New research from Mass General Brigham reveals that adolescents and young adults in Massachusetts who consistently used the medication buprenorphine for at least a year experienced significantly lower risks of opioid overdose and hospitalization. This study, published in Pediatrics, is particularly relevant as youth overdose death rates have surged to unprecedented levels, largely driven by the potent synthetic opioid, fentanyl.
The study analyzed data from 11,649 individuals aged 13 to 26 who began buprenorphine treatment between 2014 and 2020. It found that only 25% maintained high adherence to the medication for a full year. Those who did had nearly half the risk of overdose and fewer emergency department visits compared to those who discontinued treatment early.
Key Findings and Implications
According to the study, youth who discontinued buprenorphine within three to nine months faced an 82% higher risk of opioid overdose. Those who stopped within three months had a 76% higher risk, while youth with low adherence over 12 months had a 46% higher risk. These findings underscore the importance of sustained and consistent treatment.
“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, chief of Adolescent and Young Adult Medicine at Mass General Brigham for Children.
Buprenorphine is currently the only medication approved for treating opioid use disorder in adolescents under 18. However, many families opt to discontinue treatment prematurely once initial improvements are observed. The study highlights that consistent, year-long use of the medication likely offers the greatest protection against overdose and other serious outcomes.
Challenges and Recommendations
Dr. Hadland emphasized the chronic nature of opioid use disorder, which can fluctuate over several years. “Staying on treatment longer—even when things feel better—may prevent relapse and save a young person’s life,” he noted. The study advocates for enhanced support mechanisms to help youth adhere to long-term treatment plans, including long-acting injectable buprenorphine and additional support for those with co-occurring mental health issues or housing instability.
“Amid the fentanyl era, short-term treatment is simply not enough. Clinicians, insurers, and health systems should do everything possible to help young people continue medication for at least a year or longer,” Hadland urged.
Research and Funding Details
The research was conducted using the Massachusetts Public Health Data Warehouse, a comprehensive dataset linking medical, pharmacy, and mortality records. The study was funded by the National Institute on Drug Abuse, with contributions from researchers at Boston Medical Center, the Massachusetts Department of Public Health, and the University of Pittsburgh.
In addition to Dr. Hadland, the research team included Simeon D. Kimmel, Shapei Yan, Amy L. Bettano, Wei-Hsuan Lo-Ciganic, Sarah M. Bagley, Jessica B. Calihan, Heather E. Hsu, and Marc R. Larochelle. Disclosures noted that Dr. Hadland serves on the editorial board of Pediatrics, and Dr. Lo-Ciganic has received grants and consulting fees from pharmaceutical companies unrelated to this study.
Looking Forward
The findings of this study provide a compelling case for policy changes and clinical practices aimed at extending the duration of buprenorphine treatment for youth. As the opioid crisis continues to evolve, particularly with the rise of fentanyl, ensuring that young individuals have access to and maintain consistent treatment could play a crucial role in reducing overdose deaths and improving long-term health outcomes.
As the healthcare community grapples with the complexities of opioid addiction among youth, this research offers a pathway forward, highlighting the critical importance of sustained medication adherence in saving lives.
