Teens treated for addiction to heroin or prescription painkillers are less likely to continue using these drugs if they receive extended treatment with a combination of detoxification medications, rather than short-term drug therapy, a new study found.
Both buprenorphine and naloxone have been shown to be effective in treating opioid addiction, but only limited use of these drugs has been recommended for younger patients. Buprenorphine works by relieving withdrawal symptoms and naloxone prevents or reverses the effects of injected opioids.
"If you keep these young kids, average one-and-a-half years of addiction, on buprenorphine-naloxone they did a lot better," said lead study author Dr. George Woody, a professor at the University of Pennsylvania's Department of Psychiatry. "When you took them off the buprenorphine-naloxone, their opioid use went up."
Among the 15-to-21-year-olds in the study, 55 percent used heroin, 35 percent used prescription opioids such as Vicodin and Oxycontin, and 10 percent said they used both heroin and prescription painkillers, Woody said.
"Treatment programs for kids with a short addiction history have traditionally been reluctant to use the medications for anything other than short-term detoxification," Woody said. "With opioid-addicted kids you should reconsider that reluctance."
The findings are published in the Nov. 5 issue of theJournal of the American Medical Association.
For the study, Woody's team randomly assigned 152 young people to 12 weeks of treatment with buprenorphine and naloxone, or to two weeks of treatment with the same drug combination. Patients in both groups also received individual and group counseling.
The researchers found that patients receiving extended treatment had more urine tests that were positive for opioids at weeks four and eight, than at week 12. By the fourth week of treatment, 26 percent of extended-therapy patients had positive urine tests, compared to 61 percent of the short-term therapy patients.
By week eight of treatment, 54 percent of those on short-term therapy tested positive for opioids, compared with 23 percent of those on long-term treatment. After 12 weeks, 51 percent of those on short-term therapy screened positive for opioids, compared with 43 percent of those on extended drug therapy. By that time, those on extended treatment had been weaned off their medications, the researchers noted.
In addition, at 12 weeks, just 20.5 percent of the patients who received short-term drug treatment remained in treatment, compared with 70 percent of those in the extended treatment group. And, patients receiving extended treatment reported less use of opioids, cocaine and marijuana, less injecting, and less need for additional addiction treatment.
Dr. David A. Fiellin, an associate professor of medicine at Yale University School of Medicine and author of an accompanying editorial in the journal, noted that there has been an increase in the use of prescription painkillers and other opioids among teens and young adults.
The prevalence of the use of the opiod hydrocodone is reported to be 3 percent among eighth graders, 7 percent among 10th graders, and 10 percent in 12th graders, he noted.
"Most adolescents and young adults initiate their drug use early on, prior to the age of 23," Fiellin said. "In 2007, probably, 200,000 to 400,000 adolescents were playing with these medications [Vicodin and Oxycontin], taking them in a way that is not appropriate, and a fair number of those individuals will become dependant or addicted," he said.
What this study shows is that these young patients do better when they are on buprenorphine-naloxone for an extended period of time, Fiellin said.