A new nationwide study published in Health Affairs finds that adolescents aged 12 to 17 struggle to access and remain engaged in treatment, often because they are not offered youth-tailored treatment and gold-standard opioid use disorder medications.
Opioid use disorder among young people is a serious but often overlooked issue in the United States. In a national 2023 survey, 1.3% of kids between the ages of 12 and 17 reported an opioid use disorder.1 While 1.3% might not sound like a lot, it represents around 342,000 children — more than the total population of Newark, New Jersey.2 The U.S. public health system’s capacity to provide the best treatment programs and medications to these kids has life-altering consequences, influencing children’s health and development.
Unfortunately, such youth treatment opportunities are rare. A new study, published in the September 2025 issue of Health Affairs, shows that fewer than 1 in 3 kids with an opioid use disorder receive critical medications and age appropriate care. These findings have serious implications for youth contact with the criminal and juvenile legal systems, as drug use and treatment access are significant predictors of involvement in both. For the youngest kids already involved in the juvenile legal system, substance misuse is a strong predictor of violent reoffending. But rather than prioritize the delivery of the best available treatments to all children who need them, communities around the U.S. have instead stigmatized kids who use drugs, including through the use of “zero tolerance” school policies. This has created a terrible situation in which kids are routinely denied the care they need. Instead, they face educational and social exclusion on the same premise that has failed countless adults struggling with substance use disorders: that they can only be forced to “get better” through stigma, incarceration, or both.
In this briefing, we dive into this new research on the scarcity of treatment for young people with opioid use disorders, based on the most recently available national data. We also look at critical early intervention opportunities highlighted in the research, which can improve treatment access and the quality of care, and divert kids from the school-to-prison pipeline along the way.
Youth lack access to opioid use disorder treatments
Most people who develop a substance use disorder begin using drugs before the age of 18, with the highest risk among those who begin using during their early teenage years. At this stage of life, drug use can influence brain development, so it’s extraordinarily important to connect kids to early, effective treatment during this time.
But the U.S. is not rising to meet this challenge. The researchers who conducted the new study found that less than one-third (31%) of kids aged 12 to 17 with an opioid use disorder received any treatment in the past year — a similar but slightly smaller proportion than that of adults (34%). These low levels of treatment uptake are alarming given how heavily drug use is criminalized, since treatment options are even scarcer and less effective in the juvenile legal system: only around 26% of kids confined for drug offenses were held in residential treatment centers in 2023. Kids should not be removed from their communities and forced into drug treatment, and while this figure is not limited to opioid-related drug cases, it’s nonetheless notable that just over 1 in 4 kids confined for drug offenses are placed in treatment facilities.
This is especially problematic for two reasons: first, treatment is far less effective (and less ethical) in carceral environments, and second, the juvenile legal system is a relatively late-stage gateway for accessing treatment. Earlier interventions in the community (such as in schools) can ensure greater access among youth, and prevent their exposure to the cascading negative effects of criminalization. Community-based interventions are also more effective and consistent, which is important because adolescents have lower treatment retention rates than adults. Because youth struggle to remain engaged in treatment, the earlier they start with the best existing treatment protocols, the better.
The new study also finds that fewer than 1 in 4 (around 23%) treatment facilities reported offering a specifically adolescent-tailored group or program. In other words, a small proportion of treatment facilities serving kids actually design their offerings to meet adolescents’ specific developmental and psychosocial needs. The availability of facilities with adolescent-tailored programs varies considerably by region; generally speaking, there are fewer of these tailored facilities in the southeastern U.S.
Treatment settings. The researchers identified outpatient settings (excluding schools or medical offices) as the most common treatment settings for kids, followed by school health or counseling centers and emergency departments or hospitals. They note that schools (the second-most frequently reported setting for treatment) are particularly critical intervention points for engaging adolescents in screening and treatment because they are the only place that all children are required to attend. Schools present an opportunity to reach the most children from the widest variety of backgrounds, and can yield better access to care and treatment engagement for female, African American, and Hispanic/Latinx adolescents. Engaging kids in school with treatment rather than exclusion would represent a meaningful shift away from the school-to-prison pipeline.
Referrals. Schools had some of the lowest rates of referral (4%) despite their outsized potential for linking kids to treatment. Instead, aside from self-referrals or referrals from friends and families, the criminal legal system was the most common source of referral for adolescent opioid related treatment admissions (nearly 28%) — more so than for adult treatment admissions (17%). This is particularly troubling given that kids are often ushered into the juvenile legal system under the false hope that they can “receive services” while locked up. These settings are exceptionally abusive toward kids and costly to society, but more to the point, they also foster conditions that are counterproductive to actually providing effective treatment.
