Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth A randomized trial

George E. Woody, Sabrina A. Poole, Geetha Subramaniam, Karen Dugosh, Michael Bogenschutz, Patrick Abbott, Ashwin Patkar, Mark Publicker, Karen McCain, Jennifer Sharpe Potter, Robert Forman, Victoria Vetter, Laura McNicholas, Jack Blaine, Kevin G. Lynch, Paul Fudala

Research output: Contribution to journalArticlepeer-review

243 Scopus citations

Abstract

Context: The usual treatment for opioid-addicted youth is detoxification and counseling. Extended medication-assisted therapy may be more helpful. Objective: To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth. Design, Setting, and Patients: Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper (detox). Interventions: 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. Main Outcome Measure: Opioid-positive urine test result at weeks 4, 8, and 12. Results: The number of patients younger than 18 years was too small to analyze separately, but 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 (χ22=4.93, P=.09). At week 4, 59 detox patients had positive results (61%; 95% confidence interval [CI]=47%-75%) vs 58 12-week buprenorphine-naloxone patients (26%; 95% CI=14%-38%). At week 8, 53 detox patients had positive results (54%; 95% CI=38%-70%) vs 52 12-week buprenorphine-naloxone patients (23%; 95% CI=11%-35%). At week 12, 53 detox patients had positive results (51%; 95% CI=35%-67%) vs 49 12-week buprenorphine-naloxone patients (43%; 95% CI=29%-57%). By week 12, 16 of 78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week buprenorphinenaloxone patients (70%; χ12=32.90, P<.001). During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less opioid use (χ1 2 = 18.45, P<.001), less injecting (χ1 2=6.00, P=.01), and less nonstudy addiction treatment (χ12=25.82, P<.001). High levels of opioid use occurred in both groups at follow-up. Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12. Conclusions: Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification. Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence. Trial Registration clinicaltrials.gov Identifier: NCT00078130.

Original languageEnglish (US)
Pages (from-to)2003-2011
Number of pages9
JournalJAMA - Journal of the American Medical Association
Volume300
Issue number17
DOIs
StatePublished - Nov 5 2008

ASJC Scopus subject areas

  • Medicine(all)

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