Outcome of heroin-dependent adolescents presenting for opiate substitution treatment

Abstract

Because the outcome of methadone and buprenorphine substitution treatment in adolescents is unclear, we completed a retrospective cohort study of 100 consecutive heroin-dependent adolescents who sought these treatments over an 8-year recruitment period. The participants' average age was 16.6 years, and 54 were female. Half of the patient group remained in treatment for over 1 year. Among those still in treatment at 12 months, 39% demonstrated abstinence from heroin. The final route of departure from the treatment program was via planned detox for 22%, dropout for 32%, and imprisonment for 8%. The remaining 39% were transferred elsewhere for ongoing opiate substitution treatment after a median period of 23 months of treatment. Males were more likely to exit via imprisonment (p < .05), but other outcomes were not predicted by gender. There were no deaths during treatment among these 100 patients who had a cumulative period of 129 person years at risk. Our findings suggest that this treatment delivers reductions in heroin use and that one fifth of patients will exit treatment following detox completion within a 1- to 2-year time frame.

Report on the first government-funded opioid substitution programme for heroin users in the Western Cape Province, South Africa

“…However, abstinence from illicit opiates in this group was very low, as shown by the exceptionally high proportion of participants (80.6%) testing positive compared with other longer-term treatment programmes. [21][22] While this may reflect international experience that longer periods than the SBRC's 12-week programme are necessary for higher abstinence, a possible reason for the low rate could be the high rate (54.8%) of concomitant use of other potentially destabilising drugs, which often leads to impulsive use of heroin during rehabilitation. [17] In addition, so that more participants could be included in a setting where funding was limited, a lower dose of the opiate analogue was used (median 4 mg) than that required to suppress illicit opioid use.…”

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

“…Attrition and dropout seem to be important factors hindering to maximize treatment outcome in opioid dependent youth (Warden et al, 2012;Bell & Mutch, 2006;Burns et al, 2009;Marsch et al, 2005;Woody et al, 2008;Smyth et al, 2012;Matson et al, 2014). However, retention and abstinence during buprenorphine treatment have been associated with better outcomes in youth (Subramaniam et al, 2011;Woody et al, 2008;Matson et al, 2014) and adults (Armstrong et al, 2010;Mintzer et al, 2007).…”

“…In this context, retention in treatment of opioid dependence was investigated mostly in adults, with studies lasting 6 months (O'Connor et al, 1996;Fiellin et al, 2006;Armstrong et al, 2010) and those lasting 18 months or more (Fiellin et al, 2008;Parran et al, 2010). In youths, BUP/NAL treatment outcomes including retention were less examined in short-term (Marsch et al, 2005;Woody et al, 2008) and long-term (Smyth et al, 2012;Matson et al, 2014) studies conducted in outpatient settings. It is not known whether inpatient admissions impact the outcomes of BUP/NAL treatment.…”

Review on Treatment of Substance Use Disorders

“…Recent studies report drop-out rates ranging from 21.5-43% in detoxification [89,90] outpatient treatment 23-50% [91,92], inpatient treatment 17-57% [93] and substitution treatment 32-67.7% [94,95]. A meta-analysis of psychotherapy found a dropout rate between 19 and 47% [96].…”