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. Author manuscript; available in PMC: 2025 Nov 29.
Published in final edited form as: Pediatrics. 2025 Dec 1;156(6):e2025071147. doi: 10.1542/peds.2025-071147

Buprenorphine Treatment Duration and Adherence among Youth and Subsequent Health Outcomes

Scott E Hadland a,b, Simeon D Kimmel c,d, Shapei Yan c,d, Amy L Bettano e, Wei-Hsuan Lo-Ciganic f,g,h,i, Sarah M Bagley c,d, Jessica B Calihan c,d, Heather E Hsu c,d, Marc R Larochelle c,d
PMCID: PMC12662019  NIHMSID: NIHMS2104517  PMID: 41248890

Abstract

Objectives:

It is unclear how long youth with opioid use disorder (OUD) should remain on buprenorphine, and what adherence they should achieve. We identified patterns of duration/adherence, and assessed associations with subsequent overdose, emergency department (ED) use, and hospitalization.

Methods:

This retrospective cohort analysis used 2014–2022 data from the Massachusetts Public Health Data Warehouse. We identified youth aged 13–26 initiating buprenorphine, and used group-based trajectory modeling to categorize youth into duration/adherence trajectories over 12 months. Using multivariable Cox regression, we examined associations between trajectories and time to fatal/nonfatal opioid overdose, all-cause ED use, and all-cause hospitalization during the subsequent 12-month period.

Results:

Among 11,649 Massachusetts youth initiating buprenorphine, most were ≥21 (89.0%), male (60.3%), White non-Hispanic (85.9%), and Medicaid-enrolled (55.4%). We identified 4 patterns of medication use: (1) high adherence for 12 months (23.7%); (2) low adherence for 12 months (27.5%); (3) discontinuation in 3–9 months (16.4%); and (4) discontinuation in <3 months (32.5%). Trajectories included 580 (5.0%) and 774 (6.6%) youth switching to methadone and naltrexone, respectively. Compared to high adherence for 12 months, overdose risk was higher with low adherence for 12 months (aHR, 1.46; 95% CI, 1.24–1.73), discontinuation in 3–9 months (aHR, 1.82; 95% CI, 1.52–2.17), and discontinuation in <3 months (aHR, 1.76; 95% CI 1.50–2.06). Compared to high adherence, low adherence and discontinuation in <3 months had higher risk of ED use, and all other trajectories had higher risk of hospitalization.

Conclusions:

Medication adherence may prevent overdose, ED use, and hospitalization. Strategies to increase treatment duration/adherence likely avert harm.

Article Summary:

High adherence to buprenorphine or other medications for opioid use disorder for >12 months predicted low risk of overdose, emergency department use, and inpatient hospitalization.

INTRODUCTION

Approximately 1 in 80 young people aged 12–25 in the United States has an opioid use disorder (OUD).1 Without treatment with medication, individuals with OUD are at greatly elevated risk for opioid overdose.2,3 Overdose mortality in adolescents and young adults (hereafter, “youth”) reached an all-time high in 2022, driven primarily by illicitly manufactured fentanyl, a highly potent opioid.4 Numerous professional organizations including the American Academy of Pediatrics recommend the partial opioid agonist buprenorphine as an evidence-based treatment for OUD.5–7 Buprenorphine is currently the only approved medication for adolescents under 18, and is the most commonly initiated medication for youth with OUD.8 Buprenorphine reduces risk for relapse in youth by reducing cravings for opioids and treating opioid withdrawal symptoms;9 it also protects against opioid overdose by occupying opioid receptors and preventing other opioids (e.g., fentanyl) from binding.5

A critical, unanswered question is how long youth should remain on buprenorphine, and what level of adherence is needed to confer protection from overdose and other adverse health outcomes. Among adults, remaining on opioid agonist medication for OUD such as buprenorphine is associated with decreased risk for opioid overdose and lower mortality,10,11 a protective effect that, across large cohorts, appears to last for at least several years while on medication.2,3 However, among individuals of all ages receiving outpatient OUD treatment, young adults aged 18–29 are half as likely as other adults to remain on medication beyond 6 months.12 Recent national data highlight that after youth initiate buprenorphine, their median duration on medication is only 2 months.13 After an initial treatment episode, only 1 in 5 youth subsequently have a second buprenorphine treatment episode, with a median of nearly 5 months between episodes.

