New study: Kids who need treatment for opioid use disorder rarely get it

A new nationwide study published in Health Affairs finds that adolescents aged 12 to 17 struggle to access and remain engaged in treatment, often because they are not offered youth-tailored treatment and gold-standard opioid use disorder medications.

by Brian Nam-Sonenstein

Opioid use disorder among young people is a serious but often overlooked issue in the United States. In a national 2023 survey, 1.3% of kids between the ages of 12 and 17 reported an opioid use disorder. While 1.3% might not sound like a lot, it represents around 342,000 children — more than the total population of Newark, New Jersey. The U.S. public health system’s capacity to provide the best treatment programs and medications to these kids has life-altering consequences, influencing children’s health and development.

Unfortunately, such youth treatment opportunities are rare. A new study, published in the September 2025 issue of Health Affairs, shows that fewer than 1 in 3 kids with an opioid use disorder receive critical medications and age appropriate care. These findings have serious implications for youth contact with the criminal and juvenile legal systems, as drug use and treatment access are significant predictors of involvement in both. For the youngest kids already involved in the juvenile legal system, substance misuse is a strong predictor of violent reoffending. But rather than prioritize the delivery of the best available treatments to all children who need them, communities around the U.S. have instead stigmatized kids who use drugs, including through the use of “zero tolerance” school policies. This has created a terrible situation in which kids are routinely denied the care they need. Instead, they face educational and social exclusion on the same premise that has failed countless adults struggling with substance use disorders: that they can only be forced to “get better” through stigma, incarceration, or both.

In this briefing, we dive into this new research on the scarcity of treatment for young people with opioid use disorders, based on the most recently available national data. We also look at critical early intervention opportunities highlighted in the research, which can improve treatment access and the quality of care, and divert kids from the school-to-prison pipeline along the way.

Youth lack access to opioid use disorder treatments

Most people who develop a substance use disorder begin using drugs before the age of 18, with the highest risk among those who begin using during their early teenage years. At this stage of life, drug use can influence brain development, so it’s extraordinarily important to connect kids to early, effective treatment during this time.

But the U.S. is not rising to meet this challenge. The researchers who conducted the new study found that less than one-third (31%) of kids aged 12 to 17 with an opioid use disorder received any treatment in the past year — a similar but slightly smaller proportion than that of adults (34%). These low levels of treatment uptake are alarming given how heavily drug use is criminalized, since treatment options are even scarcer and less effective in the juvenile legal system: only around 26% of kids confined for drug offenses were held in residential treatment centers in 2023. Kids should not be removed from their communities and forced into drug treatment, and while this figure is not limited to opioid-related drug cases, it’s nonetheless notable that just over 1 in 4 kids confined for drug offenses are placed in treatment facilities.

This is especially problematic for two reasons: first, treatment is far less effective (and less ethical) in carceral environments, and second, the juvenile legal system is a relatively late-stage gateway for accessing treatment. Earlier interventions in the community (such as in schools) can ensure greater access among youth, and prevent their exposure to the cascading negative effects of criminalization. Community-based interventions are also more effective and consistent, which is important because adolescents have lower treatment retention rates than adults. Because youth struggle to remain engaged in treatment, the earlier they start with the best existing treatment protocols, the better.

The new study also finds that fewer than 1 in 4 (around 23%) treatment facilities reported offering a specifically adolescent-tailored group or program. In other words, a small proportion of treatment facilities serving kids actually design their offerings to meet adolescents’ specific developmental and psychosocial needs. The availability of facilities with adolescent-tailored programs varies considerably by region; generally speaking, there are fewer of these tailored facilities in the southeastern U.S.

Treatment settings. The researchers identified outpatient settings (excluding schools or medical offices) as the most common treatment settings for kids, followed by school health or counseling centers and emergency departments or hospitals. They note that schools (the second-most frequently reported setting for treatment) are particularly critical intervention points for engaging adolescents in screening and treatment because they are the only place that all children are required to attend. Schools present an opportunity to reach the most children from the widest variety of backgrounds, and can yield better access to care and treatment engagement for female, African American, and Hispanic/Latinx adolescents. Engaging kids in school with treatment rather than exclusion would represent a meaningful shift away from the school-to-prison pipeline.