When kids don’t get the care that they need, they’re at risk of being punished for it through the juvenile legal system. But not all kids fall through the cracks at the same rates; youth drug use and treatment are compounded by race, ethnicity, and socioeconomic status. A separate study found that only around 3% of Black children aged 12 to 17 received medical treatment for substance use disorder in the past year, compared to around 9% of white kids. These disparities follow kids into the juvenile legal system. Even though white youth and youth of color have similar rates of drug use, Black children make up a significantly higher proportion of confined youth for drug offenses compared to their proportion of the overall population: 24% of kids confined for drug offenses were Black, despite making up only 14% of the population.
Medications for opioid use disorder are often out of reach for young people
One reason kids struggle to remain engaged in treatment may be that medications for opioid use disorder are rarely provided to them despite the recommendations of the American Academy of Pediatrics and Society for Adolescent Health and Medicine, which call for greater access to these medications for young people.
In the new study, the researchers found that the rate of receiving medications for opioid use disorder among those who need it was nearly 8% for adolescents in the past year, compared to 19% in adults in the past year. Such medications were listed in treatment plans for less than 10% of adolescent treatment admissions, compared to a much higher proportion of adult admissions (36%). While the researchers found that these medications have been included in a growing proportion of adolescent-tailored treatment plans over the years, they remain too limited compared to the level of need.
The scarcity of these gold-standard treatments is possibly explained by several factors, including stigma among healthcare providers and family concerns. In carceral settings, medications for opioid use disorder are often seen by skeptical non-medical staff as “substituting one drug for another.” But they nonetheless can and should be made more widely available. Buprenorphine has been approved by the Food and Drug Administration for use by youth aged 16 or older, and it’s also been prescribed off-label for younger adolescents. These medications do more than just treat substance use disorders; they save lives. Between 2018 and 2023, rates of opioid-relateddeaths amongU.S. children aged 12 to 17 grew an astounding 280%.3 To put this into perspective, overdose deaths rose by a comparatively smaller (but no less troubling) 65% in adults aged 18 and over during the same time period.4
Conclusion
Effective medications and treatments exist for kids with opioid use disorder, but they are not being provided at scale, nor equitably. There are better, earlier intervention points like schools for reaching the most kids with these treatments, but these same institutions instead cave to stigma and funnel kids into the juvenile punishment system. The end result of these failures is that young people who use drugs are being needlessly set up to suffer and die, and the U.S. is dooming itself to a future in which there are many more adults and communities left to struggle with these same issues.
The best approaches are ones that can connect particularly vulnerable youth populations to direct them into treatment via gateways like schools. This involves community-based treatment, proactive outreach by people who know the local community and culture, and the development of treatment programs tailored to the needs of the participants. Kids should not be removed from their community for treatment (or to be punished). But for youth already involved in the juvenile legal system, courts and probation departments should at the very least ensure young kids who use drugs are offered the most effective substance use treatments.
This new research points toward several opportunities to change course by strengthening community-based adolescent opioid use disorder screening and treatment engagement efforts, pursuing evidenced-based treatment options including gold-standard medications, and tackling geographic disparities in access to treatments tailored for youth. What’s needed is an embrace of these public health measures for the good of all children, and an end to their exclusion, stigmatization, and criminalization.
Footnotes
For comparison, 2.1% of people over 18 and 2.2% of people over 26 self-reported an opioid use disorder in 2023. ↩
According to the CDC WONDER database, among children aged 12 to 17, there were 162 overdose deaths in 2018 compared to 589 in 2023. Expressed as a rate, that’s 0.6 deaths per 100,000 kids in 2018 compared to 2.3 deaths per 100,000 kids in 2023. ↩
According to the CDC WONDER database, among adults over the age of 18, there were 54,996 overdose deaths in 2018 compared to 91,460 overdose deaths in 2023. Expressed as a rate, that’s 21.7 deaths per 100,000 adults compared to 34.9 deaths per 100,000 adults in 2023. ↩
Failing to make it to a court appearance – routine for attorneys and witnesses – leads to 19 million additional nights in jail each year for people accused of crimes.
Of all the reasons people get sent to jail, forgetting an appointment has to be among the least justifiable. Around 5.6 million people are booked into local jail each year in the United States. With some people arrested more than once, total jail bookings are even higher, at over 7.9 million in 2024. Produced in collaboration with the Jail Data Initiative (JDI), this briefing provides new evidence on jail bookings for people arrested for “failing to appear” in court — a typically innocent mistake that is treated as a crime in and of itself, sometimes called “bail jumping.” According to our national, lower-bound estimates presented here for the first time, at least 1 in 8 jail bookings are connected to failure to make it to a court appearance (13%), and about half of those had only failure to appear (FTA) charges. This means 546,000 jail bookings were due to arrests where the only matter at hand was an FTA warrant, not any other criminal offense. In fact, if no one was sent to jail for missing court, there would be 52,000 fewer people in jail each day nationwide, and 19 million fewer nights spent in jail each year.