Real-world data are lacking on how different patterns of buprenorphine use (or “trajectories”, which can be defined by duration of treatment and adherence to medication during treatment) relate to youth’s health outcomes. Such trajectories might include, for example, staying on medication for a year or longer, discontinuing after several months, or intermittent use, and each trajectory is likely to be associated with varying risk for opioid overdose and other adverse health outcomes. Although >80% of youth who initiate OUD medication first receive buprenorphine rather than other OUD medications (i.e., methadone or naltrexone, which are approved for OUD treatment for adults over age 18), and >80% do not switch to a different OUD medication, such trajectories might also account for youth who switch from buprenorphine to another OUD medication.8,13

Using a novel state-wide database with comprehensive information on OUD treatment, opioid overdose, and healthcare use, we identified common trajectories of medication adherence and treatment duration among youth who initiated buprenorphine (and including youth who subsequently switched to methadone or naltrexone). We then examined the association of these trajectories with subsequent opioid overdose, emergency department use, and inpatient hospitalization.

METHODS

This retrospective cohort study used the Massachusetts Public Health Data Warehouse (PHD).14,15 The PHD includes every Massachusetts resident who had a health insurance claim in the state All-Payer Claims Database, and links each individual across 26 other government datasets. These additional datasets provide information typically not available in health insurance claims, including, for example, complete buprenorphine dispensing data (by linking to prescription drug monitoring program data), methadone treatment (by linking to data from opioid treatment programs), fatal opioid overdoses (by linking to vital statistics), and ambulance encounters for opioid overdoses (by linking to emergency medical services data).16 We used data from calendar years 2014–2022 for this analysis.

The study sample included youth aged 13–26 who initiated buprenorphine between July 2014 to December 2020 based on prescription monitoring program data.17 Although buprenorphine is approved for individuals ≥16, we included younger adolescents since clinical practice guidelines recommend considering the medication for youth of all ages.5,6 To identify new episodes of buprenorphine treatment, we required that youth have no buprenorphine fills in the preceding 6 months. We limited the sample to youth with ≥2 total buprenorphine fills (since many youth receiving only 1 fill may have only received buprenorphine for short-term medically managed opioid withdrawal rather than long-term OUD treatment). Although we limited our analysis to youth initiating buprenorphine (since it is the first medication used by >80% of youth8), we included youth who subsequently switched to methadone or naltrexone to account for ongoing adherence to any OUD medication.18,19

The main exposure was the trajectory of medication use over 12 months after initiating buprenorphine. For each week after initiation, we generated a binary variable for medication coverage (i.e., 0, no medication coverage that week; 1, one or more days covered with medication that week). Youth were considered adherent with medication for the number of days of medication dispensed after a prescription was filled, accounting for the use of any earlier supply before beginning the refill, and for 28 days after long-acting injectable buprenorphine. For youth who switched to methadone or naltrexone, a week was considered ‘covered’ with medication if it had ≥1 day with clinic-based administration of daily methadone or was within 28 days of receipt of injectable naltrexone. We used group-based trajectory modeling to sort youth into categories based on their medication use pattern over months 1–12 after initiating buprenorphine. Group-based trajectory modeling is a latent-variable approach used to identify subgroups of youth with similar trajectories of medication use and adherence over time.17,20,21 This function fits a latent class mixed model using parameterized nonlinear link functions between the observed outcome and the underlying latent process it measures. Parameters of the nonlinear link function and of the latent process mixed model are estimated simultaneously using a maximum likelihood method.

