Mass General Brigham Study Shows Gaps in Youth Opioid Care

Adolescents and young adults enrolled in Medicaid face large gaps in care after receiving an opioid use disorder diagnosis, according to a study published today in JAMA Network Open by investigators from Mass General Brigham.

Key Clinical Takeaways:
• Only half of the 229,847 Medicaid-enrolled patients aged 13 to 25 studied initiated treatment within 14 days of an opioid use disorder diagnosis.
• Just one-sixth of the young patients received medications, and only 3.1% remained on medication for 180 days or more.
• Younger adolescents and racially minoritized youths experienced the lowest rates of progression through the stages of care.

Medicaid Data Reveals Low Treatment Rates

One in 100 adolescents and young adults in the United States has an opioid use disorder, and overdoses have risen sharply since 2019 alongside the prevalence of fentanyl in the drug supply. To evaluate whether young patients receive reliable, evidence-based care, researchers analyzed eight years of national health insurance claims data covering 229,847 individuals aged 13 to 25.

The findings indicate that 50.7% of the cohort initiated treatment within 14 days of diagnosis. Engagement dropped further, with only 32.9% attending two or more additional treatment sessions within 34 days of starting care. Among those engaged, 46.3% began medications such as buprenorphine, methadone, or extended-release naltrexone.

Gaps in Long-Term Medication Management

Longer treatment duration is a key quality-of-care measure associated with better outcomes for patients with opioid use disorder. However, the study found that only 3.1% of the young patients remained on a prescribed medication after 180 days. Scott Hadland, MD, MPH, chief of adolescent and young adult medicine at Mass General Brigham for Children and lead author of the study, noted that these gaps leave vulnerable populations exposed to premature death.

Prior to our study, little was known about how youths progress through the stages of treatment for opioid use disorder, Hadland stated. 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.

Disparities were also pronounced across demographic lines, with younger adolescents and racially minoritized youths demonstrating consistently lower progression through successive stages of clinical intervention.

Disclaimer: The information provided in this article is for educational and scientific communication purposes only and does not constitute medical advice. Always consult with a qualified healthcare provider regarding any medical condition, diagnosis, or treatment plan.