A Generation at Risk: Combating Teen Opioid Abuse with Evidence-Based Strategies

Article posted by Melissa Morrissette, LICSW, CDP, CMHS, MA Published on March 4, 2025

Introduction: A Growing Crisis

Adolescence is a time of growth and exploration but also of vulnerability. Among the many challenges facing today’s youth, the surge in opioid abuse—particularly fentanyl—stands out as a critical public health crisis. The data is alarming: from July–December 2019 to July–December 2021, there was a 109% increase in monthly overdose deaths among individuals aged 10–19. During this time, the mortality rate from illicitly produced fentanyl (IMF) increased by 182%. Approximately 84 percent of deaths involved IMFs. Counterfeit pills accounted for nearly a quarter of cases (Tanz et al., 2022). In light of these alarming trends, this blog aims to enlighten readers and provide evidence-based strategies for addressing teenage fentanyl use.

The Dangerous Crossroads: Substance Use Risks and Developmental Challenges

The developmental journey of adolescents, marked by the complexities of relationships, education, and self-identity, renders them particularly susceptible to external influences, with substance use emerging as a prominent example. Stress and curiosity often drive experimentation, but fentanyl’s potency—100 times stronger than morphine—turns casual use into a life-threatening decision (CDC, 2023). In Jenkins et al.'s (2017) study, teenagers revealed how friends, peers, and communities influence their choices regarding substance use. The risk of a fatal overdose among teenagers has escalated due to the growing availability of illicit fentanyl (IMFs), counterfeit pills containing IMFs, and easy access to drugs on social media platforms (Friedman et al., 2022).

During adolescence, stress and developing judgment can lead some teenagers to turn to substance experimentation as a coping mechanism. Unfortunately, what begins as simple experimentation can swiftly spiral into an addiction, requiring immediate medical attention. Fentanyl, one of the most potent opioids on the market, poses a significant threat. According to the Centers for Disease Control and Prevention (CDC), fentanyl is roughly 100 times more potent than morphine commonly used in hospitals (2023). Teenagers often unaware of the severe consequences, may perceive harmlessly fun, rationalizing their actions with statements like "my friend got it from a legit source." However, they may not fully comprehend the risks involved, particularly the potential for lethal opioid poisoning, addiction, and physical dependence. Additionally, adolescents may underestimate the dangers of fentanyl use, believing they can indulge "just this once," which can lead to overdose, especially due to their tolerance and lack of familiarity with opioids.

Bridging the Treatment Gap

Effective treatment for teenage opioid use disorder (OUD) depends on dispelling misconceptions and improving access to care. Evidence shows that primary care clinics provide an accessible starting point for youth seeking treatment (Carley & Oesterle, 2021).

Treatment Spectrum: Not all teens are ready for abstinence-focused interventions. While some benefit from outpatient therapy, others may require residential or intensive outpatient programs to manage higher relapse risks (Winer et al., 2022).

Challenges in Medication Access for Teens

Buprenorphine: is the only FDA-approved medication for treating opioid use disorder in patients 16 years of age and older. It functions by connecting itself to the same brain receptors as other opioids, which lessens cravings and the symptoms of withdrawal while avoiding the same high levels of euphoria. Buprenorphine is frequently incorporated into a comprehensive therapeutic approach (Peavy & Banta-Green, 2021).

Methadone: is an effective long-acting opioid agonist that lessens cravings and prevents withdrawal symptoms. Methadone can only be administered in opioid treatment programs (OTPs) with guardians' consent, and the FDA has not approved its use in treating opioid addiction in minors under the age of 18. Since minors rarely take methadone, there is not enough research available to determine appropriate dosages. Additionally, treatment programs for opioid addiction are designed mainly for adults, so they may not be suitable for teenagers (Peavy & Banta-Green, 2021).

Naltrexone: The FDA's decision to deny naltrexone for patients under the age of 18 complicates treatment. Naltrexone works as an antagonist at the opioid receptor to prevent the effects of opioids. It is administered orally or by monthly injection, and its main objective is to prevent relapses by blocking the rewarding effects of opioids (Peavy & Banta-Green, 2021).

