Adolescents addicted to opioids who received continuing treatment with the combination medication buprenorphine-naloxone had lower rates of testing positive or reporting use of opioids compared to youths who went through a short-term detoxification program using the same medication, according to a study in the November 5 issue of JAMA.
Recent data suggest that abuse of opioids, including heroin and prescription pain-relief drugs, is increasing among adolescents, according to background information in the article. "The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months. Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist [a drug that mimics the action of a naturally occurring substance] medication," the authors write.
George Woody, M.D., of the University of Pennsylvania, Philadelphia, and colleagues conducted a study comparing outcomes of treating opioid addiction among adolescents with extended treatment using buprenorphine-naloxone vs. short-term detoxification. Buprenorphine is an oral medication that acts by relieving the symptoms of opiate withdrawal. Naloxone is a drug that prevents or reverses the effects of opioids if it is injected. The study included 152 patients, age 15 to 21 years. Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg. per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg. per day and then tapered to day 14. All were offered weekly individual and group counseling.
The researchers found that overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12. At week 4, 61 percent of detox patients had positive results vs. 26 percent of the 12-week buprenorphine-naloxone patients. At week 8, 54 percent of detox patients had positive results vs. 23 percent of 12-week buprenorphine-naloxone patients. At week 12, 51 percent of detox patients had positive results vs. 43 percent of buprenorphine-naloxone patients, who by that time had been tapered off their medication.
By week 12, 20.5 percent of detox patients remained in treatment vs. 70 percent of 12-week buprenorphine-naloxone patients. During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less use of opioids, cocaine and marijuana, less injecting, and less need for additional addiction treatment. High levels of opioid use occurred in both groups at follow-up.
"Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group," the authors write.
"Because much opioid addiction treatment has shifted from inpatient to outpatient where buprenorphine-naloxone can be administered, having it available in primary care, family practice, and adolescent programs has the potential to expand the treatment options currently available to opioid-addicted youth and significantly improve outcomes. Other effective medications, or longer and more intensive psychosocial treatments, may have similarly positive results. Studies are needed to explore these possibilities and to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence."
Editorial: Treatment of Adolescent Opioid Dependence - No Quick Fix
In an accompanying editorial, David A. Fiellin, M.D., of the Yale University School of Medicine, New Haven, Conn., writes that there is a need for more evidence regarding effective opioid-addiction treatments.
"The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling; close monitoring for relapse; and, in some cases, naltrexone should be offered following buprenorphine tapers. From a research perspective, additional efforts are needed to provide a stronger evidence base from which to make recommendations for adolescents who use opioids. There is limited research on prevention of opioid experimentation and effective strategies to identify experimentation and intercede to disrupt the transition from opioid use to abuse and dependence."
- George E. Woody; Sabrina A. Poole; Geetha Subramaniam; Karen Dugosh; Michael Bogenschutz; Patrick Abbott; Ashwin Patkar; Mark Publicker; Karen McCain; Jennifer Sharpe Potter; Robert Forman; Victoria Vetter; Laura McNicholas; Jack Blaine; Kevin G. Lynch; Paul Fudala. Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth: A Randomized Trial. JAMA, 2008; 300 (17): 2003-2011 [link]
- David A. Fiellin. Treatment of Adolescent Opioid Dependence: No Quick Fix. JAMA, 2008; 300 (17): 2057-2059 [link]
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