Comparison of Pharmacological Treatments for Opioid-Dependent Adolescents

Marsch, Lisa A.; Bickel, Warren K.; Badger, Gary J.; Stothart, Marne E.; Quesnel, Kimberly J.; Stanger, Catherine; Brooklyn, John

doi:10.1001/archpsyc.62.10.1157

Cited by 181 publications

(157 citation statements)

References 56 publications

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“…Opiate use by adolescents has more than doubled in the past 10 years (Marsch et al, 2005), increasing the urgency for understanding how adolescents respond to opiate drugs. Periadolescence in rats is defined as the 7-10 days preceding the onset of puberty (day 40) (Spear and Brake, 1983;Laviola et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

Behavioral and Electrophysiological Evidence for Opioid Tolerance in Adolescent Rats

Ingram

Fossum

Morgan

2006

Neuropsychopharmacol

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Morphine and other opiates are successful treatments for pain, but their usefulness is limited by the development of tolerance. Given that recent studies have observed differential sensitivity to drugs of abuse in adolescents, the aim of this study was to assess antinociceptive tolerance to morphine in adolescent rats using both behavioral and cellular measures. Early (28-35 days postnatal) and late (50-59 days) adolescent and adult (73-75 days) male rats were injected with morphine (5 mg/kg, s.c.) or saline twice a day for two consecutive days. On Day 3, tolerance to morphine was evident in morphine-pretreated rats when tested on the hot plate test. Although baseline latencies for the early compared to late adolescent rats were faster, the magnitude of the shift in ED 50 for morphine was similar for the two adolescent groups. However, the shift in ED 50 tended to be greater in adolescent compared to adult rats. Subsequent to behavioral testing, whole cell patch-clamp recordings were made from ventrolateral PAG neurons. The opioid agonist, met-enkephalin (ME), activated similar outward currents in PAG neurons of early and late adolescent rats. However, reversal potentials of ME-induced currents were shifted to more hyperpolarized potentials in cells from morphine-pretreated rats. In addition, ME induced larger currents in morphine-pretreated rats with faster hot plate latencies compared to the mean (more tolerant) than in rats with slower latencies. These results indicate that repeated intermittent administration of morphine produces tolerance in adolescent rats that is associated with novel changes in opioid-sensitive ventrolateral PAG neurons.

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Section: Discussionmentioning

confidence: 99%

Behavioral and Electrophysiological Evidence for Opioid Tolerance in Adolescent Rats

Ingram

Fossum

Morgan

2006

Neuropsychopharmacol

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“…Buprenorphine, particularly with naloxone, is favoured by some due to its better tolerability, adverse event profile, and easier dose reduction to abstinence. An RCT compared buprenorphine with clonidine in detoxification of 36 opioid-dependent adolescents (13-18 years old; Marsch et al, 2005) (Ib). Buprenorphine improved retention in treatment for 1 month compared with clonidine (72% vs. 39%), provided more opiate-free urines (64% vs. 32%), and more started naltrexone afterwards (61% vs. 5%).…”

Section: Opioidsmentioning

confidence: 99%

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Welch²,

et al. 2012

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The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short-and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people. KeywordsSubstance misuse, addiction, guidelines, pharmacotherapy, comorbidity 1 Imperial College London, CNWL NHS Foundation Trust, London, UK 2 Gether NHS Foundation Trust, Gloucester, UK 3 Pennine Care NHS Foundation Trust, Ashton-under-Lyne, UKOther invited participants at the consensus meeting who contributed to the discussion and commented on the guidelines were Drummond C, Farrell M, Gilvarry E, Strang J. John, a user representative, read and commented on the written guidelines. Prof W van den Brink reviewed the written guidelines.

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“…An expansive body of research has shown the effectiveness of buprenorphine for treating adults with opioid use disorders, 14 and 2 randomized controlled trials have examined the therapeutic efficacy of buprenorphine combined with substance use counseling in adolescents and young adults. Marsch et al 15 found that adolescents 13 to 18 years of age who received 2 weeks of buprenorphine treatment were more likely to continue medical care compared with those who received clonidine for the same period of time. A trial conducted by Woody et al 16 compared 2 detoxification regimens among adolescents and young adults 15 to 21 years of age.…”

Section: Introductionmentioning

confidence: 99%

Medication-Assisted Treatment of Adolescents With Opioid Use Disorders

Levy¹,

Ryan²,

Gonzalez³

et al. 2016

Pediatrics

136

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Opioid use disorder is a leading cause of morbidity and mortality among US youth. Effective treatments, both medications and substance use disorder counseling, are available but underused, and access to developmentally appropriate treatment is severely restricted for adolescents and young adults. Resources to disseminate available therapies and to develop new treatments specifically for this age group are needed to save and improve lives of youth with opioid addiction.

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Comparison of Pharmacological Treatments for Opioid-Dependent Adolescents

Abstract: Combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions.

Cited by 181 publications

References 56 publications

Behavioral and Electrophysiological Evidence for Opioid Tolerance in Adolescent Rats

Behavioral and Electrophysiological Evidence for Opioid Tolerance in Adolescent Rats

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

Medication-Assisted Treatment of Adolescents With Opioid Use Disorders

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