Naloxone and Buprenorphine Treatment for Adolescent Opioid Overdose and Opioid Use Disorder

Importance: The ongoing opioid-related overdose crisis in the US is increasingly affecting adolescents and is exacerbated by the widespread availability of illicitly manufactured fentanyl. Adolescents face significant gaps in care for prevention and treatment of opioid use and opioid-related harms. Regulatory changes have impacted the availability of 2 lifesaving medications, naloxone and buprenorphine. This narrative review summarizes the current knowledge of opioid use, overdoses, and opioid use disorder (OUD) among US adolescents in the context of fentanyl, and reviews the use of naloxone and buprenorphine, for overdose reversal and OUD treatment, respectively. Observations: Owing to their developmental stage, adolescents are uniquely vulnerable to initiating substances, experiencing substance-related harms, and developing substance use disorders. From 2018 through 2023, morbidity and mortality have increased from use of opioids, particularly fentanyl, among youth. Naloxone and buprenorphine are safe and highly effective medications for opioid overdose reversal and OUD treatment, respectively. Regulations for these medications have changed to address the worsening overdose epidemic. Naloxone is approved for over-the-counter sales (including by adolescents younger than 18 years). Any clinician with a US Drug Enforcement Administration-controlled substance license can now prescribe buprenorphine for OUD without a waiver. These policy changes present critical opportunities to save lives and reduce inequities among adolescents. Conclusion and Relevance: Harms from opioids are increasingly affecting adolescents with a notable rise in overdose fatalities in the past 5 years. Regulatory changes for naloxone and buprenorphine have occurred to improve access to both these medications. Despite these changes, adolescents continue to have low access to these life-saving interventions. Ensuring that clinicians have the knowledge to provide both medications to adolescents is a key step to addressing the epidemic of adolescent drug overdoses and reducing opioid-related harms.