- Among 11,600 youth in Massachusetts who started buprenorphine, only 1 in 4 maintained high adherence for a full year
- Those who remained adherent for 12 months had almost half the risk of overdose, and fewer emergency department visits and hospitalizations, compared with those who discontinued early
- Findings suggest that longer, more consistent treatment could be lifesaving for youth amid the ongoing fentanyl crisis
New research from Mass General Brigham finds that adolescents and young adults who stayed on the medication buprenorphine for at least a year had markedly lower risks of opioid overdose and hospitalization compared with peers who discontinued medication early or took it inconsistently. The results, published in Pediatrics , are especially relevant as youth overdose death rates recently reached record highs, driven by fentanyl.
"We are commonly asked in youth addiction treatment how long to stay on medication and how strictly it must be taken to provide protection," said lead and corresponding author Scott Hadland, MD, MPH, MS, chief of Adolescent and Young Adult Medicine at Mass General Brigham for Children. "Our findings suggest that maintaining high adherence for at least a year substantially reduces overdose risk. It's a clear message to clinicians, families and youth that longer treatment saves lives."
The study analyzed data on 11,649 youth aged 13-26 who initiated buprenorphine in Massachusetts between 2014 and 2020. Using the Massachusetts Public Health Data Warehouse—a comprehensive statewide dataset linking medical, pharmacy, and mortality records—the team identified four patterns of medication use: high adherence for 12 months (24%), low adherence for 12 months (28%), discontinuation after 3-9 months (16%), and discontinuation in under 3 months (33%).
Compared to youth with high adherence for 12 months, those who stopped within 3-9 months had an 82% higher risk of opioid overdose, while those who stopped in under 3 months had a 76% higher risk. Youth who were on medication for 12 months but had low adherence had a 46% higher risk. Youth who stayed on medication for a year and had high adherence also had lower rates of emergency department visits and hospitalizations.
While buprenorphine is the only medication approved for opioid use disorder in adolescents under 18, many families and youth elect to discontinue treatment after just weeks or months once they see improvements. However, the study's findings show that consistent, year-long use likely provides the greatest protection against overdose and other serious outcomes.
"Opioid use disorder is a condition that can come and go over the course of several years," said Hadland. "Staying on treatment longer—even when things feel better—may prevent relapse and save a young person's life."
The study underscores the importance of helping youth adhere to treatment, including through the use of long-acting injectable buprenorphine and providing enhanced support for youth with co-occurring mental illness or housing instability.
"Amid the fentanyl era, short-term treatment is simply not enough," said Hadland. "Clinicians, insurers, and health systems should do everything possible to help young people continue medication for at least a year or longer. This is a key step toward reducing youth overdose deaths."
Authorship: In addition to Hadland, authors include Simeon D. Kimmel, Shapei Yan, Amy L. Bettano, Wei-Hsuan Lo-Ciganic, Sarah M. Bagley, Jessica B. Calihan, Heather E. Hsu, and Marc R. Larochelle.
Disclosures: Hadland is a member of the editorial board of Pediatrics. 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. Kimmel reports receiving consulting fees from the Massachusetts Department of Public Health's Bureau of Substance Addiction Services.
Funding: The study was funded by the National Institute on Drug Abuse (K23DA045085, R01DA057566, K18DA059913, and related grants). Coauthors included researchers from Boston Medical Center, the Massachusetts Department of Public Health, and the University of Pittsburgh.
Paper cited: Hadland SE et al. "Buprenorphine Treatment Duration and Adherence among Youth and Subsequent Health Outcomes" Pediatrics DOI: 10.1542/peds.2025-071147
