, may actually have decreased. "There have been some real positive changes, and then there have been some really catastrophic changes," said Scott Hadland, chief of adolescent and young adult medicine at Mass General Brigham for Children.
Hadland's latest paper, published Friday in JAMA Network Open, offers a national perspective on the continuity of addiction care among young people. Researchers analyzed Medicaid enrollment and insurance claims for people ages 13 to 25 who were diagnosed with an opioid use disorder between 2016 and 2023.
Out of nearly 230,000 young people over that period, about half initiated treatment by seeing a clinician, and about a third had at least two appointments in the first month. Of those youth engaged in care, about 1 in 6 received some medication — but just 1 in 32 continued with medication for six months. As with the general population, overdose deaths skyrocketed among young people beginning around 2019 and into the early 2020s; for those age 19 and under, poisonings including overdose rose to the third-leading cause of death. In the study, fewer than 10 minors received methadone over the entire period — a number so low that researchers had to suppress it and label it "not defined" to protect patients' privacy.
Medications for opioid use disorder, specifically buprenorphine and methadone, are highly effective treatments that are also relatively cheap and easy to deliver, yet adults often struggle to get them and for minors it can be nearly impossible. Federal law requires minors to have two documented "failed" attempts at recovery without medication before they can start methadone, and even then many of the specialized clinics that provide it won't accept minors; buprenorphine is easier for doctors to prescribe, but recent research shows few residential treatment facilities for adolescents actually offer it. "Once you turn 18, a whole bigger field of people are open to helping you," said Sivabalaji Kaliamurthy, a child and adolescent psychiatrist who treats addiction. "And it's just a number if you think about it." Hadland added that he has had patients die as recently as the past month in Massachusetts from overdose: "And so the stakes here are really, really high." While dozens of studies show the safety and effectiveness of these medications, very few focus specifically on young people — leaving doctors without a definitive answer for families asking how long their child might need treatment.