To overcome these barriers, a collaborative effort between healthcare providers, policymakers, and families is essential.

Debunking Misconceptions about Medications

Teens face obstacles in accessing evidence-based opioid therapy, primarily due to misconceptions about medication and a shortage of physicians specializing in opioid use disorder (OUD) for youth specifically. Contrary to data, longer pharmacological treatments yield superior results, dispelling the myth that pharmaceuticals should only be used as a last resort. Similarly, there is no evidence to support the notion that teenagers with severe OUD need the most extensive care, such as inpatient treatment. When it comes to treating the physiological components of OUD, medications are more effective than intensive behavioral therapy. They enable teenagers to acquire coping mechanisms for long-term healing and a smooth transition to adulthood. Stigma from various sources, including family, friends, the judicial system, and self-perception, hinders teenagers from obtaining essential medical care.

Debunking Misconceptions About Treatment

Stigma and myths hinder access to evidence-based therapies:

Longer Treatments Are Effective: Contrary to myths, extended pharmacological treatments yield better outcomes. Research shows that maintenance treatments such as buprenorphine-naloxone increase retention and minimize relapse rates in adolescents when compared to detoxification alone (Minozzi et al., 2009).

Medications vs. Therapy: Medications often outperform behavioral therapy in treating the physiological aspects of OUD. According to recent research, buprenorphine treatment paired with counseling improves retention and reduces opioid usage among adolescents with opioid use disorder. A narrative review demonstrates its effectiveness as part of a comprehensive, long-term approach (Borodovsky et al., 2018).

Overcoming Age-related Challenges: While younger individuals may struggle with adherence to medication-assisted treatments, approaches suitable for adolescents, such as flexible dosing and integrated psychological support, improve outcomes (Viera et al., 2020).

Addressing these misconceptions can help to remove obstacles to care and encourage families to consider evidence-based solutions.

Evidence-Based Treatment Approaches

Numerous studies have been conducted on the effectiveness of evidence-based treatment approaches, offering insightful information on their usefulness. However, it's important to recognize that some culturally insensitive components of these approaches may make it difficult for some populations to successfully implement and use these evidence-based strategies (Alexander Street, 2016). Moreover, specialized treatments for youth with high-risk substance use are hard to come by worldwide, and they frequently focus only on abstinence without considering other options (Krausz et al., 2022).

Let's delve into some key evidence-based treatment approaches tailored for adolescents:

