Opioid Use Disorder Care Gaps Among Medicaid-Enrolled Youths

Most Medicaid-enrolled adolescents and young adults with opioid use disorder (OUD) did not receive timely, evidence-based treatment, according to a cohort study published in JAMA Network Open. Only 3.1% continued medication for 180 days or more.

The investigators used Transformed Medicaid Statistical Information System Analytic Files from 2016 to 2023, covering all US states and Washington, DC. They assessed how youths aged 13 to 25 years progressed through the OUD cascade of care. The stages were aligned with national quality measures: treatment initiation, engagement, receipt of medication for OUD (MOUD), and 180-day MOUD retention.

The study included 229,847 youths with OUD (median age, 22 years). Of these, 50.7% initiated treatment within 14 days of diagnosis and 32.9% engaged in care. Among those who engaged, 46.3% received MOUD, or 15.2% of all youths with OUD. Only 6.6% of engaged adolescents younger than 18 years received MOUD, compared with 51.2% of engaged young adults.

Buprenorphine was the most commonly initiated medication (68.5%), followed by methadone (25.5%) and extended-release naltrexone (6.0%). Among youths receiving MOUD, 180-day retention was highest with methadone (26.2%), followed by buprenorphine (19.2%) and extended-release naltrexone (5.8%). Younger adolescents aged 13 to 15 years and racially minoritized youths had consistently lower progression through the cascade.

The authors noted that claims data are subject to misclassification and do not capture treatment that was not billed to Medicaid. Requiring continuous enrollment may have excluded youths with unstable coverage, so the findings may overestimate treatment rates. The findings may also not generalize to uninsured or commercially insured youths. The authors said the gaps underscore the need for policies and care models that expand equitable access to treatment.

Source: Hadland SE, Opara I, Fung V, et al. Opioid use disorder and evidence-based care among Medicaid-enrolled youths. JAMA Netw Open. 2026;9(10):e2637263. doi:10.1001/jamanetworkopen.2026.37263