A new study highlights alarmingly low engagement and retention in treatment among Medicaid-enrolled youths with opioid use disorder in the US, exposing young people to preventable harm amid rising overdose deaths.
Among adolescents and young adults in the United States, opioid use disorder remains a serious and often under-treated condition, even as fentanyl has driven a rise in overdose deaths in this age group since 2019. A study published in JAMA Network Open by researchers at Mass General Brigham found that Medicaid-enrolled people aged 13 to 25 moved through the care pipeline at strikingly low rates, with only about half starting treatment and only a tiny fraction staying on medication for six months or longer.
The analysis drew on eight years of national insurance claims data covering 229,847 young people diagnosed with opioid use disorder. Within 14 days of diagnosis, 50.7% began treatment. Just 32.9% went on to engage in care, meaning they attended at least two additional treatment sessions in the following 34 days. Of those who engaged, 46.3% received medication, most commonly buprenorphine, methadone or extended-release naltrexone.
The drop-off was especially stark when researchers looked at sustained treatment. Only 3.1% of adolescents and young adults were still taking medication after 180 days, a period widely used as a marker of quality care because longer treatment is linked with better outcomes. The study also found that younger adolescents and racially minoritised youths were less likely to progress through each stage of care, pointing to persistent gaps in access and continuity.
Scott Hadland, who led the research and serves as chief of adolescent and young adult medicine at Mass General Brigham for Children, said untreated opioid use disorder can have both immediate and lifelong consequences and that overdoses and poisonings have become a leading cause of death in this age group. He said the findings highlight major weaknesses in care that leave young people exposed to preventable harm, and noted that the results should help inform Medicaid design, service delivery and efforts to improve equity in treatment.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
