Year-long adherence to buprenorphine sharply reduces overdose risk in young people

New research from Mass General Brigham finds that adolescents and young adults who stayed on the medication buprenorphine for at least a year had markedly lower risks of opioid overdose and hospitalization compared with peers who discontinued medication early or took it inconsistently. The results, published in Pediatrics, are especially relevant as youth overdose death rates recently reached record highs, driven by fentanyl. 

We are commonly asked in youth addiction treatment how long to stay on medication and how strictly it must be taken to provide protection. Our findings suggest that maintaining high adherence for at least a year substantially reduces overdose risk. It's a clear message to clinicians, families and youth that longer treatment saves lives."

Scott Hadland, MD, MPH, MS, lead and corresponding author, chief of Adolescent and Young Adult Medicine at Mass General Brigham for Children

The study analyzed data on 11,649 youth aged 13-26 who initiated buprenorphine in Massachusetts between 2014 and 2020. Using the Massachusetts Public Health Data Warehouse-a comprehensive statewide dataset linking medical, pharmacy, and mortality records-the team identified four patterns of medication use: high adherence for 12 months (24%), low adherence for 12 months (28%), discontinuation after 3-9 months (16%), and discontinuation in under 3 months (33%).

Compared to youth with high adherence for 12 months, those who stopped within 3-9 months had an 82% higher risk of opioid overdose, while those who stopped in under 3 months had a 76% higher risk. Youth who were on medication for 12 months but had low adherence had a 46% higher risk. Youth who stayed on medication for a year and had high adherence also had lower rates of emergency department visits and hospitalizations.

While buprenorphine is the only medication approved for opioid use disorder in adolescents under 18, many families and youth elect to discontinue treatment after just weeks or months once they see improvements. However, the study's findings show that consistent, year-long use likely provides the greatest protection against overdose and other serious outcomes.

"Opioid use disorder is a condition that can come and go over the course of several years," said Hadland. "Staying on treatment longer-even when things feel better-may prevent relapse and save a young person's life."

The study underscores the importance of helping youth adhere to treatment, including through the use of long-acting injectable buprenorphine and providing enhanced support for youth with co-occurring mental illness or housing instability.

"Amid the fentanyl era, short-term treatment is simply not enough," said Hadland. "Clinicians, insurers, and health systems should do everything possible to help young people continue medication for at least a year or longer. This is a key step toward reducing youth overdose deaths."