We used the following a priori criteria to select the model with the optimal number of latent classes and polynomial terms (among 12 models we assessed), identifying the model that: (1) had the lowest Bayesian information criterion, (2) ensured each group included ≥5% of the sample, and (3) adhered to Nagin’s criteria.20 We then assigned a descriptive name based on the characteristics of each trajectory with regard to OUD medication adherence and duration. We included available information on adherence from youth who died during months 1–12; however, these youth were not included in subsequent analyses.

The primary outcome was time to the first observed opioid overdose during months 13–24 (i.e., the 12 months after trajectory assignment). This outcome included both fatal opioid overdoses (through linkage to state vital statistics) and nonfatal opioid overdoses (from hospital and ambulance service records). Secondary outcomes included time to first all-cause emergency department (ED) use and all-cause inpatient hospitalization based on hospital records. To establish temporality, we examined these outcomes during the 12 months after the initial 12-month period used to define youth’s medication trajectories (i.e., outcomes were assessed during months 13–24 after buprenorphine initiation, and between July 2015 to December 2022).22

We used multivariable Cox proportional hazards regression to examine the associations of medication adherence with each outcome. Analyses adjusted for sociodemographic characteristics including age, sex, race and ethnicity, and insurance type; clinical characteristics during the 6 months prior to buprenorphine initiation including homelessness, depression, anxiety, opioid overdose, alcohol use disorder, stimulant use disorder, prescription fill for an opioid other than buprenorphine, prescription fill for a benzodiazepine, prescription fill for naloxone, and receipt of methadone and/or naltrexone; and year as an indicator variable.23 The models examining all-cause ED use and inpatient hospitalization, respectively, additionally adjusted for past-6-month ED use and inpatient hospitalization at baseline. We used self-reported race and ethnicity; we conceptualized these variables as social constructs and included them in analyses to identify potential inequities in MOUD use and/or study outcomes. We did not account for uncertainty in class membership when using trajectory groups as an independent variable in regression models.

We conducted analyses using SAS Studio version 3.81 (SAS Institute Inc). The Mass General Brigham Human Research Committee determined the research was exempt based on its secondary analysis of data from de-identified individuals.

RESULTS

Between July 2014 and December 2020, 11,649 Massachusetts youth filled an initial buprenorphine prescription and met inclusion criteria. Most youth were aged ≥21 years (89.0%) and male (60.3%). The most common racial and ethnic groups included White non-Hispanic youth (85.9%), followed by Hispanic youth (7.0%) and Black non-Hispanic youth (3.4%). Most youth had Medicaid (55.4%) for insurance. After initiating buprenorphine, 580 (5.0%) youth switched to methadone and 774 (6.6%) youth switched to naltrexone during the 12 months after initiation, and were included in subsequent analyses of OUD medication adherence.

Group-based trajectory modeling of OUD medication adherence revealed 4 groups of youth who we qualitatively described as: (1) high adherence for 12 months (23.7%), (2) low adherence for 12 months (27.5%), (3) discontinuation in 3–9 months (16.4%), and (4) discontinuation in <3 months (32.5%) (Figure 1, Supplemental Table 1). In the group with high adherence for 12 months, observed adherence (i.e., % of weeks with any OUD medication use) was approximately ≥75% for the first 9 months of treatment, decreasing to ≥60% during months 9–12. In the group with low adherence for 12 months, observed adherence quickly dropped during the first 3 months of treatment to approximately 30%, then ranged from approximately 25–50% during months 9–12.

Figure 1.

Figure 1.

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Adherence to MOUD use among 11,649 youth who initiated buprenorphine using group-based trajectory modeling.

