Half of Young People With Opioid Addiction Make It Through the Door. One in 32 Is Still on Medication Six Months Later.

“I have had patients die as recently as this past month here in Massachusetts, from overdose,” Scott Hadland, chief of adolescent and young adult medicine at Mass General Brigham for Children, told STAT’s Theresa Gaffney the day his newest paper came out. He wasn’t saying it for effect. He was explaining why the last number in the paper is the one that counts.

That number is 3.1%. Hadland and colleagues, writing in JAMA Network Open on October 2, followed 229,847 Medicaid-enrolled people ages 13 to 25 who were diagnosed with opioid use disorder between 2016 and 2023. One in 32 of them was still taking medication (buprenorphine, methadone or extended-release naltrexone) 180 days later.

The win is not the first appointment. The win is month six, and this country is almost never getting young people there.

The funnel loses people at every step, and the steps are small

Think of care as a series of doors. According to Mass General Brigham’s summary of the paper, 50.7% of the young people started treatment within 14 days of their diagnosis. Only 32.9% “engaged,” which here means they came back for at least two more sessions in the following 34 days. Of those who engaged, 46.3% started medication. Do the arithmetic and that is roughly one in six of the whole group on medication at all, which is the figure STAT led with. Then the floor drops out: 3.1% were still on it at 180 days.

If you are 19 and walked into a clinic once because someone finally made you, and never went back, you are not the exception in this paper. You are the rule. The data can’t tell you what happened at your second appointment. It can tell you that the appointment is where most people disappear.

The losses weren’t spread evenly. The authors report that younger adolescents and racially minoritized youths progressed through each stage at lower rates. The study was funded by the National Institutes of Health.

Methadone is a rounding error, and the law used to guarantee it

Fewer than 10 minors received methadone across the entire study period, STAT reported. Until late 2024, federal rules required minors to document two failed attempts at recovery without medication before starting it. In other words, the rule asked a 16-year-old to relapse twice, on paper, before the medicine that works was allowed in the room. That rule is gone. The study window ends in 2023, so it can’t show whether its repeal changed anything, and even now a federal change doesn’t decide what your state, your local opioid treatment program or your clinic’s consent policy will actually allow.

Better access, same drop-off

This isn’t Hadland’s first look at the problem. His 2018 JAMA Pediatrics paper, built on Medicaid claims from 2014 and 2015, found that just 24% of youths got an approved medication within three months of diagnosis, and only 4.7% of those under 18. In that earlier group, young people who got buprenorphine stayed in care a median of 123 days and those who got methadone a median of 324, against 67 days for people who received only counseling and other behavioral services.

Two caveats a clinician will already be raising. The age ranges differ (13 to 22 then, 13 to 25 now), and the yardsticks differ (days in care then, days on medication now), so you can’t line the two papers up and call it a trend. And this new analysis is observational claims data: it records what was billed, not why someone stopped. It can’t say the medication caused anyone to stay or that leaving was a failure of will. What it does show is that the opening of the funnel has widened while the far end hasn’t.

Hadland put the mixed picture bluntly to STAT: “There have been some real positive changes, and then there have been some really catastrophic changes.” Sarah Bagley, a pediatrician at Boston Medical Center, named the lever. “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,” she told STAT. “That engagement piece is everything, because without it, nothing.”

“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,” she told STAT.

What to do with it this week

If you run or staff a clinic that treats people under 26, pull the list of every patient 13 to 25 you started on medication in the last six months. Sort it by who missed the second visit. Call them this week, and open with a question instead of a reminder: what would have made that visit worth coming back to? Then put a day-14 and day-30 check-in on the calendar for every new start going forward, and check whether your program can refer a minor for methadone now that the two-failure rule is gone.

And if you are the one who stopped coming: this is still yours. Buprenorphine and methadone didn’t stop working because a visit felt like a lecture. SAMHSA’s National Helpline (1-800-662-4357) is free and answers around the clock, and Rize’s treatment finder can narrow it to programs near you.

Somewhere in those 229,847 records is a 17-year-old who showed up exactly once. The paper can’t tell us what happened in that room. It’s the one thing every clinic in the country controls.