Opioid use disorder (OUD) remains a major public health crisis, particularly among young people. Medication-assisted treatment (MAT), which includes buprenorphine, has been recognized as the gold standard for treating opioid addiction. However, despite a growing body of evidence that supports its effectiveness, the rates at which buprenorphine is being dispensed to young people have been on the decline in recent years. A recent study published in JAMA revealed that between 2020 and 2023, the number of adolescents and young adults receiving buprenorphine decreased by 6.5% annually. This raises significant concerns about the accessibility and availability of crucial treatments for young individuals facing opioid use disorder.
Understanding the Decline in Buprenorphine Dispensing to Youth
Buprenorphine is the only MAT cleared for use by adolescents aged 16 and over. The medication has proven to be effective in reducing opioid cravings and withdrawal symptoms, making it a vital part of the treatment landscape for young people battling OUD. Yet, despite its availability and demonstrated success, buprenorphine dispensing among adolescents and young adults remains worryingly low.
In 2023, approximately 712,000 adolescents and young adults aged 12 to 25 were living with opioid use disorder. However, only 38,907 adolescents and young adults aged 10 to 24 were dispensed buprenorphine that year. This disparity highlights a significant treatment gap. While some positive trends are emerging in buprenorphine dispensing—particularly for teenagers—the overall rate of treatment remains much lower than it should be.
Researchers attribute the decline in buprenorphine dispensing primarily to a decrease in prescriptions for young adults between the ages of 20 and 24. This age group has experienced a sharp drop in buprenorphine use, which accounts for much of the overall decrease. Conversely, there has been a modest increase in dispensing to adolescents aged 10 to 19. While this increase is promising, the volume of buprenorphine dispensed to this group is still low, indicating that many adolescents are still not receiving the treatment they need.
Barriers to Opioid Use Disorder Treatment for Young People
The barriers preventing young people from accessing buprenorphine are multifaceted and complex. One major obstacle is the limited availability of specialized treatment facilities that can provide MAT to adolescents and young adults. Many young people struggle to find care providers who are both qualified and willing to prescribe buprenorphine, especially since opioid addiction among youth remains highly stigmatized. The stigma surrounding opioid use disorder is a significant deterrent, preventing young people from seeking treatment and clinicians from prescribing the necessary medications.
In addition, there is a general lack of comfort among clinicians who work with youth when it comes to prescribing MAT. Many providers may not feel equipped to handle opioid addiction in young patients, especially since adolescents and young adults can face unique challenges in their treatment journey. For example, younger patients may be more vulnerable to relapse and may need specialized care to address underlying mental health issues, family dynamics, and social pressures.
Another contributing factor is the fact that young adults, especially those aged 20 to 24, may be less likely to seek out or have access to health care services in the first place. This population often faces financial, social, and logistical barriers that can make it difficult to access treatment, further exacerbating the gap in buprenorphine dispensing.
Positive Trends in Opioid Use Disorder Treatment for Young People
While the overall numbers are concerning, there are some positive trends in the data. The increase in buprenorphine dispensing to adolescents aged 10 to 19 can likely be attributed to several factors. First, there has been successful outreach to pediatricians, who are becoming more comfortable prescribing MAT for young patients. Additionally, the rise of telehealth services has played a crucial role in increasing access to treatment. Telehealth has enabled healthcare providers to offer MAT to patients remotely, removing the need for in-person visits. This has been especially beneficial during the COVID-19 pandemic and has helped to address some of the logistical barriers that young people may face when trying to access care.
Another significant change that may have contributed to the increase in buprenorphine dispensing is the elimination of the waiver requirement for prescribing MAT. This policy change has allowed more healthcare providers, including pediatricians and primary care physicians, to prescribe buprenorphine without the need for additional certification. This has made it easier for young people to access treatment from a wider variety of providers, including those who may not specialize in addiction treatment.
However, despite these positive changes, the overall volume of buprenorphine prescribing remains low, particularly for young adults aged 20 to 24. This demographic is often the hardest hit by opioid use disorder, and the fact that they are not receiving adequate treatment is concerning.
The Role of Telehealth in Expanding Access to Opioid Use Disorder Treatment for Young People
Telehealth has proven to be a game-changer in expanding access to MAT. During the COVID-19 pandemic, the U.S. Drug Enforcement Administration (DEA) introduced telehealth prescribing flexibilities, allowing controlled substances like buprenorphine to be prescribed without an in-person visit. This flexibility has made it easier for young people to access treatment, particularly in rural areas or for those facing mobility challenges.
The ability to receive care remotely has been hailed as a significant step in increasing access to MAT, especially for young people who may feel more comfortable receiving care in a virtual setting. Moreover, telehealth can help mitigate some of the stigma associated with opioid use disorder, as patients are able to receive care from the privacy of their own homes. In recognition of the success of telehealth prescribing during the pandemic, the DEA extended these flexibilities through 2025, offering hope for continued expanded access to MAT.
However, the future of telehealth prescribing remains uncertain. Although telehealth has expanded access to buprenorphine and other MAT medications, the long-term sustainability of these policies remains unclear. Advocates are calling for the permanent legalization of telehealth prescribing for opioid use disorder treatment for young people, especially those who may be less likely to access care through traditional in-person visits.
The Need for Comprehensive Solutions to Opioid Use Disorder Treatment for Young People
The decline in buprenorphine dispensing to young people is a complex issue that requires a multifaceted solution. While there are positive developments, including increased awareness and the growth of telehealth services, many young people continue to face significant barriers to accessing MAT. To address this issue, several steps need to be taken:
- Increase Awareness and Education: There needs to be a concerted effort to educate clinicians about the benefits of prescribing buprenorphine to young people and the importance of treating opioid use disorder early. Special training and outreach programs should be developed to ensure that healthcare providers feel equipped to manage addiction in adolescents and young adults.
- Expand Access to Treatment Facilities: More specialized treatment centers that cater specifically to the needs of young people should be established. These facilities should focus not only on opioid addiction but also on the mental health, social, and environmental factors that contribute to substance use disorders in youth.
- Support Telehealth Services: The expansion of telehealth services has been instrumental in increasing access to MAT, and efforts should be made to ensure these services are available long term. Policies should be put in place to guarantee that telehealth prescriptions for MAT remain a permanent option for opioid use disorder treatment for young people.
- Address Stigma: Reducing the stigma associated with opioid use disorder is crucial in encouraging young people to seek help. Public education campaigns should aim to normalize the conversation around addiction and emphasize that it is a medical condition that requires treatment.
Conclusion
The decline in buprenorphine dispensing to young people is a concerning trend, especially when considering the growing number of adolescents and young adults struggling with opioid use disorder. While some positive steps have been taken to increase access to MAT, much more work needs to be done to address the barriers preventing young people from receiving the care they need. By improving awareness, expanding treatment options, and leveraging the benefits of telehealth, we can help ensure that more young people have access to the life-saving opioid use disorder treatment they deserve.
