Access to adolescent residential addiction treatment in the United States is uneven, wait lists are long, and cost is high, a new comprehensive analysis found.
Using the Substance Abuse and Mental Health Services Administration, investigators identified 160 adolescent residential treatment facilities in the United States. More than one third had no available beds, and 10 states and Washington, DC, had no facilities at all. Half of the centers required an average up-front payment of nearly $30,000 for patients paying out of pocket.
"This study shows that affordable, timely, and effective treatment is severely lacking for the most vulnerable kids in our population," lead author Caroline King, MD, PhD, with Yale School of Medicine, New Haven, Connecticut, said in a news release.
"Systems level changes are needed to ensure effective, affordable treatment options for adolescents," added senior author Ryan Cook, PhD, research and training scientist for addiction medicine at Oregon Health & Science University (OHSU), Portland.
The study was published online on January 8, 2024, in Health Affairs.
Posing as the aunt or uncle of a 16-year-old seeking treatment after a recent nonfatal fentanyl overdose, they called each facility asking about policies, availability, and costs.
Among the 160 centers, 66 (41%) were for-profit and 94 (59%) were nonprofit.
Just over half of facilities accepted Medicaid, with a stark contrast by facility profit orientation: One in five for-profits accepted Medicaid, compared with four in five nonprofits.
Overall, 87 centers (54%) had a bed available immediately, 63 (39%) had no beds available or offered a wait list, 9 (6%) were unsure of bed availability, and 1 did not respond.
For-profit centers were more apt than nonprofit centers to a bed available that day (77% vs 395).
Among sites with a wait list, the average wait time for a bed was nearly 1 month (28 days), which is longer than among adult addiction treatment centers, which other research suggested an average wait time of 6 days.
Among the 108 facilities providing cost information, the average cost per day of treatment was $878. Daily costs among for-profit centers were triple those of nonprofit centers.
Nearly half of the facilities required some up-front payment by self-pay patients, with an average up-front cost of $28,731.
The mean monthly reported cost of treatment was $26,353 — twice the annual federal poverty level in 2022 for a single-person household ($13,590). "This is particularly striking, as opioid use disorder (OUD) disproportionately affects people with low socioeconomic status," King and colleagues noted.
According to federal data, median monthly overdose deaths among adolescents rose 109% from 2019 to 2021, and deaths involving illicitly manufactured fentanyl jumped 182%.
King and colleagues said research is needed to identify how best to expand access to affordable, evidence-based treatment for US adolescents with OUD.
Funding for the study was provided by grants from Oregon Health & Science University, the Agency for Healthcare Research and Quality, and the National Institute on Drug Abuse. Author disclosures are available with the original article.