Only 1 in 32 Young People With Opioid Addiction Stay on Medication. Here Is What Parents Should Know.

A study published last week should worry every parent of a teenager or young adult in Northwest Arkansas.

Researchers led by Dr. Scott Hadland at Mass General Brigham looked at insurance records for 229,847 young people, ages 13 to 25, who had been diagnosed with opioid use disorder. The data covered eight years, 2016 through 2023, and came from Medicaid. It was published in JAMA Network Open.

Here is what they found, step by step:

• About half started any treatment within two weeks of being diagnosed.
• About a third came back for at least two more visits in the following month.
• About one in six ended up on medication.
• Only 3.1%, about 1 in 32, were still on medication six months later.

Read that last line again. Of every 32 young people diagnosed with opioid addiction, one was still on the treatment most likely to keep them alive half a year later.

Dr. Hadland put it plainly: untreated opioid use disorder in young people has both immediate and lifelong consequences, and overdoses and poisonings have become a leading cause of death in this age group.

Why this matters right now

For about 20 years, overdose deaths among teenagers were fairly stable. That changed in 2019, when fentanyl took over the street supply.

The CDC tracked what happened next. For Americans aged 10 to 19, median monthly overdose deaths more than doubled, rising 109% between the second half of 2019 and the second half of 2021. In the deaths the CDC examined, 84% involved illicit fentanyl.

The American Academy of Pediatrics notes that young people are especially likely to run into counterfeit pills that look like real prescriptions but contain fentanyl or other synthetic opioids. I wrote last week about one of the newest, cychlorphine, which has now been found in Arkansas and does not show up on fentanyl test strips.

A young person today does not get many chances. The supply does not allow it.

Medication is what keeps young people in treatment

This is not a new finding. It keeps getting confirmed.

In an earlier study of 4,837 young people on Medicaid, also led by Dr. Hadland and published in JAMA Pediatrics in 2018, the ones who started buprenorphine early were 42% less likely to drop out of treatment than the ones who only got counseling. Young people who got counseling alone stayed in care a median of 67 days. Those started on buprenorphine stayed a median of 123 days.

The American Academy of Pediatrics says medication for opioid use disorder improves retention in care, reduces opioid-positive drug tests, and reduces overdose and death from all causes.

So why do so few young people get it?

The barriers are real

Part of it is that the medication is hard to find for young people.

The AAP reports that only about 1 in 8 treatment facilities offer buprenorphine for adolescents, and pediatricians write fewer than 2% of buprenorphine prescriptions for youth.

A study supported by the National Institutes of Health tested this directly. Researchers called adolescent residential treatment centers posing as the parent of a 16-year-old who had just survived a fentanyl overdose. Only 24% of the centers that took patients under 18 said they offered buprenorphine. Some required the teen to come off buprenorphine before they would admit them. On average, a parent would have to call nine facilities to find one that offered it.

Nine phone calls, in the middle of a crisis, with a child who just overdosed.

The other part is that many families have been told, by people who meant well, that medication is just trading one drug for another, and that real recovery means getting clean with no help. I believed some version of that once. I was wrong, and I explain why in medical detox vs. Suboxone treatment.

Staying on it is the hard part

The study's most important number is not how many young people started medication. It is how few stayed.

Young people stop treatment for ordinary reasons. A ride falls through. A pharmacy is out of stock. Insurance lapses. A clinic only sees patients during school or work hours. They feel better after a few weeks and decide they don't need it anymore. A parent, understandably, wants them off everything as soon as possible.

Each of those is a door back to the street supply.

The STAT News report on the study noted that existing research and clinical experience point the same way: the longer someone stays on medication, the better they do. There is no prize for stopping early. I go into this in how long Suboxone treatment takes.

What a parent can actually do

1. Do not wait for rock bottom. With fentanyl in the supply, rock bottom is often death. If you suspect a problem, act now. If you are not sure what to look for, start with the signs of opioid use disorder in someone you love.
2. Ask every provider directly whether they offer buprenorphine. If the answer is no, or only after detox, keep calling.
3. Keep naloxone in the house. It is sold over the counter. Keep two doses.
4. Plan for the long run. Treat the first six months as the beginning, not the finish line.
5. Remove the practical obstacles. Rides, pharmacy refills, appointment times. These small things are where young people fall out of care.

What treatment looks like for a young adult

People picture something dramatic. It usually is not.

The first visit is a conversation. I ask what they have been using, how much, how often, and when they last used. I ask about school, work, sleep and what they want their life to look like. Then we plan when to start buprenorphine so that it is timed safely, especially if fentanyl is involved.

After that, the routine is boring on purpose. A daily dose. A follow-up visit about every 28 days. Honest talk about what is working and what is not. The goal is a young person who can go to class, hold a job, drive a car and sleep through the night without thinking about where the next dose is coming from.

Parents often ask me when it ends. My answer is that we decide that together, later, when life is stable. Not on a calendar picked in the first week.

How I can help

If your son or daughter is 18 or older, they can call me directly. If they are younger, call me anyway. I will tell you honestly what options make sense and help you find the right care if it is not with me.

I answer my own phone 24 hours a day, every day of the year, at 479-856-1505. If someone needs to be seen tonight, I will come in.

A scheduled visit is $200. An unscheduled after-hours visit is $300. Follow-ups are about every 28 days. I do not bill insurance, but insurance can still be used at the pharmacy for the medication and for lab work. That also means nothing about treatment goes through a parent's employer plan unless the family chooses that.

Records are protected under HIPAA and 42 CFR Part 2, the federal rule that gives substance use treatment records extra privacy.

I was an orthopedic surgeon. I lost that career to addiction, and I recovered. I know what it is like to be the one who cannot stop, and I know what it does to the people who love you.

One in 32 is not good enough. It does not have to be your child's number.

More reading: What the first visit looks like · What treatment costs