5 OCT 2026 — Young Americans with opioid addiction rarely stay on the medicines that treat it. A study of nearly 230,000 Medicaid-insured Americans aged 13 to 25 with opioid use disorder, published on 1 October in JAMA Network Open, found that only 3.1% stayed on medication for six months. That is about one in 32.
A second study in the same issue, of mothers with opioid use disorder in Tennessee, suggests what that gap costs: the longer women received medication around childbirth, the lower their risk of overdose or death over the following year.
Where young patients drop out
The youth study, led by Scott Hadland of Mass General Brigham for Children, used Medicaid claims from every US state and Washington, DC, from 2016 to 2023. It followed patients through the stages that national quality measures track, from diagnosis to sustained medication.
Of 229,847 young people diagnosed, 50.7% started treatment within 14 days. Only 32.9% stayed engaged, defined as at least two more treatment visits within 34 days of starting. Among those who engaged, 46.3% received one of the three approved medications, buprenorphine, methadone or extended-release naltrexone. That is 15.2% of everyone diagnosed.
Just 7,070 of the 229,847 were still on medication after 180 days.
The gap for under-18s
The steepest drop was among the youngest patients. Among those who engaged in treatment, 554 of 8,352 under-18s received medication, or 6.6%. For those 18 and over, the figure was 51.2%. Patients aged 13 to 15 and young people from racial minority groups consistently moved through the stages at lower rates, the paper's abstract says.
The paper reports these as gaps in the care patients received. Its abstract does not establish why under-18s were treated so differently, whether because of prescribing rules for minors, clinicians' reluctance, families' choices or something else.
Which medicines kept people on treatment
Buprenorphine was the most common starting medication, at 68.5% of those who received one, followed by methadone at 25.5% and extended-release naltrexone at 6.0%. Methadone kept the most patients. Of those who started it, 26.2% were still taking it at 180 days, compared with 19.2% for buprenorphine and 5.8% for naltrexone.
Median time on medication was 59 days for methadone, 45 for buprenorphine and 31 for naltrexone.
Why the duration matters
The second paper, from researchers at Vanderbilt University and Emory University, followed 9,360 pregnancies among 7,776 Tennessee Medicaid patients aged 15 to 44 who received at least one day of medication in the window from 90 days before delivery to 41 days after it. Births ran from 2007 to 2020.
In the year after delivery, 1.58% died or had an overdose. Those who received medication for all 132 days of the window had about half the risk of those who received a single day, an adjusted hazard ratio of 0.52. The authors conclude that the findings support "continuous MOUD treatment", using the abbreviation for medications for opioid use disorder.
The two studies cover different patients, and the Tennessee result cannot say what would happen to teenagers kept on treatment longer. Both are observational, so they show associations rather than proving that medication caused the difference.
What the studies cannot show
Insurance claims record what was billed and dispensed, not whether a patient took the medicine or why they stopped. The youth data end in 2023, so they miss anything since. Both studies cover Medicaid patients only, and the Tennessee study covers one state.
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