Few young Medicaid patients with opioid use disorder stay on medication for six months

Read the stages in order and the largest proportional loss falls between a second appointment and a first prescription ^[6]. The two-visit group comes to roughly 77,000 young people ^[1]. If "engaged" means that group, roughly one in 18 of the whole cohort got buprenorphine or methadone at all, about 12,800 people ^[2]. About half the cohort was lost before a first visit, and about a third of those who did start dropped out before a second ^[6].

Retention is harder to read. The thing this summary doesn't tell you is which group the one-in-32 figure is drawn from, or the year-by-year numbers behind the possible decline ^[2][7]. The denominator moves the answer a long way. Measured against the same engaged group as the one-in-six figure, about 19 percent of the young people who got medication, roughly one in five, were still on it at six months ^[3]. Measured against the full cohort, the share would be about 56 percent ^[4]. In that second case most young people who started medication stayed on it, and nearly all of the failure would sit upstream ^[4].

The cohort is Medicaid enrollees aged 13 to 25, followed from 2016, the year of the pediatric guidance, through 2023 ^[4][1]. Over the same years, overdose deaths among young people climbed from around 2019 into the early 2020s ^[8]. Poisonings including overdose became the third-leading cause of death for those 19 and under ^[9]. The timing alone cannot credit the 2016 statement with the small rise in starts ^[2]. The figures also describe only young people on public insurance ^[4].

For minors the medication step is narrower still. Federal law requires two documented "failed" attempts at recovery without medication before a minor can start methadone, and many methadone clinics will not accept minors ^[11]. Fewer than 10 minors received methadone across the whole study period, a count the researchers suppressed as "not defined" for privacy ^[10]. Buprenorphine is easier to prescribe, yet few adolescent residential treatment facilities offer it, according to recent research STAT cites ^[12]. "Once you turn 18, a whole bigger field of people are open to helping you," said Sivabalaji Kaliamurthy, a child and adolescent psychiatrist who treats addiction. "And it's just a number if you think about it." ^[13]

Claims can show when a young person stops. The clinicians STAT interviewed offered reasons why. Existing research and clinical experience favor staying on medication longer ^[15]. But very few studies of these drugs focus on young people, so doctors lack firm answers for families on how long treatment should last or what its long-term effects are ^[14]. Kaliamurthy said adolescents often do not want to hear about an open-ended commitment, and families can be apprehensive about one ^[16]. Attrition through the stages was worse for Black and other racially minoritized young people than for white peers ^[17]. "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," said Sarah Bagley, an internist and pediatrician at Boston Medical Center who treats adolescents ^[18].

I think the evidence supports a narrower reading than STAT's headline, which says access has improved but retention has not ^[20]. Starts did edge up ^[2]. The largest single loss still comes before the first prescription ^[6], and retention among medicated youth runs from about one in five to more than half, depending on which denominator the paper used ^[3][4]. Kaliamurthy called the initiation numbers promising ^[19]. Hadland, who leads adolescent and young adult medicine at Mass General Brigham for Children, put it more bluntly. "There have been some real positive changes, and then there have been some really catastrophic changes," he said ^[3].