Of course, people charged with a crime have a legal duty to appear in court, as do their attorneys and any witnesses, including police officers. While preventable, missed court dates are common among all of these groups of people, across the board. In particular, police officers called to testify frequently miss scheduled hearings, at rates nearly double those of defendants.1 Yet, in many places, defendants alone face the harsh consequences of jail for what typically boils down to scheduling problems.
Jailing people shouldn’t be the first response to a court date that can be re-scheduled; it’s harmful to defendants, bogs down courts systems, and it’s expensive to keep people in jail. Instead, courts can implement practical, proven solutions to help prevent non-appearance, such as mailed notices and automated phone calls or text message reminders to ensure people have the information they need to get to court; grace periods for people who could not attend for reasons out of their control; and options to reschedule hearings instead of issuing warrants. Many courts still fail to take these basic steps and instead respond to this common problem by arresting defendants, leading to unnecessary, costly, and harmful jail stays. Further, community-based supports that strengthen the safety net for everyone could provide people what they need to make their day in court. This briefing shows the scope of the problem at the national level, using new evidence from the Jail Data Initiative.
Key findings
In new data from 562 jails, we find that more than 1 in 8 jail bookings (13%) are related to a failure to appear (FTA), and more than half of those are FTA only.2 That may not sound like many, but because so many people cycle through jails annually, these numbers add up quickly: Across the United States each year, there are around 1,033,000 jail bookings involving people facing FTA charges (either alone or alongside other criminal charges). Roughly 546,000 — or over half — of those jail bookings are due only to a failure to make it to a court appearance.
The problem is widespread — but it is clearly worse in some communities. In 27% of the jails in our sample, FTAs were associated with 1 in 5 or more bookings — significantly more than the share of bookings nationally. Arrests and bookings into jail for FTA appear to be especially common in Washington (1 in 3 bookings), Alabama (1 in 4 bookings), and Arkansas, Kentucky, and North Carolina (1 in 5 bookings).3 (Unfortunately, the sample of jails that provide this information is not large enough in every state to provide a comprehensive, state-by-state analysis of FTA prevalence among jail bookings.)
For the JDI jail sample that includes booking data by charge and sex, FTA charges make up a larger share of women’s bookings than men’s.4 This finding is consistent with other research that finds women are somewhat more likely to miss a court date than men.5 In the JDI data, 8.2% of women’s jail bookings have FTA as a sole charge compared to 6.6% of men’s jail bookings. Bookings with FTA in combination with other charges bumps the numbers up to 14.8% for women and 12.7% for men. Researchers have pointed to unmet child care needs, medical issues, and transportation problems that might especially impact women, but the data remain scant on what drives missed court dates for women. Race does not appear to have a meaningful impact on court appearance rates.
Of the jails in the sample that include charge severity (i.e., felony versus misdemeanor) and FTA data, over one-third of all FTA-related bookings were for misdemeanors. While a small share of total bookings, this suggests that a not-insignificant number of people are jailed for missing court dates for what might otherwise be non-jailable offenses.
Troublingly — both for people charged with crimes and for crowded local jails — FTA charges appear to contribute to longer stays in jail. The median length of stay for jail bookings without an FTA is 4 days (average is 32.1 days), but with an FTA-related case, it doubles to 8 days (average is 33.6 days). This is likely because FTA also contributes to higher bail amounts, and in many cases, fewer release options as some courts require detention until a hearing on the case related to the warrant can be scheduled.6
How missing a court date can result in a jail booking — and why that’s bad policy
Most people arrested and charged with a crime are released while their case proceeds. While a case can sometimes be resolved (or dismissed) at the first appearance, it often involves multiple court dates after the initial arraignment and before hearings or sentencing. In turn, that means there are often multiple opportunities to “fail to appear” (FTA) in the course of a single case. Since jury trials have all but vanished due to the heavy leverage that prosecutors have to extract a guilty plea, when people miss court, they are usually missing hearings related to testimony or the motions on the case connected to evidence and discovery. Some courts have made it easier for defendants to appear virtually or even to waive certain appearances — practices that can reduce FTA arrests.
