Engaging and Retaining Young People in OUD Treatment: Making the Wish Come True

In this episode of ASAM Practice Pearls, Dr. Stephen Taylor welcomes Dr. Marc Fishman for an insightful conversation on improving engagement and retention of youth in medication treatment for opioid use disorder (MOUD). They examine the unique challenges young people face and present developmentally informed strategies—including prevention, family involvement, and assertive outreach. The discussion highlights the importance of a medication-first approach and building partnerships with schools and communities to foster long-term recovery.

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Host

Stephen M. Taylor, MD, MPH, DFAPA, DFASAM

Dr. Stephen M. Taylor is ASAM's President and is board-certified in general psychiatry, child and adolescent psychiatry, addiction psychiatry, and addiction medicine. With over 30 years of practice experience, Dr. Taylor is dedicated to helping adolescents and adults overcome addiction and co-occurring psychiatric disorders. He has served as the Medical Director of the NBA and NBPA Player Assistance and Anti-Drug Program for 16 years and is the Chief Medical Officer of Pathway Healthcare, which operates multiple outpatient addiction and mental health treatment offices across six states. 

Expert

Marc Fishman, MD

Dr. Marc Fishman is a specialist in addiction psychiatry and addiction medicine. He is a member of the faculty of the Department of Psychiatry at the Johns Hopkins University School of Medicine. He leads Maryland Treatment Centers, which offers programs for residential and outpatient treatment of SUD and co-occurring disorders in adolescents, young adults, and adults. He has been a principal investigator on numerous research studies in addiction and has published extensively in the field. His academic focus has been on medication treatment for OUD and other SUDs, treatment of opioid use disorder in youth, models of care, and treatment engagement strategies. Dr. Fishman served as a co-editor for past editions of ASAM’s Patient Placement Criteria, leading the adolescent section, and served as the chief editor for the ASAM PPC Supplement on Pharmacotherapies for Alcohol Use Disorders. He was a member of the Guideline Committee that developed the ASAM National Practice Guideline for the Treatment of OUD in 2015 and its update in 2020. He is the chair of the Adolescent SIG for ASAM. He is a Past President of the Maryland Society of Addiction Medicine and a current member of its Board.

📖 Show Segments

• 00:05 – Introduction
• 00:17 – Introductory Vignette: Pediatric Onset of Addiction 
• 02:26 – Current Statistics and Challenges in Youth OUD 
• 03:58 – Early Intervention 
• 05:38 – Three Types of Prevention 
• 06:17 – Barriers and Challenges to Effective Treatment for Youth 
• 10:36 – The Role of Family in Treatment  
• 15:47 – Unique Strengths of Youth 
• 17:44 – Extended-Release Medications for OUD
• 21:21 – Motivating Youth in Treatment 
• 24:49 – Engaging Schools in Care
• 26:56 – Assertive Approaches to Youth OUD Treatment
• 29:32 – Final Thoughts
• 31:47 – Conclusion and Additional Learning Opportunities

📋 Key Takeaways

• Initiate Early Intervention: Addiction is a developmental disorder of pediatric onset. Early intervention is necessary to prevent the disorder from progressing to its advanced stages. 
• Encourage Family Involvement: Incorporate family or a designated concerned significant other in the treatment process to support the young patient and improve adherence. 
• Implement Youth-Specific Treatment Approaches: Understand the unique developmental and psychological challenges youths face, and tailor engagement methods to include humor, their interests, therapeutic alliances, and empathy. 
• Promote Collaboration with Other Youth-Friendly Settings: Collaborate with schools, pediatricians, and other primary care practitioners to identify and support youth with substance use to promote treatment and facilitate their reintegration into educational environments. 
• Adopt an Assertive Approach: Utilize assertive outreach methods, such as frequent texting and continuous communication, to maintain young patients' engagement in their treatment plans. 
• Employ a Medication Forward Approach: Advocate for the use of medications for opioid use disorder (MOUD) early in the treatment process as a foundational step towards recovery. 
• Integrate Holistic Treatment Plans: Develop multi-component treatment plans that address not only the substance use but also the overall well-being and functional aspects of the young person’s life. 
• Utilize Extended-Release Medications: Extended-release medications, such as buprenorphine and naltrexone, are safe and effective options that can improve adherence and retention in treatment among young people.
• Promote Location-Based Interventions: Make treatments accessible by integrating them into environments where youths already are, such as schools, family practices, specialized addiction treatment settings, or juvenile justice settings. 
• Set Realistic Expectations: Medication doesn’t have to be a lifelong commitment. Focus on the present moment, setting realistic, short-term treatment goals to establish initial stabilization and momentum for recovery. 

🔗 Resources

• ASAM’s 56th Annual Conference Session: Improving Outcomes for Youth OUD Treatment Register HERE
• Joint Meeting on Youth Prevention, Treatment, and Recovery: A conference focused on supporting youth in recovery from substance use.
• Youth Opioid Recovery Support (YORS) Intervention Study: A clinical trial designed to improve medication adherence in young adults 18–28 with opioid use disorder (OUD) through home delivery of extended-release medications, family involvement, digital communication outreach, and contingency management to increase treatment engagement and reduce return to use rates. 
• A Pilot Randomized Controlled Trial of Assertive Treatment Including Family Involvement and Home Delivery of Medication for Young Adults With Opioid Use Disorder: Fishman M, Wenzel K, Vo H, Wildberger J, Burgower R. Addiction. 2021;116(3):548-557. doi:10.1111/add.15181
• An Assertive Community Intervention to Engage Youth with Opioid Use Disorder and Their Families: Wenzel K, Mallik-Kane K, Anderson K, Fishman M. Child Adolesc Psychiatr Clin N Am. 2024;33(4):709-728. doi:10.1016/j.chc.2024.02.007
• Choice of Extended Release Medication for OUD in Young Adults (Buprenorphine or Naltrexone): A Pilot Enhancement of the Youth Opioid Recovery Support (YORS) Intervention: Wenzel K, Selby V, Wildberger J, Lavorato L, Thomas J, Fishman M. J Subst Abuse Treat. 2021;125:108306. doi:10.1016/j.jsat.2021.108306
• Engagement, Initiation, and Retention in Medication Treatment for Opioid Use Disorder Among Young Adults: A Narrative Review of Challenges and Opportunities: Fishman M, Wenzel K, Gauthier P, et al. J Subst Use Addict Treat. 2024;166:209352. doi:10.1016/j.josat.2024.209352
• The Use of Extended-Release Buprenorphine in the Treatment of Adolescent Opioid Use Disorder: A Case Series: Neptune A, Kaliamurthy S. J Addict Med. Published online February 3, 2025. doi:10.1097/ADM.0000000000001447

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