Buprenorphine Treatment for Adolescents and Young Adults With Opioid Use Disorders: A Narrative Review

Abstract

: In the past decade, a new cohort of adolescents and young adults with opioid use disorders (OUD) has emerged. While medications and psychosocial treatments are available, few adolescents and young adults with OUD can access and remain in treatment. Effective, practical, and scalable treatment paradigms for this young population are needed. Buprenorphine is a medication with unique pharmacological and regulatory characteristics that make it a promising component of adolescent and young adult OUD treatment models. Three randomized controlled trials and multiple observational studies have evaluated the use of buprenorphine to treat this population. However, data from these studies have not been consolidated into an up-to-date summary that may be useful to clinicians. The objective of this narrative review is to inform clinical practice by summarizing results of primary and secondary analyses from randomized controlled clinical trials and observational studies that have evaluated the use of buprenorphine to treat adolescents and young adults with OUD. Based on results from these studies, we encourage the conceptualization of OUD among youth as a chronic medical condition requiring a long-term management strategy. This includes treatment with buprenorphine in conjunction with medication-prescribing protocols that do not necessarily require daily clinic attendance for observed medication adherence. However, more study of treatment delivery models, addressing such issues as medication adherence and intensity requirements, is needed to determine practices that optimize outcomes for youth.

Adolescent Substance Use Disorder Treatment: an Update on Evidence-Based Strategies

“…Given only modest efficacy of current psychosocial treatments, pharmacotherapy has been explored as a potential complement to the standard of care [46•]. However, there is limited data regarding the efficacy of pharmacotherapy in treating adolescent SUDs; there are currently no FDA-approved pharmacotherapies for adolescent SUDs other than buprenorphine, which has been indicated down to age 16 for opioid use disorder and has demonstrated efficacy and feasibility among treating opioid-using adolescents [47][48][49][50][51].…”

A pilot randomized controlled trial of assertive treatment including family involvement and home delivery of medication for young adults with opioid use disorder

“…Medications for OUD (MOUD: methadone, buprenorphine and extended‐release naltrexone) are the standard of care [3,4]. Despite the evidence, uptake of MOUD in youth remains alarmingly low, and compared to older adults, adolescents and young adults with OUD tend to have poorer engagement in and response to MOUD [5–11], due probably to developmental vulnerabilities [6,12–19].…”

Age related medication for addiction treatment (MAT) use for opioid use disorder among Medicaid-insured patients in New York

“…Existing studies in New York have focused on older beneficiaries [19] and young adults are an understudied population. [20, 21] Access to substance use disorder treatment services have been challenging, especially for young adults who prefer buprenorphine and naltrexone compared to methadone [22, 23], as limited access to buprenorphine providers have been an ongoing problem [24]. Age effects of the current epidemic have been understudied, especially research on MAT [25].…”