Residential addiction treatment for adolescents is scarce and expensive

Jan. 9, 2024
NIH-supported analysis finds just seven states had a facility that accepted Medicaid, had a bed open the same day, and offered buprenorphine.

Access to residential addiction treatment centers caring for U.S. adolescents under 18 years old in the United States is limited and costly, according to a new study supported by the National Institutes of Health.

Researchers found that only about half (54%) of the residential addiction treatment facilities that they contacted had a bed immediately available, and for those that had a waitlist, the average estimated time before a bed opened was 28 days. In addition, the average daily cost per day of treatment was $878, with close to half (48%) of the facilities that provided information requiring partial or full payment upfront. On average, the quoted cost of a month’s stay at a residential addiction treatment facility was over $26,000.

Published in Health Affairs, this study was supported by the National Institute on Drug Abuse (NIDA) and the National Center for Advancing Translational Sciences (NCATS), both part of NIH, and led by researchers at Oregon Health & Science University (OHSU). The results build on previous research revealing that only one in four residential treatment centers caring for U.S. adolescents under 18 years old provide buprenorphine, a medication to treat opioid use disorder.

Residential treatment is one part of a broader continuum of care for adolescents with substance use disorders, in addition to treatment provided in outpatient, primary care, and other settings. However, little is known about the accessibility or cost of residential treatment for adolescents with opioid use disorder. To address this gap, researchers at OHSU sought to characterize treatment access and costs of U.S. residential treatment facilities that treat patients with opioid use disorder who are younger than age 18.

Using the database maintained by SAMHSA, and SpyFu, a search analytics company that compiles data on search engine advertisements, the researchers identified a list of 354 centers across the U.S. that indicated that they provided residential addiction treatment services to people under the age of 18 to include in the analysis.

Researchers called these facilities to inquire about treatment and services offered as potential users of these services for a 16-year-old with a recent non-fatal fentanyl overdose. Between October and December 2022, the study team called the facilities in a random order and confirmed that 160 (45%) of these facilities provided residential treatment to patients under the age of 18.

Of the 160 residential addiction treatment facilities found to provide treatment to young patients, the researchers found that 66 facilities (41%) were for-profit, and 94 facilities (59%) were nonprofit. For-profit treatment centers were more likely to have space immediately available (77%) compared to nonprofit facilities (39%) but at roughly triple the cost (on average, $1,211 reported daily cost for for-profit facilities vs. $395 for nonprofit facilities). Sixty-five facilities (40%) estimated the number of days until a bed opened. The average wait time for a bed in a for-profit facility was 19 days, and the average wait time for a bed in a nonprofit facility was 31 days.

The authors report that just over half of the facilities (57%) accepted Medicaid, with a stark contrast by facility profit orientation: One in five for-profits accepted Medicaid, compared with four in five nonprofits. In addition, in 23 states, researchers did not identify any adolescent residential treatment centers that accepted Medicaid. Overall, 57% of all facilities that accepted Medicaid reported a waitlist, compared to 19% of facilities that did not accept Medicaid.

Only seven states had a facility that accepted Medicaid, had a bed open the same day, and offered buprenorphine.

NIH release