Opioid Use Disorder Treatment and Adolescents

"Prior studies have highlighted several gaps in adolescent OUD treatment receipt in the US.8–17 For instance, research documents lower OUD treatment retention and engagement among adolescents than adults.18 Moreover, adolescents have low overall rates of substance use treatment use,17 with compounding disparities based on factors such as race and ethnicity or socioeconomic status.19–23

"Numerous studies also indicate that medications for OUD (MOUD) are rarely used for adolescents with OUD8,10,12–16,24,25 and are infrequently offered at adolescent-serving treatment facilities.9,26,27 MOUD is considered the “gold standard” treatment for OUD because of its efficacy in increasing retention in care and reducing opioid use and mortality risk.28 Also, the American Academy of Pediatrics and the Society for Adolescent Health and Medicine recommend increasing access to MOUD for adolescents and young adults.29,30 MOUD includes methadone, buprenorphine, and naltrexone; methadone for MOUD is solely available through accredited and certified opioid treatment programs (OTPs)—specialized clinics in which methadone and other MOUD are dispensed. OTPs have historically been permitted to admit patients younger than age eighteen only with documentation of at least two prior “unsuccessful” treatment attempts, although this restriction was removed from federal regulations in 2024.31 In contrast, buprenorphine or naltrexone can be prescribed by a variety of medical professionals across substance use or mental health treatment programs or general health care settings. Buprenorphine is recommended as the “first-line” MOUD option for adolescents and young adults,4 and in December 2022 and January 2023, federal law removed long-standing specific “X-waiver” buprenorphine prescriber training requirements and restrictions, aiming to increase buprenorphine access for all patients.32"