Teens seeking addiction care unlikely to be offered standard medication

Adolescents who seek treatment for opioid addiction at an inpatient facility are more likely to be offered horseback riding than given full access to a common, highly effective addiction medication.

According to a new research paper, just one out of every eight residential treatment facilities open to patients ages 16 or 17 offers full access to buprenorphine. By contrast, nearly two-thirds of adult treatment facilities offer the medication.

The new research, published Tuesday in the Journal of the American Medical Association, comes as U.S. opioid overdose deaths hover at all-time highs. Overdose deaths among adolescents more than doubled between 2019 and 2021.

The findings are particularly ominous because if adolescents can’t access buprenorphine at residential treatment centers, they’re unlikely to access it elsewhere, said Caroline King, a physician-researcher who conducted the research while studying for her medical degree at Oregon Health and Science University.

“You expect that the sickest kids, the kids with the least access, are going to be the kids in these residential treatment centers,” she said. “And if they can’t access bupe there, it might be a red flag that they also really can’t access it in communities and outpatient providers. We’re not going to be able to treat kids who are using fentanyl if they don’t have access to buprenorphine.”

Broadly speaking, few Americans have convenient access to medications used to treat opioid addiction. Buprenorphine is one of just two drugs approved by the Food and Drug Administration to treat opioid cravings and withdrawal. The other, methadone, is available only via specialized clinics whose patient restrictions often make the medication effectively impossible to access.

In recent years, some advocates have called for a significant deregulation of methadone — namely, allowing doctors to prescribe it directly to patients, and allowing pharmacists to dispense it.

Separately, lawmakers last year eliminated a longstanding requirement that doctors undergo a mandatory eight-hour training and receive a special license just to prescribe buprenorphine (the “X-waiver”). Amid the Covid-19 pandemic, the federal government also made it easier for patients to receive buprenorphine via telemedicine.

Though the changes were largely well-received, some detractors expressed fear that increased access to methadone and buprenorphine — which are opioids themselves — could have unintended consequences, namely an increase in overdoses involving the medications.

A new research paper published in January, however, showed that the proportion of overdose deaths involving buprenorphine did not increase despite the increased access.

While medication access is a crisis across age groups, the new paper’s findings show it to be particularly acute among 16- and 17-year-olds.

“It is tragic to see that young people with opioid use disorder are unable to access buprenorphine in most treatment facilities, despite this medication being the standard of care for people aged 16 and older” Nora Volkow, the director of the National Institute on Drug Abuse, said in a statement. “Residential treatment facilities provide an opportunity to reach young people with a range of evidence-based supports at a pivotal time in their lives, and it is crucial that buprenorphine is made available as one of those options.”

The study employed a “secret shopper” approach, in which researchers called residential treatment facilities and asked whether buprenorphine was offered as a treatment.

Just 24.4% of facilities contacted by researchers offered buprenorphine even in limited contexts, according to the paper. Some offered to initiate adolescents on buprenorphine but discontinue treatment prior to discharge, while a select few allowed people already on the medication to keep taking it — but wouldn’t provide new buprenorphine prescriptions.

Just 10.6% offered buprenorphine initiation and continued treatment.

By contrast, 25% of all facilities surveyed offered equine therapy, a form of treatment that relies on horseback riding or other horse-related activities and is not supported by evidence. More than one-third offered access to 12-step programs like Narcotics Anonymous, a group known to oppose the use of addiction medications.

“Facilities were really all over the board,” King said. “Really, it was the lack of standardization, and programs [being] all over the place, that surprised us the most.”

STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.