The group with high adherence for 12 months had a relatively higher percentage of youth who were older (24–26 years of age), female, White non-Hispanic, and Medicaid-enrolled than other groups (Table 1). Youth with high adherence for 12 months were also more likely to have a comorbid diagnosis of depression or anxiety, to have received a recent opioid prescription, or to have received methadone prior to buprenorphine. Youth with discontinuation in 3–9 months or in <3 months were more likely to have experienced homelessness, and less likely to have been dispensed benzodiazepine or naltrexone prior to initiating buprenorphine.

Table 1.

Characteristics of 11,649 youth according to trajectory of use of medication for opioid use disorder during the 12 months after initiating buprenorphine.


Characteristic		 High Adherence for 12 Months
(N = 2,759)
N (%)		 Low Adherence for 12 Months
(N = 3,201)
N (%)		 Discontinuation in 3–9 Months
(N = 1,907)
N (%)		 Discontinuation in <3 Months
(N = 3,782)
N (%)		 P value
Age at MOUD initiation, yrs
 13–17 12 (0.4) 19 (0.6) 13 (0.7) 28 (0.7) <0.001
 18–20 216 (7.8) 336 (10.5) 188 (9.9) 475 (12.6)
 21–23 829 (30.1) 1,022 (31.9) 642 (33.7) 1,362 (36.0)
 24–26 1,702 (61.7) 1,824 (57.0) 1,064 (55.8) 1,917 (57.0)
Binary sex
 Female 1,245 (45.1) 1,266 (39.6) 729 (38.2) 1,379 (36.5) <0.001
 Male 1,514 (54.9) 1,935 (60.5) 1,178 (61.8) 2,403 (63.5)
Race and ethnicitya
 Hispanic 160 (5.8) 197 (6.2) 152 (8.0) 312 (8.3) <0.001
 Black Non-Hispanic 79 (2.9) 89 (2.8) 70 (3.7) 162 (4.3)
 White Non-Hispanic 2,464 (89.3) 2,803 (87.6) 1,617 (84.8) 3,121 (82.5)
 American Indian, Alaska Native, Asian, or Pacific Islander 36 (1.3) 65 (2.0) 33 (1.7) 67 (1.8)
Insuranceb
 Medicaid 1,737 (63.0) 1,680 (52.5) 1,097 (57.5) 1,940 (51.3) <0.001
 Commercial 517 (18.7) 878 (27.4) 434 (22.8) 930 (24.6)
 Other insurance (including Medicare) 52 (1.9) 54 (1.7) 31 (1.6) 66 (1.7)
Homelessnessc 340 (12.3) 368 (11.5) 259 (13.6) 510 (13.5) 0.046
Depressionc 895 (32.4) 993 (31.0) 572 (30.0) 1,080 (28.6) 0.007
Anxietyc 995 (36.1) 1,097 (34.3) 637 (33.4) 1,156 (30.6) <0.001
Opioid overdosec 238 (8.6) 278 (8.7) 192 (10.1) 366 (9.7) 0.200
Alcohol use disorderc 600 (21.8) 661 (20.7) 427 (22.4) 830 (22.0) 0.440
Stimulant use disorderc 414 (15.0) 459 (14.3) 312 (16.4) 616 (16.3) 0.080
Opioid prescriptionc 508 (18.4) 502 (15.7) 282 (14.8) 554 (14.7) <0.001
Benzodiazepine prescriptionc 451 (16.4) 553 (17.3) 285 (14.9) 457 (12.1) <0.001
Naloxone prescriptionc 267 (9.7) 285 (8.9) 164 (8.6) 322 (8.5) 0.400
Prior MOUD (other than buprenorphine)c
 Methadone 202 (7.3) 156 (4.9) 97 (5.1) 132 (3.5) <0.001
 Naltrexone 252 (9.1) 301 (9.4) 171 (9.0) 271 (7.2) 0.003
Prior all-cause ED usec 1,400 (50.7) 1,401 (43.8) 918 (48.1) 1,770 (46.8) <0.001
Prior all-cause inpatient hospitalizationc 434 (15.7) 474 (14.8) 288 (15.1) 658 (17.4) 0.020
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a.

