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 show 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 of young people who stayed on medication for six months — already quite low — may have actually decreased.
“There have been some real positive changes, and then there have been some really catastrophic changes,” said Scott Hadland, the 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.
“I have had patients die as recently as this past month here in Massachusetts, from overdose,” Hadland said. “And so the stakes here are really, really high.”
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 these medications, 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 that 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.”
In Hadland’s study, fewer than 10 minors received methadone over the entire period — a number so low that researchers had to suppress the specific number and categorize it as “not defined” to protect people’s privacy.
While there are dozens of studies showing the safety and effectiveness of these medications, very few focus specifically on young people. That means doctors don’t have a definitive answer for families when asked how long their child might need to stay on the medications, or what the long-term effects might be. Still, existing research and clinical experience are clear that the longer someone is on the medication, the better they do.
Kids often don’t want to hear that, Kaliamurthy said, and families can be apprehensive about such an open commitment. On top of that, young people also face the same structural barriers that hamper adult care: For example, the study found that Black young people and other racially minoritized groups had worse attrition through the stages of care than their white peers.
Kaliamurthy found the number of young people initiating treatment after diagnosis to be promising, but he and others agreed that more work needs to be done to prevent attrition over time.
“It doesn’t matter how good the treatment we have actually is if we haven’t created a clinical environment that is appealing, safe, compassionate, and nonjudgmental,” said Sarah Bagley, an internist and pediatrician at Boston Medical Center who provides addiction treatment to adolescents. “That engagement piece is everything, because without it, nothing.”
For Bagley, it’s important to continue advocating and doing research around young people as a distinct population. “Because it is different taking care of young people compared to adults,” she said. They have different systems organizing their lives, like school and parents.
Primary care physicians and pediatricians who have longstanding relationships with patients and families need to feel comfortable prescribing buprenorphine, addiction doctors said. And over time, interest from generalists in understanding and treating opioid use disorder does appear to have increased, Bagley said.
Hadland sees it, too. Where he used to feel like he was pitching his pediatric colleagues and professional organizations on the importance of understanding addiction treatment, now there appears to be active demand for such knowledge. On the day the study was published, he traveled to the AAP’s annual conference, where he’ll give a plenary talk on the big stage about addiction and the potency of the drug supply. To him, that signals a cultural shift that will, hopefully, equip more doctors to help young people struggling with addiction. Because currently, he said, the pediatric workforce is not keeping up.
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