Under 39,000 Young Patients Received Buprenorphine in 2023 as Overdose Deaths Rose

Fewer than 39,000 Americans between their mid-teens and early adulthood filled prescriptions for buprenorphine in 2023, representing a decline of roughly 3,000 patients compared to 2017 levels. During this same period, fatal overdoses among young people climbed by approximately 25 percent, peaking during the pandemic years when treatment access became even more constrained.

The disparity highlights a persistent gap in the American response to the opioid crisis: while medication-assisted treatment has expanded dramatically for adults over 34, the demographic facing the fastest-growing overdose risk remains largely disconnected from the most effective intervention available.

The Scale of the Gap

According to the most recent federal estimates, approximately 544,000 Americans under age 26 have been clinically diagnosed with opioid use disorder. Yet fewer than 39,000 received buprenorphine in 2023—a medication that reduces overdose mortality by as much as half when taken consistently.

Brendan Saloner, a professor of addiction medicine at Brown University, notes that decades of research consistently demonstrate better outcomes for patients on medication. The problem is not efficacy but reach. The reasons behind the prescribing decline remain unclear in part because there is no standardized national system for tracking either the disorder or its treatments.

Why Young Patients Fall Through the Cracks

Several barriers consistently emerge in research on adolescent and young adult treatment access. Insurance coverage gaps, out-of-pocket costs, and transportation challenges all impede care. But perhaps more fundamentally, the clinical workforce equipped to treat young people remains vanishingly small.

Marc Fishman, an addiction psychiatrist and medical director of Maryland Treatment Centers, estimates that as few as 5 percent of the roughly 4,800 addiction medicine physicians nationwide work with adolescents. Facilities specifically dedicated to teenage addiction treatment are scarce, and research suggests most do not provide buprenorphine even when they do exist.

Prescriber knowledge compounds the shortage. In 2023, slightly more than 53,000 primary care providers consistently prescribed buprenorphine—roughly 1 in 14 of those authorized to do so. Among pediatricians, only about 1 in 16 had recommended buprenorphine at least once in their careers.

A survey of 403 primary care providers in Ohio conducted by Berkeley Franz, a professor at Ohio University, found that around half did not understand how treatments like buprenorphine work. Those same providers reported receiving less than one day of education on substance use disorders during their training.

How Fentanyl Changed the Picture

Sharon Levy, an addiction medicine specialist and pediatrician at Harvard Medical School, explains that fully synthetic opioids like fentanyl and nitazenes have fundamentally altered how dependence develops. Young people now become dependent after sporadic or even accidental use, often through counterfeit pills that mimic prescription medications.

This shift has complicated diagnosis. Young patients previously presented with consistent symptoms that made identification straightforward. Today, many show only a handful of classic indicators. Levy assesses that a growing share of cases are simply being missed entirely by providers unprepared for this evolving presentation.

For treatment planning, this matters profoundly. A patient using counterfeit pills containing fentanyl may experience a different withdrawal course and require a different induction protocol than someone using prescription opioids. These clinical judgments require experienced prescribers—precisely the resource most scarce for young patients.

The Consequences of Missing Treatment

The story that prompted renewed attention to this gap illustrates the stakes. A mother in Wichita Falls, Texas, sought help for her 19-year-old daughter in 2022. Rehab proved too expensive, so she tried vitamins recommended online, then a change of environment, then kratom purchased as a withdrawal remedy. The daughter's pediatrician did not offer an opioid agonist medication. Four months later, the young woman died of an overdose.

Medical detox manages withdrawal symptoms with medication and monitoring, then transitions patients directly into ongoing treatment. Detox by itself is not treatment. For opioid use disorder, that transition step is typically medication-assisted treatment, and the evidence for starting immediately is robust. Without that pathway, patients often return to use after tolerance drops, creating lethal risk from doses they previously tolerated.

Unlike methadone, which is tightly restricted and generally dispensed through specialized opioid treatment programs, buprenorphine can be prescribed by any doctor or nurse practitioner and picked up at a pharmacy. It has been recommended for patients as young as 16. Studies show that when teenagers and emerging adults take the medication daily, their likelihood of both opioid misuse and fatal overdose drops substantially.

Pathways Forward

Addressing the gap will require expanding the workforce trained to treat young people, integrating addiction education into primary care and pediatric training, and reducing structural barriers like prior authorization requirements that delay treatment initiation. Some states have begun mandating that emergency departments offer buprenorphine to patients presenting with opioid use disorder, creating intervention opportunities at moments of crisis.

For families seeking help, the critical question for any program is whether it offers medication-assisted treatment on-site or arranges a warm handoff to a prescriber before discharge. Detox without that link is where most people lose ground.

People seeking medication-assisted treatment programs can find resources to locate providers who treat adolescents and young adults. The gap between those who need help and those who receive it remains wide—but the tools to narrow it exist and are available to those who can access them.