It is not established that young people’s access to addiction medication has improved nationally while retention has failed to keep pace. The strongest recent evidence here explains what can make care hard to start or continue: interviews with young people and providers point to costs, practical barriers, treatment experiences and relationships with care teams. The evidence concerns medications for opioid use disorder (MOUD), not addiction medications generally.
What the evidence says about access and retention
Access and retention are different parts of care. A young person may be referred or connected to a provider, start medication, and still face obstacles to continuing treatment. The available studies describe these experiences and potential barriers; they do not establish a national trend showing that access has improved while retention has not.
A 2025 qualitative study interviewed 20 English-speaking adolescents and young adults (AYAs) aged 15–25 who had accessed opioid use disorder (OUD) care. Its four themes were “chasing care,” “needs first,” “relationships matter,” and “real talk and real options.” The interviews offer detailed accounts, not a representative estimate of how common any barrier is. The Pediatrics study and its PubMed abstract describe the design and findings.
A separate 2024 qualitative study interviewed medical providers in Philadelphia about retaining adolescents and young adults on MOUD. Its local provider perspectives help explain continuity challenges, but do not rank interventions or represent providers nationwide. The Philadelphia provider study reports both barriers and facilitators.
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Why is it hard for adolescents to access medication-based treatment?
Finding a workable connection to care
In the 2025 interviews, “chasing care” described difficulty establishing a viable connection to treatment. In some accounts, that meant relying on adult involvement or reaching care only during a crisis. A referral or search for a provider is not the same as being able to start and continue treatment.
Basic needs can determine whether care is feasible
Young people described housing, transportation and employment needs as part of the treatment picture. Insurance and medication affordability also matter: a treatment plan may be difficult to follow if a person cannot reliably get to appointments or pay for medication. These are reported constraints, not proof that social support alone can substitute for clinical OUD care. The study’s full-text article discusses these practical barriers and treatment experiences.
Clear, respectful conversations matter
Participants valued trusted providers, nonjudgmental treatment and informed, authentic conversations. Stigma, poor treatment experiences, inadequate medication dosing and a lack of transparency about withdrawal or the treatment process could undermine engagement. These accounts underscore why a young person should be able to ask what to expect and discuss concerns with a qualified clinician; they do not establish that one medication or approach suits everyone.
What can make it harder to stay on MOUD?
Providers interviewed in Philadelphia described several obstacles to retention: return to substance use, cost, delays in receiving medication, pharmacy challenges and requirements for in-person visits. They also identified motivation and support networks as patient-level facilitators, and telehealth access and certified recovery specialists as system-level facilitators. These are provider-reported themes, not a tested ranking of which support works best.
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The youth interviews add a complementary view: unstable housing, transportation difficulties, work demands, insurance and medication costs, and difficult treatment experiences can all complicate continuity. Relationships and clear communication may help young people remain engaged, but the studies do not show that any single factor causes retention or solves the other barriers.
What the available numbers do—and do not—show
A prior Medicaid-based study, as reported in the discussion of the 2025 Pediatrics article, found that 24% of Medicaid-enrolled youth aged 13–22 received any MOUD within three months of an OUD diagnosis; the figure was 5% for those aged 13–17. These figures describe that earlier Medicaid population and three-month period. They are reported secondhand in the 2025 article, are not findings from its 20 interviews, and do not establish current national rates or a change over time. The article discussion is the cited source for the figures.
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How to assess whether a care option is workable
These studies do not compare or endorse particular clinics, medications or programs. When discussing options with a qualified provider, the reported barriers suggest useful questions to ask:
- How quickly can an evaluation happen, and what is required to begin medication?
- What will medication cost, what insurance is accepted, and how will continuity be handled if coverage changes?
- Which pharmacy fills prescriptions, and what happens if medication is delayed or unavailable?
- Are visits available by telehealth, or must they be in person?
- Can staff help address practical obstacles such as transportation or housing?
- Will the care team explain withdrawal, medication choices and next steps clearly, and respond respectfully to concerns?
For clinical recommendations, the American Academy of Pediatrics’ adolescent opioid FAQ is an appropriate starting point. Eligibility, consent and confidentiality rules, and local services vary by jurisdiction; the studies summarized here do not resolve those local details.
What remains unproven
The 2025 youth study is small and qualitative, and the provider study is qualitative and based in Philadelphia. Together, they make the difference between reaching treatment and sustaining it easier to understand, but they cannot demonstrate a national, causal or longitudinal trend. They also do not identify a universally best medication, clinic or retention strategy.
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