Adolescent Community Reinforcement Approach (A-CRA): is a valuable intervention, emphasizing the advantages of living a drug-free lifestyle with the goal of encouraging abstinence. This approach supports adolescents in their recovery journey by fostering stronger connections, improving their academic achievement, and providing support from non-substance-related sources of reinforcement. (Davis et al., 2019).
Motivational Enhancement Therapy (MET): Founded on the principles of motivational interviewing, MET uses a range of strategies, such as goal-setting treatments, family- and individual-oriented methods, psychoeducation, problem identification, and motivation targeting. Collectively, these elements aim to increase engagement in treatment (Hogue et al., 2018).
Cognitive Behavioral Therapy (CBT): As a skills-based technique, CBT plays an important role in helping individuals recognize and challenge harmful thought patterns linked to substance use. It aims to improve adaptive coping mechanisms, promote self-control, and make using newly acquired problem-solving strategies easier. There is, however, a lack of studies explicitly examining the effectiveness of CBT for young adults and adolescents with opioid use disorder (Davis et al., 2019).
Family-Based Therapy-Enhanced (FBT-E): Emerging as the most effective and well-researched strategy for adolescent substance use, FBT-E places a strong emphasis on family participation. Various manualized models are available for this approach, providing a well-researched framework for overcoming adolescent substance use problems (Hogue et al., 2018).
Harm Reduction: Harm reduction focuses on minimizing the negative effects of substances through empathy, understanding, and voluntary withdrawal. When integrating harm reduction into adolescent care plans, it is important to take into account the differences between peer and community groups. A patient-centered approach recognizes the possible advantages of substance use while minimizing harm and promoting reduction or cessation. By working with young people, validating their experiences, and exploring potential usage benefits—such as realizing that teenagers may use cannabis to address anxiety symptoms—healthcare providers can tailor their approaches to each individual patient (Winer et al., 2022).
Communities That Care (CTC): An evidence-based system of services, CTC uses evidence-based preventative programs tailored to each community's risk and protective characteristics to reduce adolescent delinquency. CTC uses training and community initiatives to alter the service system at the community level through training sessions and community initiatives. This improves provider collaboration and the implementation of evidence-based programs that address community risk and protective factors (Fishbein & Sloboda, 2022).
Adolescent Community Reinforcement Approach (A-CRA): This intervention emphasizes the benefits of a drug-free lifestyle, fostering stronger social connections and academic achievement (Davis et al., 2019).
Motivational Enhancement Therapy (MET): Using goal-setting, psychoeducation, and motivation-focused strategies, MET increases engagement in treatment (Hogue et al., 2018).
Cognitive Behavioral Therapy (CBT): This skills-based therapy helps teens identify and challenge harmful thought patterns, promoting adaptive coping strategies (Davis et al., 2019).
Family-Based Therapy-Enhanced (FBT-E): Recognized as the most effective approach, FBT-E prioritizes family involvement to address substance use issues comprehensively (Hogue et al., 2018).

Tailoring Treatment to Gender and Developmental Stage

Effective treatment of drug use disorders in teens and young adults necessitates consideration of developmental stage and gender differences. Enhancing efficacy means modifying treatment strategies to conform to best practices for every population. Research indicates that the type of treatment may not have a significant effect on teenage girls; nevertheless, for teenage guys, specific approaches, like CBT with or without MET, appear promising. For young adult women, Treatment as Usual (TAU)—a combination of supportive psychotherapy, case management, and 12-step facilitation—proved to be more effective than other approaches in preventing future opioid use. Treatment strategies should be adapted to best practices for each population, with specific approaches showing promise for different demographics (Davis et al., 2019).

Tailoring Treatment to Gender and Developmental Stage

Gender and developmental stage significantly influence treatment outcomes:

For Teenage Boys: CBT, with or without MET, shows promising results. Tailored interventions considering boys' unique developmental needs may enhance outcomes (Davis et al., 2019).
For Teenage Girls: Evidence suggests that girls benefit from approaches addressing co-occurring psychiatric symptoms and social stressors, with buprenorphine-assisted treatment proving effective in reducing symptoms (Hammond et al., 2021).
For Young Women: Treatment as Usual (TAU), incorporating psychotherapy and 12-step facilitation, is particularly effective, especially when addressing mental health and trauma-related factors (Huhn et al., 2020).

Customized approaches ensure that treatment aligns with the unique needs of each individual.

A Call to Action: Building a Healthier Future

Addressing teen fentanyl usage calls for a multifaceted approach.

Raising Awareness: Educational initiatives aimed at parents, teenagers, and educators can dispel myths and highlight the risks of fentanyl.
Improving Access to Medication: Expanding FDA approvals and training more physicians in teenage OUD therapy is essential.
Community Involvement: Programs like CTC empower local communities implement effective preventative measures.
Family Engagement: Encouraging family involvement increases the support structures required for recovery.

By combining these approaches, we may help teenagers achieve a healthier, substance-free future.

Conclusion: A Multifaceted Strategy for a Healthier Future:

Fighting teenage fentanyl use requires a multifaceted strategy that incorporates awareness-raising, medication access, evidence-based treatment tailored to each patient's needs, and family involvement. By dispelling misconceptions, addressing barriers, and using evidence-based practices, our youth can look forward to a brighter, substance-free future. With the right strategy based on recent research, navigating the complexities and guiding adolescents toward a healthier future is possible.