Sarah Bagley: The treatment for opioid use disorder in adolescents and young adults really falls into 

two buckets. One is behavioral health treatment, and that can include different kinds of 

manualized but evidence-based therapy, like Cognitive Behavioral Therapy, Motivational 

Enhancement Therapy, and the Adolescent Community Reinforcement Approach among 

others. Importantly, any kind of behavioral health treatment that's offered to 

adolescents and young adults should also involve the family and should include family 

therapy and potentially for families, like Mutual Help Groups.

Best practice currently calls for medication to be added to behavioral therapy for 

patients who have opioid use disorder. What I often tell my patients is that the 

medication is going to help calm their brain down so they're able to focus on their 

recovery, but that it's going to be really hard to talk about their depression or anxiety or 

think about relapse prevention and how we're not going to go out and use again if 

they're having a lot of cravings and that's what medication can do, but that it's really 

important that patients also engage in behavioral health treatment because it takes a 

lot of work to get sober and getting extra help from trained professionals is going to 

lead to better success for them.

With adolescents and young adults, it's critical to intervene early because we're trying to 

prevent the downstream effects of long standing addiction. That means that we're 

trying to prevent transmission of HIV, of Hepatitis C, of complications from injection, like 

skin infections or infections in the blood stream or the heart. And we know that some of 

these medications can help prevent those diseases from occurring. We're also trying to 

ensure that adolescents and young adults are able to stay engaged with school or work, 

with the other goals that they have with their life and that medication's going to help 

them do that.

Although here have been fewer studies conducting in adolescents and young adults 

compared to older adults, the evidence that we do have shows that treatment with 

these medications does work. Importantly, a statement from the American Academy of 

Pediatrics came out in 2016 and recommended that providers offer medication 

treatment to adolescents and young adults with opioid addiction. This statement from 

the American Academy of Pediatrics was the first statement of its kind from a pediatric 

organization recommending treatment with medication for opioid use disorder in 

adolescents and young adults and represented a real paradigm shift in how we're 

thinking caring for this age group with opioid use disorder.

Oftentimes we hear from patients and families and sometimes other treatment 

providers that medication should be used as a last resort. However, when we think 

about other chronic illnesses, like asthma or diabetes, we would never wait until 

someone hit bottom before starting treatment. We think that it's important to offer 

medication for opioid use disorder to adolescents and young adults as soon as we have 

a diagnosis.

There are three medications that we use to treat opioid use disorder in adolescents and 

young adults. Two of medications, Methadone and Buprenorphine, work by controlling 

withdrawal symptoms or treating the withdrawal symptoms that one may have after 

stopping opioid use. They also help control cravings that people have for using the drug. 
For example, if someone is spending a lot of time thinking about how they're going to go 

get heroine, taking Methadone or taking Buprenorphine helps take away some of those 

thoughts. Methadone and Buprenorphine also go to that opioid receptor and sit on it 

really tightly. If someone tries to use heroine or another opioid while they're taking their 

medication, that heroine or other opioid isn't able to cause a high.

Naltrexone works a little bit differently. Naltrexone goes to the opioid receptor and sits 

on it and blocks any other opioid from coming and causing a high. Naltrexone doesn't 

necessarily help with cravings with all patients, but it helps for some. You may have 

heard of Naloxone or NARCAN. This is the medication that's used to reverse an acute 

opioid overdose and is being distributed to people who use drugs and also to family 

members and anyone else who may be around someone who's at risk for an overdose. 

Naloxone can be given different ways. It can be given as a spray in the nose and can also 

be given intermuscularly. And once administered, it can reverse an opioid overdose and 

save a life.

In addition to medication and behavioral health care, it's important to recognize that 

there may be other barriers to care that teens and young adults may be facing. And 

these related to social issues they might be having. A lot of our patients are faced with 

homelessness or housing insecurity, might have a hard time accessing healthy food, 

might also have a hard time with transportation and being able to get around to their 

appointments or to school or their jobs. We recognize that it's going to be really hard for 

them to do all they need to do to get sober if we're not also addressing their needs.