New research in JAMA Network Open shows that while more young people with opioid use disorder are starting medications like buprenorphine and methadone, the increase is small and long-term retention has not improved. The study analyzed Medicaid enrollment and claims for nearly 230,000 people ages 13 to 25 diagnosed between 2016 and 2023.
About half of those diagnosed initiated treatment with a clinician, and a third had at least two visits in the first month. Among those engaged in care, roughly 1 in 6 received medication, but only 1 in 32 stayed on it for six months. The authors note that this already low retention rate may have decreased over the study period.
Structural barriers remain severe, especially for minors. Federal rules require two documented failed attempts at recovery without medication before methadone can be started, and many clinics won't accept minors. Fewer than 10 minors received methadone during the entire study period. Buprenorphine is easier to prescribe, but few residential treatment facilities for adolescents offer it.
Experts quoted in the article agree that improving engagement and retention is critical. Sarah Bagley of Boston Medical Center stressed that treatment is useless without a clinical environment that is appealing, safe, compassionate, and nonjudgmental. They also point to racial disparities and a pediatric workforce that is not keeping up with demand. Study lead author Scott Hadland said the stakes are high, noting recent overdose deaths among his own patients.