Challenges Persist in Young People's Opioid Addiction Treatment Retention

While recent data indicate that more young individuals diagnosed with opioid use disorder are beginning treatment with medications like buprenorphine and methadone, the progress is tempered by alarmingly low retention rates. Almost half of the nearly 230,000 young people studied between 2016 and 2023 engaged in some form of care, yet only about 1 in 32 remained on their medication after six months.

Scott Hadland, chief of adolescent and young adult medicine at Mass General Brigham for Children, characterized the situation as containing both positive changes and serious setbacks. His recent study, published in JAMA Network Open, outlines the challenges faced in ensuring continuity of care among youth diagnosed with opioid use disorder.

Current State of Youth Treatment

Data reveal that while initiation into treatment has improved, significant issues remain in maintaining that treatment over time. Only about a third of those starting treatment had two or more appointments in the first month, leading to what experts consider catastrophic attrition rates. This is also occurring against the backdrop of increasing overdose deaths among youth, with poisonings becoming the third leading cause of death for those aged 19 and under since 2019.

Hadland shared the harrowing reality faced in medical practice: “I’ve had patients die as recently as this past month here in Massachusetts, from overdose,” underlining the gravity of the current crisis.

Barriers to Effective Treatment

Despite the availability of effective and affordable medications for opioid use disorder, barriers remain particularly impactful for minors. Until late 2024, federal law mandated that minors must have two documented failed attempts at recovery without medication before being eligible for methadone. Many treatment facilities remain reluctant to accept these patients, further complicating access. Although buprenorphine has traditionally been more accessible, a significant number of residential treatment centers for adolescents still do not offer it.

Sivabalaji Kaliamurthy, a child and adolescent psychiatrist, noted, “Once you turn 18, a whole bigger field of people are open to helping you.” This stark disparity highlights the systemic obstacles that impede care continuity for younger patients.

The Need for Tailored Approaches

With fewer than ten minors receiving methadone during the study period—a figure so low it had to be categorized as “not defined” for privacy reasons—it's clear that more targeted approaches are necessary. While existing research overwhelmingly supports the efficacy of addiction medications, few studies focus specifically on young people, leaving many questions unanswered regarding the duration and long-term effects of treatment.

Young patients and their families often find it difficult to commit to a long-term treatment plan. The study demonstrates that Black youth and other racially minoritized groups face even greater challenges in navigating the healthcare system, leading to worse retention outcomes compared to their white peers.

Building Engaging Treatment Environments

Kaliamurthy remains hopeful about the number of young people starting treatment, but emphasizes that retaining those patients is where the real work lies. The clinical environment needs to be welcoming, compassionate, and nonjudgmental—a sentiment echoed by Sarah Bagley, an internist and pediatrician at Boston Medical Center who specializes in treating adolescents with substance use disorders. “That engagement piece is everything, because without it, nothing,” she stated.

Bagley also advocates for ongoing research focusing on young patients and insists that the medical community must understand the unique circumstances surrounding adolescent treatment. Primary care physicians and pediatricians, who often have established relationships with their patients, should feel empowered to prescribe addiction medications like buprenorphine, a trend that Bagley notes is gradually improving.

A Shift in Medical Culture

Hadland sees a shift in medical culture, where there’s increasing demand among pediatricians for knowledge about treating addiction. He will be presenting this topic at the American Academy of Pediatrics’ annual conference, reflecting a growing recognition of the need to equip healthcare providers to better support youth struggling with addiction.

The current situation underscores that while access to medications may be improving, enhancing retention rates requires a concerted effort across various fronts—medical education, systemic support, and community engagement—to foster an environment where young patients can thrive. Moving forward, it's essential that the pediatric workforce better matches the demands of treating this vulnerable population.

Correction: An earlier version of this story misstated the federal law around minors taking methadone. The “fail first” rule was eliminated in late 2024.

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