Only 1 in 32 Young People With Opioid Addiction Is Still on Medication Six Months Later. The Treatment Didn't Fail Them.

Count out thirty-two young people. Every one of them is between 13 and 25, every one has a Medicaid card, and every one has an opioid use disorder diagnosis in their chart. Walk them through the clinic door. About sixteen see a clinician within two weeks. About ten are still showing up the month after. Roughly five walk out with a prescription for buprenorphine, methadone or extended-release naltrexone. One is still taking it six months later.

That is not a thought experiment. It is the arithmetic of 229,847 real young people tracked through Medicaid claims from 2016 to 2023, published October 2 in JAMA Network Open by Scott Hadland and colleagues. Of those young people, 50.7% started treatment within 14 days of diagnosis, 32.9% stayed engaged, and 3.1% were still on medication at day 180.

Those 31 did not fail treatment. The treatment was barely offered, and then it was made hard to keep.

The medicine works. We keep making it hard to get.

The gap between “diagnosed” and “medicated” is the first place the staircase breaks. The study’s own breakdown shows about one in six young people who got into care received any medication for opioid use disorder at all (the paper and the Mass General Brigham summary differ by about a point on the exact share, so treat it as roughly 15 to 16.5%). Buprenorphine made up 68.5% of those prescriptions, methadone 25.5%, extended-release naltrexone 6%. Nobody reading that table can say the field doesn’t know what to prescribe. The problem is who is allowed to receive it.

Age is the sharpest dividing line. Among adolescents under 18, only 6.6% received medication, compared with 51.2% of young adults 18 and over. Methadone, the medicine with the longest track record for keeping people in care, was close to nonexistent for minors: fewer than ten minors received it across the entire seven-year study period, a number so small the researchers had to suppress it to protect privacy. Until 2024, federal rules required a minor to have two documented “failed” attempts at recovery without medication before a clinic could dispense methadone. Read that again in plain language: a 16-year-old had to fall down twice, on paper, before the safety net was legally allowed to open. Even with that rule gone, STAT reports, many specialty methadone clinics still refuse to take patients under 18, and few adolescent residential programs offer buprenorphine.

You may have lived the human version of this table. If you were 17 and asked for help and heard “come back when you’re 18,” you did not imagine that, and you were not unlucky. You were the 6.6%.

Sivabalaji Kaliamurthy, a child and adolescent psychiatrist who treats addiction, told STAT the cutoff is real and it is abrupt: “Once you turn 18, a whole bigger field of people are open to helping you.” Hadland’s own summary of the national picture cuts both ways: “There have been some real positive changes, and then there have been some really catastrophic changes.” The positive changes are small. The catastrophic ones are the 96.9% who are off medication by the six-month mark.

We have measured this before and filed it

Nothing about this finding is new, and that is the part that should make you angry. In 2016 the American Academy of Pediatrics told doctors to offer these medications to adolescents and young adults who need them. Hadland’s own 2018 JAMA Pediatrics paper, covering 2.49 million Medicaid-enrolled youths across 11 states, had already found that only 1 in 4 young people with an opioid use disorder got a medication, and only 1 in 21 adolescents. In that same data, the young people who did get medication stayed in care far longer: a median of 123 days on buprenorphine and 324 days on methadone, against 67 days for counseling alone.

In 2016 the American Academy of Pediatrics told doctors to offer these medications to adolescents and young adults who need them.

So the field spent ten years knowing three things: the medicine keeps young people in treatment longer, the youngest patients are the least likely to get it, and the rules and clinics standing between them and the prescription were fixable. In 2026 the under-18 receipt rate is 6.6%, about 1 in 15. Against the 2018 figure that is a move from roughly 1 in 21 to roughly 1 in 15, which is the speed at which a glacier files paperwork. (The two studies use different samples, 11 states and ages 13 to 22 then, all 50 states and ages 13 to 25 now, so it is a direction, not a clean before-and-after.) We have watched this movie with adults too: STAT reported in March 2024 on how rigid rules at methadone clinics were jeopardizing patients’ path to recovery, and the federal rewrite that followed came a generation after the evidence. Young people are living through the same lag with the added handicap that most cannot sign their own consent forms.

The new paper does carry limits a clinician already knows, and they are worth naming. It runs on Medicaid billing claims, so it sees a refill or it doesn’t, and it cannot tell you why a young person stopped. Some stopped because they were finished and well. Some stopped because the pharmacy was 40 minutes away. Some stopped because a parent, a judge or a sober-house director told them medication “doesn’t count.” The authors note the requirement of six months of continuous enrollment may skew the sample toward young people with more stable coverage, which means the real 180-day number for kids who lose insurance or housing is plausibly lower, not higher. The data end in 2023, so they predate the 2024 methadone rule change. Uninsured and commercially insured young people are not in the picture at all.

