Many youth with opioid use disorder miss out on treatment

One in 100 adolescents and young adults in the United States has an opioid use disorder (OUD) and, with the rise of fentanyl in the drug supply, overdoses in this age group have risen sharply since 2019. A new study by investigators from Mass General Brigham asked whether Medicaid-enrolled 13-to-25-year-olds with OUD receive evidence-based, reliable treatment. Using eight years of national data from 229,847 adolescents and young adults, they found only half began treatment, one-third engaged in care, one-sixth received medication, and 1 in 32 continued medication for 180 days or more. Results are published today in JAMA Network Open.

Untreated opioid use disorder in young people has both immediate and lifelong consequences, and overdoses and poisonings have become a leading cause of death in this age group. Our findings suggest large gaps in care that are keeping this population vulnerable to premature death and poor health outcomes."

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

Using health insurance claims data, researchers found that within 14 days of diagnosis, 50.7% of adolescents and young adults with an OUD initiated treatment and 32.9% engaged in care by attending two or more additional treatment sessions in the 34 days after initiating care. Of those that engaged in treatment, 46.3% began medication. The three most prescribed medications were buprenorphine, methadone, and extended-release naltrexone. Only 3.1% of adolescents and young adults with an OUD were still on a medication after 180 days, a timeframe that has become a key quality of care measure given that longer treatment is associated with better outcomes. Additionally, younger adolescents and racially minoritized youths had consistently lower progression through the stages of care.

"Prior to our study, little was known about how youths progress through the stages of treatment for opioid use disorder," said Hadland. "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."