High 12-month Adherence to Buprenorphine Associated with Improved Health Outcomes in Youth with Opioid Use Disorder

Buprenorphine reduces mortality among people with opioid use disorder (OUD), but ideal treatment duration and minimal adherence to achieve protective effects are not well established in youth. This retrospective cohort study examined buprenorphine duration/adherence patterns (defined as trajectories) in 11,649 Massachusetts youth with OUD aged 13–26 and subsequent health outcomes over 12 months, 2014–2022. Weekly buprenorphine adherence was defined as ≥1 day.

• Four patterns of buprenorphine receipt emerged: 1) high adherence for 12 months (24 percent of the cohort); 2) low adherence for 12 months (28 percent); 3) discontinuation in 3–9 months (16 percent); and 4) discontinuation in <3 months (33 percent).
• Compared with youth with high buprenorphine adherence for 12 months…
  • overdose risk was greater among those with low adherence for 12 months (adjusted hazard ratio [aHR], 1.46), discontinuation in 3–9 months (aHR, 1.82), and discontinuation in <3 months (aHR, 1.76).
  • risk of all-cause ED usage was greater among those with low adherence for 12 months (aHR, 1.09), and discontinuation in <3 months (aHR, 1.08).
  • risk of all-cause inpatient hospitalization was greater among youth in all three of the other trajectories.

Comments: These findings warrant clinician encouragement of high adherence to and longer duration of buprenorphine among youth with OUD. Limitations included possible overestimation of weekly adherence and the potential effect of other overdose prevention medications (i.e., naloxone) on beneficial outcomes in the high adherence cohort.

Emily Nields, DO

Reference: Hadland SE, Kimmel SD, Yan S, et al. Buprenorphine treatment duration and adherence among youth and subsequent health outcomes. Pediatrics. 2025;156(6):e2025071147.