Referrals. Schools had some of the lowest rates of referral (4%) despite their outsized potential for linking kids to treatment. Instead, aside from self-referrals or referrals from friends and families, the criminal legal system was the most common source of referral for adolescent opioid related treatment admissions (nearly 28%) — more so than for adult treatment admissions (17%). This is particularly troubling given that kids are often ushered into the juvenile legal system under the false hope that they can “receive services” while locked up. These settings are exceptionally abusive toward kids and costly to society, but more to the point, they also foster conditions that are counterproductive to actually providing effective treatment.

When kids don’t get the care that they need, they’re at risk of being punished for it through the juvenile legal system. But not all kids fall through the cracks at the same rates; youth drug use and treatment are compounded by race, ethnicity, and socioeconomic status. A separate study found that only around 3% of Black children aged 12 to 17 received medical treatment for substance use disorder in the past year, compared to around 9% of white kids. These disparities follow kids into the juvenile legal system. Even though white youth and youth of color have similar rates of drug use, Black children make up a significantly higher proportion of confined youth for drug offenses compared to their proportion of the overall population: 24% of kids confined for drug offenses were Black, despite making up only 14% of the population.

Medications for opioid use disorder are often out of reach for young people

One reason kids struggle to remain engaged in treatment may be that medications for opioid use disorder are rarely provided to them despite the recommendations of the American Academy of Pediatrics and Society for Adolescent Health and Medicine, which call for greater access to these medications for young people.

In the new study, the researchers found that the rate of receiving medications for opioid use disorder among those who need it was nearly 8% for adolescents in the past year, compared to 19% in adults in the past year. Such medications were listed in treatment plans for less than 10% of adolescent treatment admissions, compared to a much higher proportion of adult admissions (36%). While the researchers found that these medications have been included in a growing proportion of adolescent-tailored treatment plans over the years, they remain too limited compared to the level of need.

The scarcity of these gold-standard treatments is possibly explained by several factors, including stigma among healthcare providers and family concerns. In carceral settings, medications for opioid use disorder are often seen by skeptical non-medical staff as “substituting one drug for another.” But they nonetheless can and should be made more widely available. Buprenorphine has been approved by the Food and Drug Administration for use by youth aged 16 or older, and it’s also been prescribed off-label for younger adolescents. These medications do more than just treat substance use disorders; they save lives. Between 2018 and 2023, rates of opioid-related deaths among U.S. children aged 12 to 17 grew an astounding 280%. To put this into perspective, overdose deaths rose by a comparatively smaller (but no less troubling) 65% in adults aged 18 and over during the same time period.

Conclusion

Effective medications and treatments exist for kids with opioid use disorder, but they are not being provided at scale, nor equitably. There are better, earlier intervention points like schools for reaching the most kids with these treatments, but these same institutions instead cave to stigma and funnel kids into the juvenile punishment system. The end result of these failures is that young people who use drugs are being needlessly set up to suffer and die, and the U.S. is dooming itself to a future in which there are many more adults and communities left to struggle with these same issues.

The best approaches are ones that can connect particularly vulnerable youth populations to direct them into treatment via gateways like schools. This involves community-based treatment, proactive outreach by people who know the local community and culture, and the development of treatment programs tailored to the needs of the participants. Kids should not be removed from their community for treatment (or to be punished). But for youth already involved in the juvenile legal system, courts and probation departments should at the very least ensure young kids who use drugs are offered the most effective substance use treatments.

This new research points toward several opportunities to change course by strengthening community-based adolescent opioid use disorder screening and treatment engagement efforts, pursuing evidenced-based treatment options including gold-standard medications, and tackling geographic disparities in access to treatments tailored for youth. What’s needed is an embrace of these public health measures for the good of all children, and an end to their exclusion, stigmatization, and criminalization.

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For more information, including detailed footnotes, see the full version of this briefing on our website.