Smaller racial and ethnic groups combined to protect individuals’ identities; race and ethnicity data were missing for 222 (1.9%) individuals

b.

Classified according to the insurance an individual had at the time they initiated buprenorphine; insurance information was missing for 2,233 (19.2%) individuals

c.

Within the 6 months preceding or at the same time as initiation of buprenorphine

Among the 11,649 youth initiating buprenorphine, 146 (1.3%) died during the initial 12 months. These included 23 (0.8%) youth with high adherence for 12 months, 32 (1.0%) youth with low adherence for 12 months, 23 (1.2%) youth with discontinuation in 3–9 months, and 68 (1.8%) youth with discontinuation in <3 months (p = 0.002 for the difference among groups). In a sensitivity analysis in which these individuals were excluded from group-based trajectory modeling, their exclusion did not impact the selection of the final set of trajectories based on our a priori criteria or their qualitative descriptions.

The remaining 11,503 youth were included in the multivariable Cox regression analyses examining outcomes during the subsequent year (i.e., months 13–24 after buprenorphine initiation). During this time, there were 1,369 incident opioid overdoses (incidence rate, 127.4 per 1,000 person-years). Of these, 133 (9.7%) opioid overdoses were fatal (incidence rate, 11.6 per 1,000 person-years). During months 13–24, adherence tended to decrease among youth in the trajectories with high and low adherence over the initial 12 months, and tended to increase in the trajectories with discontinuation in 3–9 and <3 months (Supplemental Table 2).

Compared to youth with high adherence for 12 months, risk of opioid overdose during months 13–24 after buprenorphine initiation was higher among all other individuals, including youth with low adherence for 12 months (adjusted hazard ratio [AHR], 1.46; 95% CI, 1.24–1.73), discontinuation in 3–9 months (AHR, 1.82; 95% confidence interval [CI], 1.52–2.17), and discontinuation in <3 months (AHR, 1.76; 95% CI 1.50–2.06) (Table 2; full multivariable models in Supplemental Table 3).

Table 2.

Trajectories of use of medication for opioid use disorder among 11,503 youtha who initiated buprenorphine and health outcomes during the subsequent year.b

Opioid Overdose All-Cause Emergency Department Use All-Cause Inpatient Hospitalization
Trajectory Rate, per 1,000 Adjusted Hazard Ratio (95% CI) Rate, per 1,000 Adjusted Hazard Ratio (95% CI) Rate, per 1,000 Adjusted Hazard Ratio (95% CI)
High adherence for 12 months 86.6 Reference 750.6 Reference 189.0 Reference
Low adherence for 12 months 122.8 1.46 (1.24 – 1.73) 714.5 1.09 (1.01 – 1.17) 212.3 1.20 (1.06 – 1.35)
Discontinuation in 3–9 months 157.8 1.82 (1.52 – 2.17) 734.0 1.05 (0.96 – 1.14) 216.0 1.20 (1.05 – 1.38)
Discontinuation in <3 months 147.1 1.76 (1.50 – 2.06) 721.5 1.08 (1.01 – 1.16) 207.8 1.22 (1.08 – 1.37)
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a.

Among the 11,649 youth who initiated buprenorphine, 146 individuals (1.3%) died of an overdose before time zero (i.e., beginning of month 13 after initiating buprenorphine) in the time-to-event analysis, and thus were excluded

b.

Multivariable Cox regression models adjusted for the covariates listed in Table 1, with the models examining all-cause ED use and all-cause inpatient hospitalization adjusting for prior ED use and inpatient hospitalization, respectively

In an analysis of fatal opioid overdoses only, compared to youth with high adherence for 12 months, youth with discontinuation in 3–9 months demonstrated significantly higher risk of fatal opioid overdose (AHR, 1.76; 95% CI, 1.01–3.05). Fatal opioid overdose risk was not significantly higher in the other trajectories (low adherence for 12 months: AHR, 1.33; 95% CI, 0.79–2.25; discontinuation in <3 months: AHR, 1.41; 95% CI, 0.85–2.35).

