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November 10, 2008
Longer Treatment Improves Outcomes for Opioid-Addicted Youth
Young adults addicted to opioids were more successful at remaining drug-free when they received 12 weeks of treatment with the combination medication buprenorphine-naloxone than those who received the same treatment for only 2 weeks. The findings suggest that longer-term pharmacological treatment, along with counseling, could be beneficial to adolescents who want to break their opioid addictions.
Abuse of opioids—including heroin, morphine and certain prescription painkillers—remains a problem among adolescents nationwide, according to recent studies. The standard treatment is short-term detoxification and counseling. However, relapse continues to be a major challenge.
The new clinical trial, supported by NIH's National Institute on Drug Abuse (NIDA), compared the effectiveness of short- and long-term treatment regimens that included counseling and the prescription medication Suboxone. Suboxone is a combination of 2 medications—buprenorphine and naloxone—in a single tablet. Buprenorphine works by acting on the brain's opiate receptors to relieve withdrawal and cravings without prompting the same intense high and dangerous side effects as other opioids. Naloxone is added to discourage patients from abusing the tablets by crushing and injecting them. Naloxone blocks the effects of opiates when injected, leading to severe and immediate withdrawal symptoms, but has no adverse effects when taken orally as prescribed.
The investigators recruited 154 opioid-addicted patients aged 15 to 21 at 6 outpatient substance abuse treatment clinics around the country. The patients had been addicted to opioids for an average of 1.5 years. All the participants were offered group and individual counseling for 12 weeks. In addition, they were randomly assigned to either 2 weeks of detoxification using Suboxone or 12 weeks of extended Suboxone treatment. In the latter group, the daily dose of Suboxone was gradually tapered downward starting at week 9, and the drug was discontinued at week 12.
The study results, published in the November 5, 2008, edition of the Journal of the American Medical Association, showed that urine samples from patients in the extended-treatment group were much less likely to have evidence of opioid use at weeks 4 and 8 than those in the standard detoxification group. During the first 12-week period, patients who continued to take Suboxone were less likely to use opioids, cocaine and marijuana, to inject drugs or drop out of treatment than those who received short-term detoxification and counseling. By week 12, however, when the extended-term medications had tapered off, the 2 groups had similar rates of opioid use.
Follow-up evaluations continued for a year and showed that rates of opioid use climbed in both groups compared to the end of the treatment period; however, the rates remained somewhat lower in both groups than before treatment, particularly in the extended-treatment group. Although patients were young, the study's results resembled those of older adults with longer term opioid dependence.
“These findings should reassure and encourage providers who have been hesitant to offer extended Suboxone treatment to this population,” said NIDA Director Dr. Nora Volkow. “They also highlight the need for longer-term studies to determine whether sustained treatment can improve outcomes.”