Study: Low retention in youth addiction treatment

A new study by Scott Hadland and other researchers found low retention in treatment using medications for opioid use disorder (MOUD) among young people.

• The study looked at 2016-2023 Medicaid claims from all states for participants with opioid use disorder (OUD) aged 13-25.

The findings:

• Among nearly 230,000 young people with OUD enrolled in Medicaid, about half initiated treatment within 14 days of diagnosis, and about a third engaged in care (i.e., had at least two additional treatment encounters within 34 days of treatment initiation).
• Of those who engaged in treatment, 46.3% received MOUD, representing 15.2% of all 230,000 youth with OUD.
• But only 6.6% of adolescents who engaged in treatment received MOUD, compared with 51.2% of young adults.
• Buprenorphine was the most initiated medication (68.5%), followed by methadone (25.5%) and extended-release naltrexone (6.0%). Fewer than 10 minors received methadone.
• Only 3.1% of youth continued medication for 6 months or more.
• Retention was highest for methadone (26.2%), followed by buprenorphine (19.2%) and extended-release naltrexone (5.8%). Median time receiving MOUD was 59 days for methadone, 45 days for buprenorphine, and 31 days for extended-release naltrexone.
• Younger adolescents aged 13-15 and racially minoritized youth had consistently lower progression through the cascade of care.

The context: Minors face additional barriers in accessing MOUD on top of those also experienced by adults.

• Until late 2024, federal law required minors to have two documented “failed” attempts at recovery without medication before they could start methadone treatment. And still, even without that requirement, many methadone clinics will not accept minors.
• Buprenorphine has been easier for doctors to prescribe, but few residential treatment facilities for adolescents offer it.
• While research demonstrates the safety and effectiveness of MOUD, few studies focus specifically on young people. That makes it hard for doctors to answer exactly how long a young person may need to stay on the medications or what the long-term effects might be, though research demonstrates better outcomes the longer a person is on the medication. Young people and families can often be apprehensive about an open-ended commitment.
• While there was been some increased interest from primary care physicians and pediatricians in understanding and treating OUD, more is needed to equip doctors to help young people.

The main point: Most Medicaid-enrolled youth with OUD did not receive timely, evidence-based treatment, and only 1 in 32 received sustained pharmacotherapy.

• Why it’s important: While the number of young people receiving MOUD increased, the increase was small, and the number who stayed on medication for 6 months, already low, may have decreased. Policies and care models that expand equitable treatment access are needed.

Read more: Access to addiction meds for young people has improved – but retention hasn’t