One in 15 adolescents in opioid treatment gets medication

Clinical takeaway: Consider buprenorphine or extended-release naltrexone off-label for adolescents with opioid use disorder. Primary care could improve engagement and retention in this population. 

Overdose has become a leading cause of death for adolescents and young adults. Deaths among those 25 and younger have risen more than fourfold since 2019 as fentanyl spread through the drug supply. Professional societies urge clinicians to connect these patients quickly to evidence-based care, including drug treatment, at every age. 

Less is known about what happens after diagnosis, because the quality measures that track timely, continuous treatment were built and validated mostly in adults. A recent national cohort analysis follows Medicaid-enrolled young patients from diagnosis through sustained treatment and quantifies where they fall out of care. 

Among adolescents younger than 18 who engaged in treatment, only 6.6% received medication for opioid use disorder, versus about half of engaged young adults 18 and older. Buprenorphine accounted for nearly all adolescent medication. Methadone was nearly absent, and ER naltrexone was rarely prescribed. 

Across all youths, about half started treatment within two weeks of diagnosis and one-third engaged in care. One in six received medication, and one in 32 stayed on it for 180 days or more. Among those who received medication, retention by first drug received ran highest for methadone at about one in four. Buprenorphine followed at about one in five, and ER naltrexone trailed at about one in 17. 

Retention among those on medication weakened over time, to about one in eight of those diagnosed in 2022 and 2023 from about one in four in 2016 and 2017. Poorer retention on buprenorphine drove the decline. Non-Hispanic Black youths were half as likely as White youths to receive medication. 

This retrospective cohort study drew on Medicaid claims from all 50 states and Washington, DC, covering 229,847 adolescents and young adults aged 13 to 25 with continuous enrollment and a new opioid use disorder diagnosis from 2016 through 2023. Treatment stages followed national quality measures. 

The authors call the falling retention unanticipated and say patient factors, clinician behavior, insurance plan design, or policy changes could each be behind it. State rules on prior authorization and prescriber restrictions fell outside what the claims captured. 

"Prior to our study, little was known about how youths progress through the stages of treatment for opioid use disorder," said lead author Scott Hadland, MD, MPH, chief of adolescent and young adult medicine at Mass General Brigham for Children. "What we found is essential to inform Medicaid plan design, service delivery, and policies to improve quality and equity in youth opioid use disorder care." 

Source: Hadland SE, et al. (2026 Oct 2) JAMA Netw Open. Opioid Use Disorder and Evidence-Based Care Among Medicaid-Enrolled Youths