While the number of people booked into jail on FTA warrants might suggest a serious problem with court attendance, defendant no-show rates aren’t really unusually high. A 2009 estimate, the most recent national one available, indicated 17% of released defendants in felony cases from large urban counties missed at least one court date.7 A recent no-show estimate for medical appointments was 18%.8 City-specific studies have shown that when they need to testify as witnesses, police fail to appear in court in 31% of cases, nearly double the rate for defendants. Recent national data on state courts showed about 26% of people contacted for jury duty failed to respond, and that jury nonresponse or failure to appear rates have been trending upward.9
Reasons why people miss court include failing to understand the court notification or forgetting the appointment, dealing with competing responsibilities, lack of support for transportation or childcare, and past negative experiences with court. Recently, the Trump administration’s immigration agents have been arresting people that appear in court for hearings on criminal cases as defendants or witnesses, over the objection of local court leaders.10 Court reminders can’t solve those kinds of barriers.
Missed court appearances impact court operations and other parties. They lead to longer case processing times and add the burden of additional trips to court for victims or witnesses. But enforcement of these FTA warrants has a high cost as well. Issuing and clearing bench warrants and dealing with FTA charges contributes to further court backlogs and delays. Processing FTA arrests takes law enforcement time that could be spent responding to more serious crime. And detaining people while waiting for the next court date (which can be weeks away) leads to expensive jail stays, crowded jail conditions, and the additional burden on jail staff to transport defendants to court. In West Virginia, this expense motivated a 2023 reform that sought to reduce jail stays for failure to appear. Weighing the balance of the evidence, these FTA jail stays are expensive and likely counterproductive, even in terms of the limited goals of law enforcement.
The personal and economic consequences of even short stays in jail raise further questions about these counterproductive FTA jail bookings. Pretrial detention threatens employment, housing, and health, and leads to worse case outcomes. Court practice improvements that use reminders and grace periods can save money in terms of jail costs and reduce unnecessary, harmful disruption in people’s lives.
In contrast, evidence-based policy reforms exist that can reduce jail bookings for failure to appear (FTA), although they range widely in their impact on jail incarceration and ease of implementation. Automated text reminders can be effective at reducing FTAs, but as “nudges” they only help those who did not receive the information about their appearance or forgot. Still, these low-lift approaches have a proven track record of reducing FTAs, sometimes by as much as 30%.
When communities rely on police to respond to addiction and poverty, far too often this means criminalization and arrest rather than useful connections to community-based services. Automated reminders won’t help when those kinds of cases are churning through jails and court. (And a court reminder may also not help if federal immigration agents are arresting people at criminal courts.)
Technical reforms that make warrant issuance less likely and easier to solve once people appear in court include grace periods, alternative court scheduling or “open hours,” virtual appearance options, and simply making court information clearer. To be more helpful, these policies could be expanded. In West Virginia, the grace period created in 2023 is only 24 hours, but in New York it is 30 days. Mechanisms for clearing warrants without a trip to jail are especially useful. St. Louis County, Missouri developed the Tap In Center, a drop-in clinic at the public library for clearing warrants and getting new court dates in collaboration between public defenders, prosecutors, and The Bail Project.11 These and other voluntary pretrial services have demonstrated strong court appearance rates.
Ultimately, getting to the root of the problem requires a stronger safety net that ensures people’s basic needs are met. Affordable housing, transportation, childcare, and adequate health care could both reduce the kinds of problems where police are called in the first place and help people make it to a court hearing if they have one. Community-based supports that are not system-controlled might be a path forward, such as the 2024 Illinois Pretrial Success Act, which has funded grant programs for transportation and childcare to reduce FTAs.12 But universal programs that strengthen the safety net for everyone would also provide these kinds of benefits.
Conclusion
An innocently missed court date should not open a Pandora’s box of consequences, making already-difficult involvement in the criminal legal system even worse. There are so many different reasons why someone might miss court; responding to those absences with the blunt instrument of arrest makes little sense. More work is needed to accommodate people who want to attend court but can’t due to matters like a challenging work schedule or a lack of childcare, healthcare, or transportation, which are all out of their control. A strategy combining nudges like court date reminders with technical reforms expanding access to justice represent the floor of what can and should be done to reduce the number of people jailed for missing court.
Advocates can and should look beyond courts for solutions as well, and actually address these structural, routine obstacles to attendance that are part of peoples’ daily lives. This includes doing more to help those that shouldn’t have been arrested and brought to court in the first place. For those kinds of cases, community-based supports that strengthen the safety net for everyone will provide people ensnared in the justice system with the chance to handle their situation, and make their day in court.