Compared to youth with high adherence for 12 months, risk of ED use was higher in youth with low adherence for 12 months (AHR, 1.09; 95% CI, 1.01–1.17) and discontinuation in <3 months (AHR, 1.08; 95% CI, 1.01–1.16). All other trajectory groups had a higher risk of inpatient hospitalization, including youth with low adherence for 12 months (AHR, 1.20; 95% confidence interval [CI], 1.06–1.35), discontinuation in 3–9 months (AHR, 1.20; 95% CI 1.05–1.38), and discontinuation in <3 months (AHR, 1.22; 95% CI, 1.08–1.37).

DISCUSSION

We identified 4 common trajectories of medication use occurring during the 12 months after youth initiated buprenorphine. The most common trajectory was discontinuation in <3 months of initiating buprenorphine. Switching from buprenorphine to either methadone or naltrexone was uncommon, observed in only approximately 1 in 9 youth initiating buprenorphine. Among the 4 trajectories of buprenorphine use, high adherence to medication for 12 months—a pattern observed in only 24% of youth—was associated with the lowest risk of opioid overdose, ED use, and inpatient hospitalization during the subsequent year.

These findings are consistent with those from adult-focused studies showing that consistent and prolonged use of OUD medications is associated with improved outcomes, including overall survival and reduced risk for opioid overdose, ED use, and hospitalization.2,3,24 Buprenorphine, like methadone and naltrexone, binds tightly to opioid receptors throughout the body and likely protects against opioid overdose by preventing other highly potent opioids, such as fentanyl, from binding. Buprenorphine is long-acting and is typically administered every 12–24 hours but has effects at opioid receptors that last beyond this time.25 Thus, even incomplete adherence to buprenorphine may offer some protection against opioid overdose, which may account for our finding that youth with low adherence for 12 months showed a trend towards a lower risk of opioid overdose than youth who discontinued OUD medications altogether (notably, 95% confidence intervals of these estimates overlapped and thus were not statistically different). In fact, no group had 100% adherence, and the ‘high adherence’ group experienced lower risk for opioid overdose even though their adherence was only approximately ≥75% for the first 9 months of treatment and ≥60% for months 9–12.

Despite our observation that high medication adherence for 12 months was associated with significantly lower risk for opioid overdose and inpatient hospitalization, fewer than 1 in 4 youth demonstrated this pattern of medication use. Given the high mortality we observed in our youth cohort—approximately 1 in 41 youth died during the two years after initiating buprenorphine—these findings highlight the critical need to enhance medication adherence among youth with OUD. This elevated mortality is particularly concerning in light of data highlighting that many youth with OUD do not even receive MOUD to begin with.8,26 Even as OUD prevalence among youth in the US climbed to a prevalence of 1.2% in 2023,1 buprenorphine dispensing to youth declined by 6.5% annually from 2020 to 2023.27

Importantly, the subgroup of youth with high medication adherence for 12 months had a higher percentage of individuals with Medicaid enrollment and with diagnoses of depression and anxiety, highlighting that youth with public health insurance and comorbid mental health concerns can be successfully retained in treatment. Conversely, youth with other trajectories had higher percentages of individuals with other substance use disorders, suggesting that this group of individuals may benefit from stronger supports to engage and retain them in addiction treatment, including treatment of comorbid alcohol and stimulant use disorders.28,29

Qualitative studies highlight that youth often have ambivalence surrounding buprenorphine and other OUD medications.30,31 Many youth and families report a desire to discontinue medication once an OUD is clinically improved, often seeking to stop after several weeks or months of treatment.30 Clinical trial data suggest that discontinuation of buprenorphine after only 4 vs. 8 weeks of treatment is associated with risk for relapse to opioid use among youth, likely in part because of the risk for cravings to use opioids and unpleasant withdrawal symptoms that ensue.9 Additionally, observational data suggest that discontinuation of OUD medication is associated with early dropout from addiction care among youth.8

