One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit

Mutlu, Caner; Demirci, Arzu Ciftci; Yalcin, Ozhan; Kılıçoğlu, Ali Güven; Topal, Melike; Karaçetin, Gül

doi:10.1016/j.jsat.2016.04.002

Cited by 13 publications

(10 citation statements)

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“…Those two studies examined methadone treatment. A number of studies examining use of buprenorphine in other settings report much higher rates of attrition among adolescent patients [16–18]. In contrast to Bell & Mutch, we found no significant difference between the two opioid agonist medications, although many patients in our study did switch from buprenorphine to methadone during treatment [16].…”

Section: Discussioncontrasting

confidence: 95%

“…There was no upper ceiling dose used in this service and our finding may indicate that dose was appropriately titrated against clinical need. There is research to indicate increased heroin use at lower OST doses in both adolescents and adults [18, 27]. In contrast, Kellogg et al detected greater heroin use among young adults on higher methadone doses [15].…”

Section: Discussionmentioning

confidence: 99%

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Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

2018

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BackgroundOpioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment.MethodsWe included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis.ResultsOST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9–36%) at month three and it was 46% (95% CI = 30–63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry.ConclusionsWe found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1137-4) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

2018

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“…Among the nine included in this review, four examined buprenorphine only, two examined methadone only, one examined buprenorphine and extended‐release naltrexone and two examined buprenorphine and methadone. Additionally, within the nine observational studies, only one study described how pre‐existing mental health conditions affected treatment outcome (Mutlu et al, 2016). Of the remaining studies, five did not report on psychiatric comorbidities, while the remaining three simply reported prevalence, which was between 50 and 90% (Kellogg et al, 2006; Smyth et al, 2012; Vo et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

“…Three retrospective cohort studies reported 1‐year retention rates for buprenorphine treatment near 10% (Dayal & Balhara, 2017; Matson et al, 2014; Mutlu et al, 2016). Retention rates were much higher at the beginning of buprenorphine treatment: 69.9% at 30 days reported by Mutlu et al ( N = 112), 45% at 60 days reported by Matson et al ( N = 103) and 33.8% at 90 days reported by Dayal and Balhara ( N = 68).…”

Section: Resultsmentioning

confidence: 99%

Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Westenberg

Tai

Elsner

et al. 2021

Early Intervention Psych

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Aim First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high‐risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high‐risk opioid use among youth. After full‐text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost‐effectiveness for opioid agonist treatment than abstinence‐based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions From the limited findings, there is no evidence to deny youth with high‐risk opioid use the same treatment options available to adults. A combination of pharmacological and youth‐specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.

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“…Conversely, observational data on young adults with OUD who received a short (3-day) buprenorphine detoxification in an outpatient setting, indicate lower rates of abstinence (12% abstinent at six months)(Gandhi et al, 2003) although these rates are higher when detoxification is implemented in residential treatment settings (approximately 31-43% at six months) (Schuman-Olivier et al, 2014b). In terms of retention, published observational studies have generally reported six-month retention rates ranging from 25% (Matson et al, 2014) to 40 % (Schuman-Olivier et al, 2014a; Vo et al, 2016) and one-year retention rates between 9-17% (Smyth et al, 2012; Matson et al, 2014; Schuman-Olivier et al, 2014a; Mutlu et al.). Importantly, close to one-fourth of youth who receive an induction leave treatment within the first week (Bell et al, 2006; Matson et al, 2014) but anywhere from one-fourth to one-half of youth who drop out of treatment will come back within a year (Bell et al, 2006; Matson et al, 2014; Mutlu et al.…”

Section: Observational Studiesmentioning

confidence: 99%

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

Borodovsky

Levy

Fishman

et al. 2018

Journal of Addiction Medicine

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: 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.

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One-Year Follow-Up of Heroin-Dependent Adolescents Treated with Buprenorfine/Naloxone for the First Time in a Substance Treatment Unit

Cited by 13 publications

References 35 publications

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

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

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