Medication appears effective in treating teen heroin addiction

09/29/05

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 www.jamamedia.org.)

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 www.jamamedia.org.)

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

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