Which medicine, and who is still in the room at day 180

Look at what the staying numbers say about each medication. Among young people who started, 180-day retention was 26.2% on methadone, 19.2% on buprenorphine, and 5.8% on extended-release naltrexone, with median time in treatment of 59 days for methadone and 45 for buprenorphine. “Retention” here means still collecting the medicine, not “still sober” or “still alive.” It is a proxy, but a hard one: people who stay on these two drugs die less often than people who leave them. An umbrella review of 16 systematic reviews covering 371 trials, published in CNS Drugs in August, found buprenorphine’s six-month retention about 24% lower than methadone’s across 16 trials, and the youth data point the same direction at the same size of gap.

That doesn’t make methadone the answer for a 15-year-old, and no one in this story should be told to pick a drug by league table. Buprenorphine can be started in a regular doctor’s office, it has a milder overdose profile, and for a teenager, being prescribed the medicine that actually shows up in the pharmacy beats being denied the medicine that scored higher. What the numbers do say is that getting the delivery right matters more than the brand name. In one of the few trials in youth, letting patients take home two or three doses a week produced 43.2% opioid-negative urine screens, against 8.6% when patients had to come to the clinic daily. That is a five-fold difference from changing a scheduling rule, not a molecule.

The cost of stopping early is not abstract either. A Pediatrics study, reported by HealthDay in November 2025, found young people aged 13 to 26 who left buprenorphine within three to nine months had an 82% higher risk of overdose than those who stayed a year, and those who left in under three months had a 76% higher risk. The study’s authors are not named in that coverage, so treat the exact percentages as reported rather than independently checked. The direction is not in dispute: the first months after stopping are the most dangerous ones, because a body that has lost its tolerance meets the old dose.

The direction is not in dispute: the first months after stopping are the most dangerous ones, because a body that has lost its tolerance meets the old dose.

The staircase is steeper for Black young people, and for the youngest

Among all those who got medication, the retention gap by race is the second place the system shows its hand. Non-Hispanic white youth reached 4.0% retention at 180 days; non-Hispanic Black youth reached 1.2%. The authors report that younger adolescents and racially minoritized young people showed lower progression through nearly every stage of care. Hadland told Mass General Brigham that untreated opioid use disorder in young people has both immediate and lifelong consequences, and he describes the gaps as “keeping this population vulnerable to premature death and poor health outcomes.” One reason the paper is more credible than most is the way it was built: the team says it worked with an advisory board of young people with lived experience of opioid use disorder, so the question “what does staying actually take?” came from the people living it.

Sarah Bagley, an internist and pediatrician at Boston Medical Center who treats adolescents with addiction, gave STAT the sentence that explains why a prescription pad alone won’t fix any of this: “It doesn’t matter how good the treatment we have actually is if we haven’t created a clinical environment that is appealing, safe, compassionate, and nonjudgmental.” Treat that as an operating requirement. A young person who got judged at the front desk in week one does not come back in week six, and a Black teenager who has already been treated as a suspect at school has fewer reasons to assume the clinic will be different.

What a program can change by Friday

Here is what to do this week if you run or work in a program that sees young people. Pull your own numbers for the four steps in this study: how many young patients got a visit within 14 days, how many came back within a month, how many were offered medication, how many were still refilling at 180 days. Take the four-number chart to your next team meeting and ask which step loses the most people. If your clinic cannot dispense methadone to someone under 18, write down, by name and phone number, the programs that can and the date you last confirmed it, so a referral is a warm handoff and not a shrug. If your appointment rule requires daily or twice-weekly in-person visits for someone stable, ask your prescriber whether two or three take-home doses a week fit within your state’s rules, because the one adolescent trial in this field suggests that rule alone moves retention. And build a bridge for the 18th birthday: that is the cliff Kaliamurthy describes, and it is a scheduling problem you can solve with a calendar and a named adult clinic.

If you are the young person in this story, or the parent holding a phone at 2 a.m. checking pharmacy hours, here is what is still yours. Starting medication is not a one-shot decision. Programs restart it routinely after a gap, and a gap is part of the pattern in this data, not a verdict on you. Naloxone can be handed to you without a prescription in many places, and the SAMHSA National Helpline, 1-800-662-4357, is free, confidential and answers around the clock. If you have been told, at any point, that taking medication means you aren’t really in recovery, that sentence has no data behind it. The 31 who left the study did not run out of willpower. They ran out of clinic.

For more on what staying in treatment looks like from the inside, read Relapse After Two Years Sober. For the wider picture, see our treatment and recovery coverage and our opioids pillar.

Thirty-two kids went through the door. The one who is still taking the medicine six months on is not the strong one, or the motivated one, or the lucky one. That one just never hit a wall. The job of the next ten years is to take the walls down for the other thirty-one.

The job of the next ten years is to take the walls down for the other thirty-one.