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

A new study reveals a critical gap in care for adolescents struggling with opioid use disorder. Published in the September 2025 issue of Health Affairs, the research highlights that young people often do not receive the specialized treatment and medications proven effective for this condition. This lack of access has significant consequences, potentially increasing involvement with the juvenile legal system and hindering long-term health and development.

The Scope of the Problem

According to a 2023 national survey, an estimated 1.3% of adolescents aged 12 to 17—around 342,000 children—reported an opioid use disorder. This number exceeds the total population of Newark, New Jersey. The study in Health Affairs found that fewer than one in three of these young people receive the medications and age-appropriate care they need.

Did You Know? Most people who develop a substance use disorder begin using drugs before the age of 18, with the highest risk during early adolescence.

The Link to the Juvenile Legal System

The research underscores a troubling connection between untreated opioid use disorder and involvement with the juvenile legal system. Drug use and access to treatment are significant predictors of contact with both systems. For young people already involved in the legal system, substance misuse is a strong predictor of violent reoffending. Communities have often responded to youth drug use with stigmatization and “zero tolerance” policies, denying necessary care and instead relying on approaches that have proven ineffective for adults.

Barriers to Effective Treatment

One key finding is the limited availability of treatment programs specifically tailored to adolescents. Fewer than one in four treatment facilities (around 23%) offer groups or programs designed to meet the unique developmental and psychosocial needs of this age group. This disparity is particularly pronounced in the southeastern United States.

Outpatient settings are the most common treatment location for kids, followed by school health centers and emergency departments. Schools, where all children are required to attend, are seen as critical intervention points for screening and treatment. Schools could potentially improve access to care for female, African American, and Hispanic/Latinx adolescents.

Expert Insight: The reliance on punitive measures like “zero tolerance” policies, rather than evidence-based treatment, represents a missed opportunity to intervene early and prevent long-term negative consequences for young people struggling with opioid use disorder.

Disparities in Access to Medication

The study also revealed significant disparities in access to medications for opioid use disorder. Only about 8% of adolescents who need these medications receive them, compared to 19% of adults. These medications were included in treatment plans for less than 10% of adolescent admissions, compared to 36% of adult admissions. While the use of these medications in adolescent treatment plans is increasing, it remains far below the level of need.

Racial Disparities in Treatment

Access to treatment is not equitable across all racial groups. 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 children. Despite similar rates of drug use among white youth and youth of color, Black children comprise a disproportionately high percentage (24%) of youth confined for drug offenses, representing 14% of the overall population.

Looking Ahead

If current trends continue, it is likely that more adolescents will fall through the cracks and face the negative consequences of untreated opioid use disorder, including increased involvement with the juvenile legal system and long-term health problems. Strengthening community-based screening and treatment efforts, pursuing evidence-based treatment options, and addressing geographic disparities in access to care could improve outcomes. A shift towards prioritizing public health measures and ending the stigmatization and criminalization of young people who use drugs may be necessary to address this growing problem.

Frequently Asked Questions

What percentage of adolescents reported an opioid use disorder in a 2023 national survey?

1.3% of adolescents aged 12 to 17 reported an opioid use disorder, representing around 342,000 children.

What proportion of treatment facilities offer programs specifically tailored for adolescents?

Fewer than one in four (around 23%) treatment facilities reported offering a specifically adolescent-tailored group or program.

What is the rate of receiving medications for opioid use disorder among adolescents who need it?

The rate of receiving medications for opioid use disorder among adolescents who need it was nearly 8% in the past year, compared to 19% in adults.

How can communities better support adolescents struggling with opioid use disorder?