Medication appears effective in treating teen heroin addiction

October 03, 2005

CHICAGO - In a comparison of two drugs prescribed to treat teenagers dependent on heroin and other opioids, the drug buprenorphine was more effective, especially in treatment retention, according to a study in the October issue of Archives of General Psychiatry, one of the JAMA/Archives journals.

The use of heroin among adolescents has more than doubled in the past ten years, and the use of prescription opiates, including controlled release oxycodone (OxyContin) and hydrocodone bitartrate and acetaminophen (Vicodin), has also increased, according to background information in the article. Opiates are the second most commonly abused class of illicit drugs among adolescents, second only to marijuana. Despite the need to identify effective treatments, virtually no research has been conducted to systematically characterize or evaluate treatment interventions for adolescent heroin and opioid abusers.

Lisa A. Marsch, Ph.D., and colleagues at the University of Vermont, Burlington, evaluated the relative efficacy of buprenorphine hydrochloride and another drug, clonidine hydrochloride, in detoxification of opioid-dependent teenagers. (Dr. Marsch is now with the National Development and Research Institutes and St. Luke's-Roosevelt Hospital Center, New York.) Buprenorphine hydrochloride treats opiate addiction by preventing symptoms of withdrawal from heroin and other opiates. Clonidine hydrochloride belongs to a class of drugs known as alpha-blockers. It is commonly prescribed to treat high blood pressure.

The researchers conducted a double-blind, randomized, controlled trial in an outpatient research clinic at the University of Vermont from October 2001 to December 2003. A volunteer sample of 36 opiate-dependent adolescents (aged 13-18) took part in the study. They were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Both drugs were provided along with behavioral counseling three times a week, and incentives contingent on opiate abstinence.

"Results clearly demonstrated that combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions," the authors report.

The major difference between the two medications was in treatment retention. Over the course of the 28-day detoxification program, 72 percent of those who received buprenorphine were retained in treatment, compared with 39 percent of the group receiving clonidine.

"Participants in both groups reported relief of withdrawal symptoms and drug-related human immunodeficiency virus risk behavior," the authors write. "Those in the buprenorphine condition generally reported more positive effects of the medication."

After detoxification, all teens in the study were offered continued treatment with the drug naltrexone hydrochloride, an alternative to methadone. A relatively high proportion of those in the buprenorphine group, 61 percent, accepted naltrexone treatment, compared with only five percent of those given clonidine. "Given the efficacy of naltrexone in promoting continued abstinence postdetoxification from opioids, this finding further underscores the importance of and likelihood of success with early intervention among opioid-dependent adolescents," the authors write.

"In sum, this research provides novel and clinically important empirical information regarding effective interventions for the largely unstudied and expanding population of opioid-dependent adolescents," they conclude. "Results demonstrate that buprenorphine combined with behavioral therapy is one such efficacious intervention for this population."

(Arch Gen Psychiatry. 2005;62:1157-1164. Available pre-embargo to the media at

Editor's Note: This study was sponsored by a grant from the National Institute on Drug Abuse, Bethesda, Md., and research funds from the Department of Psychiatry and the College of Medicine at the University of Vermont, Burlington.

Commentary: Adolescent Opioid Abuse

In an accompanying commentary, Charles P. O'Brien, M.D., Ph.D., of the University of Pennsylvania/Philadelphia VA Medical Center, Philadelphia, discusses the findings and says Marsch and colleagues are to be congratulated for conducting a double-blind study among teenagers.

"Despite the fact that substance abuse usually begins in adolescence, there are very few controlled studies of treatments for this group of patients. The study by Marsch and colleagues shows that double-blind clinical trials can be conducted in this group of patients," he writes. "Given the sometimes unexpected responses of adolescents to medications that have only been studied in adults, such clinical trials are badly needed."

(Arch Gen Psychiatry. 2005;62:1165. Available pre-embargo to the media at

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail .

The JAMA Network Journals

Related Clinical Trials Articles from Brightsurf:

Nearly 1 in 5 cancer patients less likely to enroll in clinical trials during pandemic
A significant portion of cancer patients may be less likely to enroll in a clinical trial due to the ongoing coronavirus pandemic.

COVID-19 clinical trials lack diversity
Despite disproportionately higher rates of COVID-19 infection, hospitalization and death among people of color, minority groups are significantly underrepresented in COVID-19 clinical trials.

Why we should trust registered clinical trials
In a time when we have to rely on clinical trials for COVID-19 drugs and vaccines, a new study brings good news about the credibility of registered clinical trials.

Inclusion of children in clinical trials of treatments for COVID-19
This Viewpoint discusses the exclusion of children from coronavirus disease 2019 (COVID-19) clinical trials and why that could harm treatment options for children.

Review evaluates how AI could boost the success of clinical trials
In a review publishing July 17, 2019 in the journal Trends in Pharmacological Sciences, researchers examined how artificial intelligence (AI) could affect drug development in the coming decade.

Kidney patients are neglected in clinical trials
The exclusion of patients with kidney diseases from clinical trials remains an unsolved problem that hinders optimal care of these patients.

Clinical trials beginning for possible preeclampsia treatment
For over 20 years, a team of researchers at Lund University has worked on developing a drug against preeclampsia -- a serious disorder which annually affects around 9 million pregnant women worldwide and is one of the main causes of death in both mothers and unborn babies.

Underenrollment in clinical trials: Patients not the problem
The authors of the study published this month in the Journal of Clinical Oncology investigated why many cancer clinical trials fail to enroll enough patients.

When designing clinical trials for huntington's disease, first ask the experts
Progress in understanding the genetic mutation responsible for Huntington's disease (HD) and at least some molecular underpinnings of the disease has resulted in a new era of clinical testing of potential treatments.

New ALS therapy in clinical trials
New research led by Washington University School of Medicine in St.

Read More: Clinical Trials News and Clinical Trials Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to