Study: Residential addiction treatment for adolescents limited, costly

Key takeaways:

• The mean daily cost of adolescent residential addiction treatment is $878.
• The mean upfront cost was just under $30,000, twice the federal poverty level.

Residential addiction treatment centers serving adolescents are scarce and expensive in the United States, new study findings suggest, despite increasing overdose rates among young people in recent years.

The study, published today in Health Affairs, follows findings reported last year that showed buprenorphine was rarely available for adolescents at U.S. addiction treatment centers.

“One of our co-authors, [Olivia Rae Wright, MD], runs an adolescent treatment center in Washington,” Ryan Cook, PhD, MSPH, assistant professor of medicine at the Oregon Health & Science University School of Medicine, told Healio. “It was spurred mostly by her observation that the residential treatment infrastructure across the country was lacking, and it encouraged us to do some exploration.”

Cook, Wright and colleagues compiled a list of U.S. residential facilities that treat adolescents with opioid use disorder from a government-sponsored online treatment locator, which is designed to be a database for people seeking treatment.

Ryan Cook

“We called every facility on the list posing as the aunt or uncle of a 16-year-old who had recently overdosed on fentanyl,” Cook said. “We asked questions about the cost and availability of treatment and what types of treatments were offered.”

Among a sample of 354 residential addiction treatment facilities that indicated they provided services to adolescents, 7.6% could not be reached and 54.4% had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Only 56.9% accepted Medicaid, and 47.5% of the facilities required some upfront payment if using self-pay. Of facilities providing cost information, the mean cost of treatment per day was $878. Mean upfront costs were also high, totaling $28,731, with a median cost of $18,225.

Although the authors expected treatment to be “expensive and not widely available,” Cook said they were still “a little shocked by just how expensive” the treatment cost was.

“We were just as surprised by the high upfront costs,” Cook said. “The mean upfront payment was just under $30,000, which is twice the federal poverty level, and most families dealing with opioid use disorder aren't super wealthy.”

“The ability to access timely, evidence-based treatment for addiction can be a matter of life or death, and the current system too often fails young people,” Nora Volkow, MD, director of the NIH’s National Institute on Drug Abuse (NIDA) said in a statement. “We need to make access to timely, affordable and evidence-based care the norm across treatment settings.”

Cook said he is interested in a similar survey of outpatient opioid treatment for patients of all ages across the country.

“What we want is for families to be able to turn to primary care providers and pediatricians first for this kind of problem,” Cook said. “Ideally, their pediatricians and primary care providers would be knowledgeable and plugged in to the local treatment resources — both residential centers, if they're available, and outpatient options — to be able to recommend a path for families to get their kids treated. This exemplifies why we really need to strengthen the primary care system for addiction, because people in crisis shouldn't be searching on the internet for care on their own.”