Study Maps Eight Ways to Make Opioid Treatment Fit Young People

Young people between 16 and 24 use opioid agonist treatment far less than any other age group, even though the medication is the standard of care in both Canada and the United States and overdose remains one of the leading causes of accidental death among adolescents. A qualitative study published in Addiction Science & Clinical Practice set out to find out why the fit is so poor, and came back with eight recommendations built from interviews with the people on both sides of the prescription pad.

The research team, led by first author Kirsten Marchand, recruited 17 participants in British Columbia between March 2024 and March 2025 through youth mental health and substance use services across the province. The group included six young people aged 16 to 24 who had accessed opioid agonist treatment, four of their caregivers, five service providers and two decision-makers. Interviews were semi-structured, and the transcripts were analyzed using directed content analysis to organize what participants said into guidance that a clinic could actually act on.

British Columbia was a deliberate setting. The authors note that overdose is one of the leading causes of accidental death among youth in the province, which makes the question of why treatment uptake lags an urgent one rather than an academic one.

What the eight recommendations ask for

The first four concern the clinical relationship. Services should build and maintain trust with young patients. Providers should check in regularly about a young person's goals and about what is and is not working in treatment. All medication options should be presented with their benefits and drawbacks instead of steering a patient toward a single default. Induction plans — the process of starting the medication — should be developed with the young person rather than handed to them.

The remaining four push past the exam room. Treatment should be delivered as part of a comprehensive approach to a young person's health and circumstances rather than as an isolated prescription. Services should operate in low-barrier, non-judgmental settings that reduce the friction of staying in care. Tapering, when a patient decides to reduce or stop medication, should also be planned collaboratively. And caregivers should be supported and brought in, on the premise that families often determine whether a young person stays engaged at all.

Underneath the eight items, the researchers identified four foundations: positive relationships between youth and providers, flexible plans that can adapt as circumstances change, low-barrier settings, and service delivery that treats health as a whole rather than as a prescription.

Why the framing matters

Much of the policy conversation about medication for opioid use disorder has focused on supply — who may prescribe, how many patients a clinician can take, whether telehealth can substitute for an in-person visit. Those barriers are real, and removing the federal waiver requirement in the United States in 2023 was expected to widen access. The British Columbia interviews point at a different constraint: even where medication is available, young patients disengage when the service feels like a condition imposed on them rather than a choice they helped shape.

That is a design problem, and design problems are cheaper to fix than supply problems. Moving a clinic toward same-day starts, offering all three medication options with honest counseling, and asking a 19-year-old what they want their life to look like in six months cost training time, not new facilities.

The recommendation on caregivers is the one most likely to collide with confidentiality rules. Adolescent treatment in the United States generally protects minors' privacy, sometimes in ways that leave parents outside the process entirely. The study's participants, including four caregivers, argued that excluding families produces worse retention — a claim that runs directly into a legal framework built to protect young people from exactly that kind of involvement.

What the study cannot say

The authors are explicit about the limits. Seventeen participants recruited on purpose from one Canadian province generate expert recommendations, not measured outcomes. The study did not test whether clinics that adopt the eight practices retain more young patients, and it did not compare models of care. The researchers call for implementation research that examines how youth-centred models perform once adopted, with attention to differences across communities, age ranges, genders and clinical and cultural settings.

That caveat matters for anyone tempted to read the recommendations as evidence. They are a map drawn by people who have been through the system, not a trial result — and the field's larger problem, documented repeatedly in the United States, is that adolescents who need medication for opioid use disorder often cannot find a prescriber at all. Earlier this month this blog covered a Mass General Brigham study finding that only 3.1 percent of young Medicaid enrollees diagnosed with opioid use disorder were still on medication six months later, which puts the British Columbia findings in context: the design questions come second to the access question.

For families trying to navigate the system, opioid addiction treatment generally begins with an assessment of whether medication is appropriate, and the choice among buprenorphine, methadone and extended-release naltrexone is one a patient is entitled to discuss rather than accept.