(Boston)—According to national estimates, nearly 2.2 million U.S. adolescents aged 12–17 met the criteria for at least one substance use disorder (SUD) in 2023. Drug and alcohol- related concerns are the second leading cause of death and disability within this age group and the third leading cause of death for children nationally. For opioid, alcohol and nicotine use disorders, national experts recommend a comprehensive treatment approach that includes both medication-based and behavioral interventions. For opioid use disorder, medication is the recommended first-line treatment. Nonetheless, access to medication among adolescents with SUD remains extremely limited.
In a new review in the Journal of Addiction Medicine, researchers from Boston University Chobanian & Avedisian School of Medicine found that very little research has been done to investigate and inform the use of medications for SUD in people under the age of 18, particularly those identifying as racial, gender and sexual minorities. These findings underscore the urgent need for additional research into medication treatments for diverse youth with SUD and for additional policy and funding initiatives to support its realization.
"The results of this study highlight a gap in the research informing medication options for adolescents with SUD. While these findings weren't entirely unexpected, they definitely highlight how little concrete evidence pediatric clinicians currently have to draw from when trying to help their patients through the SUD recovery process," explained corresponding author Clare Westerman, a third-year medical student at the school.
The researchers performed a review to identify published papers and randomized-controlled trials of medications for SUD that were available between January 1, 1999, and December 4, 2024, and included at least one participant aged 13–17, with none aged 26 years or older. Key study characteristics were extracted and analyzed to identify trends in design, medications tested and participant diversity.
Even when including options for six different substance use disorders, the researchers identified only 36 studies meeting inclusion criteria during the past 25 years. None of the studies focused on benzodiazepine use disorder. A 2019 NIH study found the use of these drugs by high school seniors more than doubled over the past two decades. Although the collection and reporting of demographic-related factors were inconsistent, the demographic data available demonstrated low participation in the studies by individuals aged younger than 18, racial/ethnic minorities and gender-diverse youth.
"We know that certain medications can be life-changing in adults and have some good initial data to show that they can have a similar impact for adolescents, but their widespread use is limited by a lack of concrete data to draw from when making recommendations," says senior author Sarah Bagley, MD, associate professor medicine at the school and a primary care physician at Boston Medical Center. "We hope that our findings can serve as a call to action for researchers, policymakers, general pediatricians, and psychiatrists/addiction medicine specialists to consider the role of medication treatment for SUD in appropriate patients and to champion more research in this area to ensure that all people with SUD have access to the evidence-based treatment that they deserve," she said.