Whatever reforms have been implemented, the new JDI data show the widespread use of jails as a response to FTA persists, despite a large body of evidence and lifetimes of lived experience that show just how harmful and counterproductive criminalizing court absences can be.
Methodology
Many counties have websites that post names and information about the people who have been arrested, booked into, and detained in their jail, often called jail rosters. These public rosters of jail bookings can assist loved ones or attorneys who are seeking to secure release on bail, call or visit. The Jail Data Initiative at the New York University Public Safety Lab collects these rosters in an automated way from local jails, and processes them into usable data for analysis. The Prison Policy Initiative has used this data for priorbriefings on jail bookings.
For our analysis of Failure to Appear, we used a dataset of 562 jail rosters that met the following criteria:
1) the rosters were collected at least 75% of the time during 2024
2) the rosters were first collected before 2024 and were also collected at some point in 2025
3) charge data was included for at least 1 jail booking on the roster
4) more than 1% of the bookings with charges listed included some indicator of Failure to Appear
There were four rosters that met these criteria but were excluded when the charge data were found to contain information from previous bookings. Jail bookings by sex were available for 512 rosters. Jail bookings by charge level (misdemeanor, felony, or unknown) were available for 132 rosters.
Booking records were standardized across rosters to account for when people first and last appeared on a jail roster, or if available, the specific date that people were booked into jail or released. For more information on how the Jail Data Initiative constructs “individuals” and “bookings” across time, please see their documentation. Jail bookings with admission dates before January 1, 2024 were removed. Similarly, any bookings with reported release dates after Dec 31, 2024 were removed. The sample of booking records was further filtered by removing duplicates and those missing charge information.
Bookings were identified as being related to failure to appear with the following key word search terms within charge information fields: “Failure to Appear,” “FTA,” and the combination of “fail” and “appear” as well as “bail” and “jump” or “bail” and “skip.” Some bookings had additional criminal charges listed. This approach is under-inclusive because in some jail rosters failure to appear may be coded more generally as a “detainer,” “hold,” or “capias” without a specific indicator that it relates to failure to appear in court.
In order to reach national estimates, we assume that FTA keywords were missing completely at random. Further, we assume the large sample of jail rosters approximates what the results would be with a random sample. Given these two assumptions, national estimates can be calculated by multiplying each rosters values with weights to reach a national estimate. The weights are the same for each roster, and are calculated by taking the ratio of the number of jail bookings nationally to the number of jail bookings on rosters in the sample.
In a substantial portion of the jails, FTAs were not tracked within criminal charges on rosters, and instead appear to be under “holds or detainers” which might lead to undercounting. (For more on data, see methodology). ↩
This is calculated as the share of the un-weighted sums of FTA related jail bookings across the state, divided by all jail bookings across the state among the counties that are in the JDI sample. The sample provides a broad view of bookings in these states: In Alabama, Arkansas, and Kentucky about half the counties have jail rosters included, and in North Carolina and Washington, about a quarter are included. ↩
The sample with this detail is slightly smaller, and covers bookings from 512 jails. ↩
In states like Texas, the penal code treats FTA as a separate offense, and standard bond schedules indicate a separate amount: $3,500 if failing to appear for a hearing on a felony, $500 to $1,000 on most misdemeanors. In contrast, in Los Angeles County, California, which used to require a $5,000 bond for an FTA, new procedures in the updated bail policy eliminates bail for FTA and many other offenses, but has a provision allowing for a magistrate to review a case when someone has three or more FTAs in the three prior years. ↩
Moreover, only 3% of released defendants had not returned to court within the one-year study period. The figures cited here come from Table 18 of the Bureau of Justice Statistics report Felony Defendants in Large Urban Counties, 2009. In general, there’s a lack of detailed national data from court systems, and the federal government has not collected data on court processing since 2009; a long-overdue update is reportedly “in the field” as of this publication date. ↩
This number comes from an audit of Veteran’s Health Administration clinics, discussed in Michael Davies et al., “Large-Scale No-Show Patterns and Distributions for Clinic Operational Research,” which finds that “No-show rates have been shown to range from 15%-30% in general medicine clinics and urban community centers.” ↩
We calculated 26% from Table 1 of the linked report section titled “Performance Measures for Jury Operations,” which starts on page 48 of the PDF. Looking at the two-step system data, we summed the nonresponse rate to qualification (22% of those who received a jury service notice) and the nonresponse/FTA rate to summoning (8% of the 48% who were qualified in step one, or about 4% of everyone contacted). The most recent nonresponse rate for one-step systems was 16%. ↩
Federal immigration arrests of defendants and witnesses at local criminal courts were introduced by the Trump administration in 2017, and have been expanded widely so far in 2025. ↩
