New research from Mass General Brigham reveals that adolescents and young adults in Massachusetts who maintained consistent use of buprenorphine for at least a year experienced significantly lower risks of opioid overdose and hospitalization. This study, published in Pediatrics, underscores the potential life-saving benefits of prolonged treatment amid the ongoing fentanyl crisis.
Among the 11,600 youth who began buprenorphine treatment, only 25% adhered to the regimen for a full year. Those who did had nearly half the risk of overdose and fewer emergency department visits compared to peers who discontinued early. The findings are particularly pertinent as youth overdose death rates have climbed to record highs, largely driven by fentanyl.
Study Highlights the Importance of Adherence
The study analyzed data from 11,649 individuals aged 13-26 who started buprenorphine treatment in Massachusetts between 2014 and 2020. Utilizing the Massachusetts Public Health Data Warehouse, researchers identified four patterns of medication adherence: high adherence for 12 months (24%), low adherence for 12 months (28%), discontinuation after 3-9 months (16%), and discontinuation in under 3 months (33%).
“Our findings suggest that maintaining high adherence for at least a year substantially reduces overdose risk. It’s a clear message to clinicians, families, and youth that longer treatment saves lives,” said Dr. Scott Hadland, the study’s lead author.
Compared to those with high adherence, youth who stopped within 3-9 months had an 82% higher risk of overdose, while those who discontinued in under 3 months had a 76% higher risk. Even those who were on medication for a year but with low adherence faced a 46% higher risk.
Broader Implications for Youth Treatment
Buprenorphine is the sole medication approved for opioid use disorder in adolescents under 18. Despite this, many families choose to discontinue treatment prematurely once improvements are observed. The research indicates that consistent, year-long use of buprenorphine offers the greatest protection against overdose and other severe outcomes.
“Opioid use disorder is a condition that can come and go over the course of several years,” noted Hadland. “Staying on treatment longer—even when things feel better—may prevent relapse and save a young person’s life.”
The study highlights the necessity of supporting youth in adhering to treatment, suggesting options like long-acting injectable buprenorphine and enhanced support for those with co-occurring mental health issues or housing instability.
Call to Action for Health Systems
The research advocates for clinicians, insurers, and health systems to facilitate longer treatment durations. “Amid the fentanyl era, short-term treatment is simply not enough,” Hadland emphasized. “This is a key step toward reducing youth overdose deaths.”
The study, funded by the National Institute on Drug Abuse, included contributions from researchers at Boston Medical Center, the Massachusetts Department of Public Health, and the University of Pittsburgh. The authors call for a concerted effort to ensure that young patients remain on medication for at least a year to combat the rising tide of opioid-related fatalities.
Next Steps and Future Research
As the opioid crisis continues to evolve, further research is needed to explore additional strategies for improving treatment adherence among youth. The integration of comprehensive support systems and innovative treatment options could play a crucial role in addressing this public health challenge.
For now, the message is clear: consistent medication adherence can save lives, and it is imperative for healthcare providers and policymakers to prioritize long-term treatment plans for young individuals battling opioid use disorder.
