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

Illicit fentanyl is now the leading contributor to overdose deaths among adolescents, but data about adolescents' health care utilization after fentanyl exposure remains limited. Most adolescents do not receive prompt access to medications for opioid use disorder (MOUD). We aim to characterize opioid-related medication access for adolescents with fentanyl positive urine drug screens during an emergency department (ED) encounter and hypothesize that inpatient admission is associated with increased prescription of MOUD.

We conducted a retrospective cross-sectional study at a free-standing academic children's hospital. Eighty-four ED encounters for adolescents aged 12 to 19 years with positive UDS results for fentanyl between November 2023 and February 2025 were analyzed. Outcomes included ED disposition, admission diagnosis, and prescriptions for buprenorphine and naloxone.

Thirty-four percent of encounters resulted in inpatient admission. Among encounters where OUD was diagnosed, those admitted were more likely to receive buprenorphine prescription (10/13 (77%) versus 3/13 (23%), p = 0.01). Naloxone prescription was associated with having an opioid-related diagnosis, but not with inpatient admission.

This study offers novel data on opioid-related medication access for adolescents with illicit fentanyl exposure. Findings highlight potential missed opportunities for adolescents who are not admitted from the ED and suggest the need for standardized clinical pathways for ED initiation of MOUD and prescription of naloxone. More research is needed to understand barriers to MOUD initiation for non-admitted adolescents with OUD.