Closing the Treatment Gap: Opioid Use Disorder Medications in Adolescents and Young Adults

Findings from the PROUD trial highlight the need for youth-centered prescription strategies in primary care.

Adolescents and young adults are far less likely than older adults to receive evidence-based medications for opioid use disorder (OUD), even though buprenorphine and extended-release naltrexone are recommended treatments. Despite their effectiveness, these therapies remain consistently underutilized in youth.

To better understand how primary care providers can bridge this treatment gap, a research team led by Laura J. Chavez, PhD, MPH, principal investigator in the Center for Child Health Equity and Outcomes Research at Nationwide Children’s Hospital, conducted a subgroup analysis of the Primary Care Opioid Use Disorder (PROUD) trial. The findings were published in Pediatrics Open Science.

The PROUD trial tested a nurse care management model in 12 primary care clinics across six health systems. Nurse care managers worked alongside physicians to coordinate follow-up, support patients and reduce documentation burdens that often discourage prescribing these kinds of medications. In the broader population, this model increased the number of OUD medication treatment days.

“Medications for OUD can reduce cravings, support recovery and prevent overdose,” Dr. Chavez explains. “We wanted to know if younger patients had a similar experience to the adults in this trial.”

The team reviewed a subset of the trial records of more than 46,000 behavioral health patients ages 16 to 25 years treated between 2016 and 2020. About half were seen in intervention clinics using nurse care management and the rest in primary care clinics. Researchers tracked prescriptions for buprenorphine and naltrexone.

Overall, OUD diagnoses were uncommon among youth in both settings, and only a fraction of diagnosed patients received medication. Among those treated, youth in intervention clinics had a median treatment length of 81.5 days, compared with 64 days in primary care clinics. Notably, the odds of receiving medication were slightly higher in intervention clinics but did not reach statistical significance.

“We did not find evidence that a nurse care management model would meaningfully increase OUD medication treatment for young patients,” says Dr. Chavez. “This suggests that we as providers need additional, tailored approaches to overcome barriers unique to this age group.”

Such barriers include stigma, reluctance to use medication, co-occurring mental health conditions and clinician hesitation to prescribe to younger patients.

For primary care physicians, the findings point to two priorities:

• First, recognize primary care as a critical entry point for youth who may not otherwise access specialty addiction treatment.
• Second, adopt youth-centered outreach and treatment strategies to engage young people more effectively.

Dr. Chavez emphasizes the need for more study to tackle both priorities. “Nurse care management is a good first step, but it’s not enough. We need a more proactive approach that meets young people where they are, instead of waiting for them to ask for treatment,” she concludes.

More Resources for Pediatricians Treating Youth With Substance Use Disorders

References:

1. Feder KA, Krawczyk N, Saloner B. Medication-assisted treatment for adolescents in specialty treatment for opioid use disorder. Journal of Adolescent Health. 2017;60(6):747–750.
2. Terranella A, Guy GPJr, Mikosz C. Buprenorphine dispensing among youth aged ≤19 years in the United States: 2015–2020. Pediatrics. 2023;151(2):e2022058755.
3. Chavez LJ, Yu O, Wartko PD, Braciszewski JM, Glass JE, Horigian VE, Arnsten JH, Murphy MT, Stotts AL, Bagley SM, Lapham GT, Samet JH. Opioid use disorder medications among youth in primary care: Subgroup analysis of the PROUD trial. Pediatrics Open Science. 2025;1(2):10.1542/pedsos.2024-000392.
4. Wartko PD, Bobb JF, Boudreau DM, Matthews AG, McCormack J, Lee AK, Qiu H, Yu O, Hyun N, Idu AE, Campbell CI, Saxon AJ, Liu DS, Altschuler A, Samet JH, Labelle CT, Zare-Mehrjerdi M, Stotts AL, Braciszewski JM, Murphy MT, Dryden D, Arnsten JH, Cunningham CO, Horigian VE, Szapocznik J, Glass JE, Caldeiro RM, Phillips RC, Shea M, Bart G, Schwartz RP, McNeely J, Liebschutz JM, Tsui JI, Merrill JO, Lapham GT, Addis M, Bradley KA; PROUD Trial Collaborators; Ghiroli MM, Hamilton LK, Hu Y, LaHue JS, Loree AM, Murphy SM, Northrup TF, Shmueli-Blumberg D, Silva AJ, Weinstein ZM, Wong MT, Burganowski RP; PROUD Trial Collaborators. Nurse care management for opioid use disorder treatment: the PROUD cluster randomized clinical trial. JAMA Internal Medicine. 2023;183(12):1343–1354.

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