Opioid-Related Medication Access for Adolescents Who Test Positive for Fentanyl

Area of Science:

• Adolescent Health
• Pharmacology
• Public Health

Background:

• Illicit fentanyl drives adolescent overdose deaths.
• Adolescents often lack timely access to medications for opioid use disorder (MOUD).
• Limited data exists on healthcare utilization post-fentanyl exposure in adolescents.

Purpose of the Study:

• Characterize opioid-related medication access for adolescents with fentanyl-positive urine drug screens (UDS) in the emergency department (ED).
• Hypothesize that inpatient admission is associated with increased MOUD prescription.
• Identify potential gaps in care for adolescents with fentanyl exposure.

Main Methods:

• Retrospective cross-sectional study at an academic children's hospital.
• Analyzed 84 adolescent (12-19 years) ED encounters with positive fentanyl UDS (Nov 2023-Feb 2025).
• Examined ED disposition, admission diagnosis, and buprenorphine/naloxone prescriptions.

Main Results:

• 34% of encounters resulted in inpatient admission.
• Admitted patients with diagnosed opioid use disorder (OUD) were more likely to receive buprenorphine (77% vs. 23%, p=0.01).
• Naloxone prescription correlated with opioid-related diagnosis, not inpatient admission.

Conclusions:

• Provides novel data on MOUD access for adolescents with fentanyl exposure.
• Suggests missed opportunities for non-admitted adolescents.
• Recommends standardized clinical pathways for ED-initiated MOUD and naloxone.