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Youth and the Opioid Epidemic. The current epidemic of opioid addiction has arguably been the most recalcitrant in the nation's history and the first to involve substantial numbers of adolescents. The country has embarked on a public health response, including increasing access to addiction treatment. However, the treatment infrastructure, which was initially created in the 1970s, is ill equipped for meeting the needs of adolescents and young adults, who are often cared for in pediatric primary care. In this article, I review the development of the current treatment system, examine shortfalls in regard to youth-specific needs, and propose suggestions for addressing the current crisis while simultaneously preparing to address future epidemics of addiction by enabling pediatricians to better manage substance use disorders in primary care.