Which medications for opioid use disorder are US Food & Drug Administration (FDA) approved for treating youth?
Buprenorphine is FDA approved for adolescents 16 years and older, and naltrexone is FDA approved for young adults 18 years and older. Methadone is available to adolescents under 18, but regulatory restrictions make accessing methadone very difficult. (Adolescents under 18 need to demonstrate two prior documented ‘unsuccessful’ attempts at addiction treatment that did not involve a medication, after which they need to locate an opioid treatment program that accepts adolescents under 18, which are exceedingly rare.) Despite these age cutoffs, in some clinical practices, buprenorphine and naltrexone are used off-label for ages younger than those approved by the FDA. However, any prescriber considering this should be aware that the lack of FDA approval for younger ages is due to insufficient clinical trial data for these younger ages.
What are some key differences in treating adolescents with opioid use disorder as compared to treating adults?
The American Academy of Pediatrics and other professional organizations recommend that adolescents and young adults receive the same evidence-based treatment for opioid use disorder as adults (including use of pharmacotherapy with buprenorphine, naltrexone, or methadone). Options for pharmacotherapy, therefore, are the same for adolescents as for adults. Where treatment differs is often with regard to developmental considerations. Adolescents are in a transitional age in which they are experiencing substantial change. This includes increasing autonomy in health care decisions; often navigating health insurance and medication copays for the first time; and potentially experiencing changes in housing, education, and employment as high school comes to an end. Additionally, many adolescents have ambivalence surrounding addiction treatment, particularly if they have been brought into treatment by a concerned parent or other trusted adult, rather than choosing to come to treatment themselves. Thus, motivation for treatment can fluctuate, and providers may need to be prepared to provide treatment ‘on demand’, recognizing that the ability to pursue treatment could change from moment to moment. Nonetheless, many teens are very early in the trajectory of addiction and its harms, and thus might be more treatment-responsive than many adults with much longer histories of substance use. Additionally, since many adolescents with opioid use disorder have never received a medication for addiction treatment previously, you may be the first provider to offer them evidence-based pharmacotherapy, offering a significant opportunity for successful treatment.
