Despite the alarming rise in overdose deaths among young people in 2022, a recent study conducted by Oregon Health & Science University highlights the significant absence of buprenorphine, a proven medication for treating opioid use disorder, in three-quarters of adolescent residential treatment centers across the United States. The researchers emphasize that buprenorphine is crucial in combating the opioid epidemic, particularly as illicit fentanyl continues to contribute to the surge in fatalities.
Published in the Journal of the American Medical Association, the study underscores the resistance observed in using buprenorphine, which undermines nationwide efforts to address the overdose crisis that claimed over 109,000 lives in 2022, according to provisional statistics from the Centers for Disease Control and Prevention (CDC). Recognizing the vulnerability of young people, particularly with the contamination of fentanyl in other illicit substances, the researchers aimed to determine the prevalence of buprenorphine provision in adolescent treatment centers throughout the country.
Lead author Caroline King, M.D., Ph.D., formerly a medical student at OHSU and currently an emergency medicine resident at the Yale School of Medicine, stated, “These residential treatment centers cater to some of the most vulnerable adolescents in our communities, but they are failing to provide the standard of care for these young individuals. Given the escalating fentanyl-related overdoses among adolescents, it is imperative that these centers offer the best possible treatment.”
CDC data reveals a significant increase in overdose deaths among young people nationwide and in the Pacific Northwest due to the proliferation of illegal fentanyl in recent years. Buprenorphine is one of the three medications approved by the Food and Drug Administration to treat opioid dependence. It works by normalizing brain function and targeting the same receptors affected by prescription opioids, heroin, and fentanyl – all highly addictive substances.
Co-author Todd Korthuis, M.D., M.P.H., head of addiction medicine in the OHSU School of Medicine, emphasized the critical role of buprenorphine in treating adolescents with opioid use disorder, stating, “It is the only medication approved for use in adolescents, yet it remains underutilized in facilities treating young individuals with severe opioid use disorder. It is difficult to envision successfully weaning adolescents off fentanyl without the use of buprenorphine.”
Although buprenorphine is not currently approved for individuals under the age of 16 in the United States, there is no evidence suggesting major safety concerns for its use in younger populations. The American Society of Addiction Medicine recommends considering buprenorphine for the treatment of opioid use disorder in younger individuals.
Korthuis acknowledged that some treatment providers are hesitant to use buprenorphine, even with adult patients, due to concerns that it simply replaces one drug with another. However, he emphasized that this perception can be changed through education and technical assistance provided to treatment centers, advocating for improved funding to adequately staff these facilities, and increasing public awareness about the necessity of buprenorphine in the treatment of opioid addiction.
The findings of the study highlight the potential benefits of offering support to the majority of adolescent residential treatment centers in the United States.
To conduct the study, King and three other OHSU medical students compiled a comprehensive catalog of treatment centers catering to adolescents in the United States, primarily utilizing a database maintained by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). Among the 354 residential treatment centers identified nationwide, less than half served adolescents.
The researchers posed as the aunt or uncle of a 16-year-old seeking treatment following a recent non-fatal fentanyl overdose. From October to December of the previous year, they made inquiries by phone.
The researchers found that out of the 160 residential treatment facilities serving adolescents nationwide:
- Only 39 offered buprenorphine, either directly or through partnerships with prescribing clinicians, and just 12 of those provided it to adolescents under the age of 16.
- Among the remaining 121 facilities that either did not offer buprenorphine or were uncertain, 57 indicated that adolescents prescribed buprenorphine by their own clinician could temporarily continue using it, although some centers stated they would discontinue it before discharge.
- 27 residential treatment centers required adolescents to stop using buprenorphine upon admission, thereby refusing admission to adolescents receiving proven medication-assisted therapy in these “abstinence-only” centers.
In summary, only one out of every four adolescent residential treatment centers offered buprenorphine, and even fewer provided it as an ongoing treatment option.
The authors of the study assert, “The average parent would need to contact nine facilities from the SAMHSA list to find one that offers buprenorphine. To find one for an adolescent under 16, they would need to reach out to 29 facilities.”
For additional information on substance and mental health treatment programs in your area, please call the free and confidential National Helpline at 1-800-662-HELP (4357) or visit www.FindTreatment.gov.
The research received support from the National Institute on Drug Abuse of the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Oregon Clinical and Translational Research Institute, among others.
Frequently Asked Questions (FAQs) about Opioid epidemic response
What does the study reveal about the provision of buprenorphine in US adolescent treatment centers?
The study reveals that only one in four adolescent residential treatment centers across the United States provides buprenorphine, a proven medication for treating opioid use disorder. This lack of provision undermines efforts to combat the opioid epidemic and address the rising number of overdose deaths among young people.
Why is buprenorphine important in the treatment of opioid use disorder?
Buprenorphine is a crucial medication approved for treating opioid dependence. It normalizes brain function and targets the same receptors as prescription opioids, heroin, and fentanyl. It is effective in helping individuals overcome addiction and is particularly vital for adolescents with opioid use disorder, especially with the increasing prevalence of fentanyl-related overdoses.
Why are many adolescent treatment centers not providing buprenorphine?
The study suggests that there is resistance to using buprenorphine in some treatment centers, with concerns that it replaces one drug with another. However, education and technical assistance, improved funding, and raising public awareness about the importance of buprenorphine can help overcome these obstacles and encourage the provision of this effective treatment option.
Can adolescents under the age of 16 receive buprenorphine?
Although buprenorphine is not currently approved for individuals under the age of 16 in the United States, there is no evidence of major safety concerns for its use in younger populations. The American Society of Addiction Medicine recommends considering buprenorphine for the treatment of opioid use disorder in younger individuals.
How can we address the lack of buprenorphine provision in adolescent treatment centers?
The study suggests several approaches to address this issue. These include providing education and technical assistance to treatment centers, advocating for better funding to support these facilities, and raising public awareness about the necessity of buprenorphine in treating opioid addiction. These efforts can help improve the standard of care in adolescent treatment centers and better address the opioid epidemic.
More about Opioid epidemic response
- Oregon Health & Science University: Link to the study
- Journal of the American Medical Association: Link to the study publication
- Centers for Disease Control and Prevention (CDC): CDC overdose death statistics
- Substance Abuse and Mental Health Services Administration (SAMHSA): SAMHSA treatment locator