A new study published in JAMA and supported by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences (NCATS), both part of the National Institutes of Health, has revealed that only 1 in 4 residential addiction treatment facilities in the United States that care for adolescents under 18 years old offer buprenorphine, a medication used to treat opioid use disorder. The study, conducted by researchers at Oregon Health & Science University (OHSU), highlights a significant gap in access to evidence-based addiction treatment for young people.
The recent increase in overdose mortality among young people (ages 14-18) is believed to be primarily caused by the proliferation of counterfeit and illegal fentanyl-containing medications. Medication-based treatment has proven to be highly effective in addressing opioid use disorder, reducing the risk of relapse, and preventing fatal overdoses.
Among the medications approved by the FDA for use in young adults and adolescents, buprenorphine is currently the only one. While there is limited research on its use in children, several medical organizations recommend considering buprenorphine as a treatment option for teenagers under the age of 16.
Dr. Nora Volkow, the director of the National Institute on Drug Abuse (NIDA), has expressed concern about the lack of access to buprenorphine for young people with opioid use disorder, despite it being considered the gold standard of therapy for adults aged 16 and older. While residential treatment facilities are crucial in the continuum of care for adolescents with opioid use disorder, there is a lack of knowledge regarding evidence-based treatment options, including medication availability, for these young individuals.
To address this knowledge gap, researchers from Oregon Health and Science University (OHSU) utilized the Substance Abuse and Mental Health Services Administration’s (SAMHSA) FindTreatment.gov database. Through their study, they identified 354 facilities in the United States that offered substance use therapy to children and adolescents in residential or round-the-clock care settings. These facilities provided 24/7 care. The researchers contacted these facilities to inquire about the level of medical care they would provide to a hypothetical 16-year-old girl who recently survived a fentanyl overdose.
The study found that 45 percent (160) of the evaluated clinics offered residential care to patients under the age of 18. Only 24% (39 out of 160) of these addiction treatment centers reported providing buprenorphine to patients aged 16 and above, either directly or in collaboration with prescribing specialists outside the facility. Due to location-specific restrictions on buprenorphine distribution, only 20 clinics (12.5%) were authorized to provide it for long-term treatment. Additionally, 7.5% of the treatment centers, or 12 in total, administered buprenorphine to adolescents under the age of 16.
Among the 121 facilities that did not administer buprenorphine or had unclear policies, 47% (57) acknowledged that teenagers prescribed buprenorphine by their own practitioners could remain on it temporarily. However, some of these facilities mentioned discontinuing buprenorphine before the patients were discharged. Furthermore, 22% (27) of residential treatment facilities required that young people seeking admission should not be using buprenorphine at the time of application.
Based on these findings, an individual seeking buprenorphine would need to contact all nine institutions on the SAMHSA list or reach out to any of the 29 facilities to determine if they offer buprenorphine to minors under the age of 16.
Dr. Caroline King, the primary author of the study from OHSU School of Medicine, emphasized the need to support residential treatment institutions in adopting evidence-based care as the standard for vulnerable adolescents.
Dr. Todd Korthuis, the chief of addiction medicine at OHSU and a co-author of the study, highlighted the underutilization of buprenorphine in institutions treating young people with severe opioid use disorder. He called for increased support in the form of education, funding, and public awareness to make buprenorphine a crucial component in the recovery of young individuals affected by opioid use disorder.