UNITED STATES — A growing body of research shows that adolescents in the United States face significant barriers to accessing effective drug treatment, a gap that is especially acute for young people who become involved in the juvenile legal system. A study published in Health Affairs finds that adolescents ages 12 to 17 often struggle to access and remain engaged in treatment because of a lack of youth-specific care and limited availability of appropriate medications for opioid use disorder.
The Prison Policy Initiative reports that opioid use disorder among young people is a serious but frequently overlooked public health issue. Data from the National Survey on Drug Use and Health show that 1.3% of children ages 12 to 17 reported an opioid use disorder. While the percentage may appear small, it represents approximately 342,000 children—more than the total population of Newark, New Jersey. The Prison Policy Institute notes that the U.S. public health system’s capacity to provide effective treatment programs and medications has a profound impact on children’s health and long-term development.
Youth treatment opportunities remain limited. A 2025 Health Affairs study shows that fewer than one in three children with opioid use disorder can access essential medications and age-appropriate care. These findings have significant implications for how young people interact with the criminal and juvenile legal systems.
Children in juvenile systems already experience high rates of mental health and substance use disorders, which are linked to higher rates of reoffending, according to a National Institutes of Health study.
Rather than prioritizing effective treatment for all children in need, many U.S. communities have relied on stigmatizing approaches toward drug use, often through “zero-tolerance” school policies. According to the Prison Policy Institute, these policies have resulted in children being denied essential care and pushed out of educational and social settings, based on the mistaken belief that stigma or incarceration leads to improvement.
An NIH study on drug abuse indicates that 70% of high school students have tried alcohol, about half have used an illegal drug, nearly 40% have smoked cigarettes, and more than 20% have used a prescription drug for nonmedical purposes. At this developmental stage, substance use can significantly affect brain development. The NIH study emphasizes that access to effective treatment during adolescence is critical.
The Prison Policy Initiative highlights that the nation is failing to adequately address this challenge. Only 31% of children ages 12 to 17 with an opioid use disorder received any form of treatment in the past year. These low treatment rates are particularly troubling, given the extent to which drug use is criminalized. Treatment options are even more limited and often less effective within the juvenile legal system.
This situation is especially alarming because treatment in carceral settings is generally less effective and raises ethical concerns, and involvement in the juvenile legal system often occurs late in the trajectory of substance use—when earlier intervention could have made a difference.
A separate NIH study found that outpatient settings, excluding schools and medical offices, are the most common treatment environments for children. Schools, however, offer a unique opportunity to reach a broad range of young people and can improve access to care and treatment engagement, particularly for female, African American and Hispanic/Latinx adolescents.
When children are unable or unwilling to obtain necessary care, they often face punitive responses through the juvenile legal system. Significant racial and socioeconomic disparities persist in youth drug treatment access. According to the Prison Policy Institute, only about 3% of Black children ages 12 to 17 received treatment for a substance use disorder in the past year, compared with about 9% of white children.
Despite similar rates of drug use across racial groups, Black children account for a disproportionate 24% of confined youth for drug offenses, while representing only 14% of the overall youth population.
The new research also found that only about 8% of adolescents who needed medications for opioid use disorder received them in the past year, compared with 19% of adults. While the use of these medications in adolescent-focused treatment has increased over time, availability still falls far short of actual need, according to the Prison Policy Institute.
The Prison Policy Institute argues that youth should be treated within their communities rather than removed for punishment or treatment. This approach includes community-based care and proactive outreach efforts. For children already involved in the juvenile legal system, the institute contends that courts should ensure access to effective, evidence-based substance use treatment.
Recent research underscores the need for improved community-based opioid screening, expanded access to evidence-based therapies, and targeted efforts to address geographic disparities. Ultimately, the findings point toward a public health approach that prioritizes young people and works to eliminate stigma and criminalization as barriers to care.
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