Taken together, these results suggest that clinicians should counsel youth and families that research suggests that, after initiating buprenorphine, outcomes are best when youth remain on medication (and are adherent) for longer periods of time. As a condition with relapsing and remitting features, OUD should be treated for at least 12 months as suggested by the present study, or even longer, as suggested by adult studies.2,24 Use of long-acting injectable buprenorphine, which typically is administered every 4 weeks, may be helpful for youth who may struggle with adherence to a daily medication.32,33 Additionally, for youth and families that elect to discontinue MOUD, clinicians might counsel that, based on adult studies, the 4 weeks immediately following discontinuation are associated with high risk of OUD relapse and overdose death.2,3,18 Individuals who discontinue medication might benefit from close clinical follow-up and opioid overdose prevention services during this period of elevated risk – though notably, these supports are critical for all youth with OUD regardless of treatment duration and medication adherence.33–35

Our study had limitations. First, we used Massachusetts data, and findings may not fully generalize to other settings. Second, given the use of observational data, we are unable to establish causality; however, we sought to establish temporality by lagging outcomes relative to the measurement period for medication adherence. Third, during the 12-month lag, OUD symptoms and comorbidities may have evolved, and outcomes were not assessed until after this period. Fourth, weekly adherence was assessed based on whether there was medication coverage of ≥1 day; thus, we may have overestimated adherence. Additionally, the 4 identified adherence trajectories represent statistically distinct patterns; these should not be interpreted as indicating truly discrete biological or etiologic subtypes. Despite a high entropy value and high average posterior probability of group membership in this study, class assignment in group-based trajectory modeling is imperfect and may result in misclassification.20,21 Fifth, other interventions commonly administered alongside OUD medication (e.g., naloxone distribution) likely also contributed to improved outcomes in adherent youth.

Amid unprecedented youth mortality resulting from fentanyl, optimizing medication use may be a key strategy to averting overdose and related harms in youth. Specifically, youth, families, clinicians, health systems, insurers, and policymakers should be aware that longer durations of treatment (i.e., ≥1 year) and higher adherence to medication (i.e., ideally ≥75% or higher) are associated with lower risk for subsequent opioid overdose, ED use, and hospitalization.

Supplementary Material

Supplemental Material

What’s Known on This Subject:

Medications for opioid use disorder (e.g., buprenorphine) are recommended for adolescents and young adults. However, the ideal length of treatment with medication and level of adherence needed are unclear.

What This Study Adds:

High adherence to medications for opioid use disorder lasting for at least 12 months was associated with the lowest risk of subsequent opioid overdose and inpatient hospitalization, relative to shorter durations of treatment and lower levels of adherence.

Funding/Support:

This study was supported by the National Institute on Drug Abuse (Hadland: K23DA045085, R01DA057566, K18DA059913; Kimmel: K23DA054363; Lo-Ciganic: R01DA050676; Hsu: K01DA054328). The other authors have no conflicts of interest relevant to this article to disclose.

Conflict of Interest Disclosures (includes financial disclosures):

Dr. Hadland is a member of the editorial board of Pediatrics. Dr. Lo-Ciganic has received grants from Merck Sharp & Dohme and Bristol Myers Squibb, holds a pending patent (U1195.70174US00), and has been compensated by Teva Pharmaceuticals for consulting services unrelated to this work. Dr. Kimmel reports receiving consulting fees from the Massachusetts Department of Public Health’s Bureau of Substance Addiction Services.

Role of Funder/Sponsor (if any):

Funders had no role in the design and conduct of the study.

Abbreviations:

OUD

opioid use disorder

PHD

Public Health Data Warehouse

ED

emergency department

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