Study reveals large gaps in care for youths with opioid use disorder

Study reveals large gaps in care for youths with opioid use disorder

Retrospective cohort study led by Mass General Brigham researchers of Medicaid-enrolled 13-to-25-year-olds with opioid use disorder shows most patients do not receive timely, evidence-based treatment

One in 100 adolescents and young adults in the United States has an opioid use disorder (OUD) and, with the rise of fentanyl in the drug supply, overdoses in this age group have risen sharply since 2019. A new study by investigators from Mass General Brigham Open external link in a new window asked whether Medicaid-enrolled 13-to-25-year-olds with OUD receive evidence-based, reliable treatment. Using eight years of national data from 229,847 adolescents and young adults, they found only half began treatment, one-third engaged in care, one-sixth received medication, and 1 in 32 continued medication for 180 days or more. Results are published today in JAMA Network Open Open external link in a new window .

"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," said lead author Scott Hadland, MD, MPH Open external link in a new window , Chief of Adolescent and Young Adult Medicine at Mass General Brigham for Children Open external link in a new window . "Our findings suggest large gaps in care that are keeping this population vulnerable to premature death and poor health outcomes."

Using health insurance claims data, researchers found that within 14 days of diagnosis, 50.7% of adolescents and young adults with an OUD initiated treatment and 32.9% engaged in care by attending two or more additional treatment sessions in the 34 days after initiating care. Of those that engaged in treatment, 46.3% began medication. The three most prescribed medications were buprenorphine, methadone, and extended-release naltrexone. Only 3.1% of adolescents and young adults with an OUD were still on a medication after 180 days, a timeframe that has become a key quality of care measure given that longer treatment is associated with better outcomes. Additionally, younger adolescents and racially minoritized youths had consistently lower progression through the stages of care.

"Prior to our study, little was known about how youths progress through the stages of treatment for opioid use disorder," said Hadland. "What we found is essential to inform Medicaid plan design, service delivery, and policies to improve quality and equity in youth opioid use disorder care."

Authorship: In addition to Hadland, Mass General Brigham authors include Vicki Fung, Dandi Dong, Marie-Abèle C. Bind, Meredith Glass, Margarita Alegría and George Karandinos. Additional authors include Ijeoma Opara, Sitara Weerakoon, Jonathan Rodean, Bonnie T. Zima and Arthur Robin Williams.

Disclosures: Hadland reports grants from the National Institute on Drug Abuse during the conduct of the study; honoraria from the American Academy of Pediatrics, American Society of Addiction Medicine and American Dental Association; and fees for media appearances from TEGNA. Additional author disclosures can be found in the paper.

Funding: This study was funded by the National Institutes of Health (R01DA057566, K18DA059913, R34DA062280 and DP5OD029636).

Paper cited: Hadland SE et al. "Opioid Use Disorder and Evidence-Based Care Among Medicaid-Enrolled Youths," JAMA Network Open DOI: 10.1001/jamanetworkopen.2026.37263

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Mass General Brigham is an integrated academic health care system, uniting great minds to solve the hardest problems in medicine for our communities and the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a nonprofit organization committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation's leading biomedical research organizations with several Harvard Medical School teaching hospitals. For more information, please visit massgeneralbrigham.org Open external link in a new window .