Limited Availability of Buprenorphine in Adolescent Treatment Facilities Highlights Urgent Need for Improvement

New research reveals a concerning disparity in the provision of buprenorphine, the sole approved medication for treating opioid addiction in 16-18 year olds, with only 25% of U.S. adolescent addiction treatment facilities offering it. This study underscores the urgent need for enhanced education, funding, and public awareness to bridge the gap in evidence-based addiction treatment for young people. The National Institutes of Health (NIH)-funded study underscores the necessity of expanding access to evidence-based treatment among adolescents.

According to a recent study supported by the NIH and led by researchers at Oregon Health & Science University (OHSU), only 25% of residential addiction treatment facilities catering to adolescents below 18 years old in the United States provide buprenorphine, a medication essential for combating opioid use disorder. Furthermore, only 12.5% offer buprenorphine for ongoing treatment. These findings underscore a significant deficiency in access to evidence-based addiction treatment for young individuals. Published in the Journal of the American Medical Association (JAMA), this study aims to address this issue and was made possible through the support of the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences (NCATS), both components of the NIH.

Recent years have witnessed a distressing surge in overdose fatalities among individuals aged 14-18, largely attributable to the consumption of illicit counterfeit pills containing fentanyl. Medications remain the most effective treatment options for preventing relapse and overdose deaths among those affected by opioid use disorder. Buprenorphine, sanctioned by the U.S. Food and Drug Administration for use in 16-18 year olds, stands as the sole medication for treating opioid use disorder in this age group. While buprenorphine lacks approval for use among those under 16 years old in the United States, some professional medical societies advocate for considering it as a viable treatment option for younger individuals.

“It is truly tragic that the majority of treatment facilities fail to provide access to buprenorphine for young people grappling with opioid use disorder, despite this medication being the standard of care for individuals aged 16 and older,” remarked Dr. Nora Volkow, the director of NIDA. “Residential treatment facilities offer a critical opportunity to provide a range of evidence-based support to young people during a crucial period in their lives, and it is imperative that buprenorphine is made available as one of these options.”

Residential treatment facilities constitute an integral part of the comprehensive care provided to adolescents with opioid use disorder. However, limited information is available concerning the evidence-based treatment options offered to young individuals within these facilities, particularly in terms of medications for opioid use disorder. To bridge this knowledge gap, researchers at OHSU sought to determine the extent to which buprenorphine was available for treating opioid use disorder in adolescent treatment centers across the United States.

By utilizing the FindTreatment.gov database, maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA), the research team identified 354 centers nationwide that offered “substance use” treatment within a “residential/24-hour residential” service setting, specifically catering to “children/adolescents” (defined as individuals aged 17 and below). Subsequently, the researchers contacted these facilities, assuming the role of potential users seeking treatment and services for a 16-year-old individual who had recently experienced a non-fatal fentanyl overdose. Between October and December 2022, the study team randomly called the facilities, confirming that 45% (160) of them provided residential treatment for patients under 18 years old.

Among the 160 residential addiction treatment facilities identified as providing treatment to young patients, the researchers discovered that only 24% (39 facilities) offered buprenorphine to individuals aged 16 or older, often through partnerships with external prescribing clinicians. The specific parameters for administering buprenorphine varied among the sites. For instance, only 12.5% (20 facilities) reported offering buprenorphine for ongoing treatment, while 7.5% (12 facilities) claimed to provide buprenorphine to adolescents under 16 years old.

Among the remaining 121 facilities that either did not provide buprenorphine or were uncertain, 47% (57 facilities) indicated that adolescents prescribed buprenorphine by their own clinician could continue taking it temporarily, though some facilities stated that it would be discontinued prior to discharge. Additionally, 22% (27 facilities) required adolescents not to be on buprenorphine to be admitted for residential treatment.

These findings indicate that the average individual would need to contact nine facilities listed on SAMHSA to find one that offers buprenorphine. To find a facility catering to an adolescent under 16 years old, they would need to reach out to 29 facilities.

“These residential treatment centers serve some of the most vulnerable adolescents in our communities,” emphasized lead author Caroline King, M.D., Ph.D., who conducted this research during her time as a student at the OHSU School of Medicine. “We must support these centers in adopting evidence-based care as the standard.”

Dr. Todd Korthuis, co-author and head of addiction medicine at OHSU, stated, “Buprenorphine is the only medication approved for use in adolescents, yet it is underutilized in facilities responsible for the care of young individuals grappling with severe opioid use disorder. While it is indeed a significant issue, it is one that we can address by providing education and technical assistance regarding buprenorphine to these treatment centers, ensuring better funding for staffing, and raising public awareness about the necessity of buprenorphine as a vital treatment for healing young minds.”

For further information on substance and mental health treatment programs available in your area, please call the toll-free and confidential National Helpline at 1-800-662-HELP (4357) or visit www.FindTreatment.gov.

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More about adolescent treatment facilities

• National Institute on Drug Abuse (NIDA): Link
• National Center for Advancing Translational Sciences (NCATS): Link
• Oregon Health & Science University (OHSU): Link
• Substance Abuse and Mental Health Services Administration (SAMHSA): Link
• Journal of the American Medical Association (JAMA): Link
• FindTreatment.gov: Link
• National Helpline: Link