Center for Addiction Medicine

12/05/2008 - Study Shows Extended Agonist Therapy Substantially Improves Outcomes of Opioid-Addicted Youth

Utilizing a prescription drug designed to aid in the treatment of opioid addiction may offer substantial improvement in the treatment of opioid-addicted youth.

In a study published in the November 5 issue of the Journal of the American Medical Association, extended therapy with buprenorphine-naloxone, marketed as Suboxone, significantly improved outcomes in youth addicted to opioid drugs, including heroin. The multicenter, randomized clinical trial tested the efficacy of extended addiction-related pharmacotherapy in 152 opioid-addicted patients age 15-21. Subjects in the test group were prescribed up to 24 mg per day of buprenorphine-naloxone for nine weeks, then tapered to week 12.

Researchers found subjects who received 12 weeks of buprenorphine-naloxone and counseling were considerably less likely to have opioid-positive urine tests when compared to those who received treatment with short-term detoxification (detox) that included buprenorphine-naloxone and counseling. Urine tests were evaluated at weeks four, eight and 12.

·         At week four, urine tests were positive for opioids in 59 detox patients and in 58 patients in the 12-week buprenorphine-naloxone group.

·         At week eight, urine tests were positive for opioids in 53 detox patients vs. 52 patients in the 12-week buprenorphine-naloxone group.

• At week 12, 53 detox patients had positive results vs. 49 in the 12-week buprenorphine-naloxone group.
• Treatment adherence through week 12 occurred in 16 (20.5%) of 78 detox patients vs. 52 (70%) of 74 patients in the 12-week buprenorphine-naloxone group.

In addition to reducing opioid use, treatment with buprenorphine-naloxone also reduced cocaine and marijuana use and improved adherence to counseling sessions.

More and more American youth are seeking treatment for opioid addiction, and treatment with Suboxone, according to the study, may offer a more effective treatment option for this population. Health care providers have been hesitant in the past to use agonist medication for an extended period of time in youth. However, investigators hope that the findings of this study will encourage clinicians to consider pharmacotherapy in younger patients with opioid addiction.

The idea behind the study was to compare an extended agonist therapy and counseling approach with the traditional treatment method of short-term detox and psychosocial counseling, a widespread practice that continues to yield high relapse rates. Medical practitioners have, in the past, resisted treating addiction with any type of medication. However, evidence, including this study, shows that when used appropriately, prescribed medications can be quite effective for addiction treatment.

Buprenorphine is a schedule III opioid partial agonist that has been successfully used to treat heroin addiction in adults and has a less intensive withdrawal than full agonists. In the medication Suboxone, it is combined with naloxone in a 4:1 ratio to reduce its abuse potential.

Buprenorphine-naloxone has an advantage over treatments like methadone because it can be used in a primary care setting, which may increase access to addiction treatment. The medication has also been shown in a number of studies to reduce the risk of death by overdose.

The findings of the study are promising for the increasing number of young Americans that struggle with opioid addiction, and should encourage physicians that specialize in addiction treatment to add extended therapy as a treatment option for young opioid-dependent patients.

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