Extended treatment with combination medication for opioid-addicted youths shows benefit

November 04, 2008

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."

(JAMA. 2008;300[17]:2003-2011. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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."

(JAMA. 2008;300[17]:2057-2058. Available pre-embargo to the media at www.jamamedia.org)

Editor's Note: Please see the article for additional information, including financial disclosures, funding and support, etc.
-end-


The JAMA Network Journals

Related Opioids Articles from Brightsurf:

One in 10 older dental patients inappropriately prescribed opioids
A new study by researchers at the University of Illinois Chicago and the University of Pittsburgh suggests that a significant proportion of older patients receiving opioids at dental visits also use psychotropic medications -- a potentially harmful combination.

Look beyond opioids to solve national substance use epidemic, study suggests
A new study published reveals that three-quarters of participants in an inpatient addiction intervention program at Oregon Health & Science University came into the hospital using more than one substance.

Placenta can indicate how body responds to opioids during pregnancy
Scientists at the University of Missouri have discovered possible biological markers that they hope could one day help identify the presence of an opioid use disorder during human pregnancy.

Research Finds Women Often Overprescribed Opioids After Childbirth
Excessive opioid prescriptions following childbirth may lead to higher rates of addiction within communities, according to a new report in The Journal of the American Osteopathic Association.

Women significantly more likely to be prescribed opioids, study shows
Women are significantly more likely to receive prescriptions of opioid analgesics.

Opioids for chronic non-cancer pain doubled in quarter century
A review of 24 years of global research has shown opioid prescribing doubled between 1991-2015, with demand most common for chronic conditions such as chronic lower back pain, finds University of Sydney-led research.

Cancer screening among women prescribed opioids
US women who take prescription opioids are no less likely to receive key cancer screenings when compared to women who are not prescribed opioids.

Parents: Turkey makes great leftovers -- opioids do not
Leftover prescription opioids pose big risks to kids, yet most parents keep their own and their child's unused painkillers even after they're no longer medically necessary for pain.

Co-addiction of meth and opioids hinders treatment
A study published in the Journal of Substance Abuse Treatment found that methamphetamine use was associated with more than twice the risk for dropping out of treatment for opioid-use disorder.

Computer game may help to predict reuse of opioids
A computer betting game can help predict the likelihood that someone recovering from opioid addiction will reuse the pain-relieving drugs, a new study shows.

Read More: Opioids News and Opioids Current Events
Brightsurf.com 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 Amazon.com.