Pharmacologically Assisted Treatment of Opioid-Dependent Youth
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Opioid misuse, abuse, and dependence are global problems whose patterns vary across cultures. In the USA, the non-medical use of prescription opioids has become particularly serious because of its association with addiction and overdose death. Agonist and antagonist medications have been shown to be effective for opioid-dependent adults, and there is a growing body of data that they are also effective for youth. Here, we summarize evidence that detoxification alone results in high rates of treatment dropout and relapse but that the limited but growing data on the extended use of medication-assisted treatment for opioid-dependent youth have been positive. The implementation of medication-assisted treatment as a standard practice is feasible, easily integrated with counseling or psychotherapy, and has potential to greatly improve outcomes. Although concerns about safety and efficacy with youth require more research, and we do not advocate indefinite maintenance, we suggest that opioid-dependent youth should be considered as candidates for medication-assisted treatment delivered in a comprehensive, developmentally appropriate context, beginning at the first episode of care, with the strength of the recommendation to use medication increasing with each care episode.
KeywordsHeroin Buprenorphine Naltrexone Opioid Dependence Prescription Opioid
No funding sources were used to prepare this article, but MF is a member of the Clinical Advisory Board for Orexo, which manufactures a buprenorphine product for which it is seeking FDA approval. MF has an equity interest in a community treatment provider (Maryland Treatment Centers) at which youth opioid treatment is delivered, including medications. GW and AP received salary support from NIDA U10 DA-13043, and GW received salary support from NIDA KO5 DA-17009. GW was the principal investigator of a Clinical Trials Network (CTN) study on buprenorphine among adolescents in which the medication was supplied by Reckitt-Benckiser, and Alkermes has provided XR-NTX for a study in which he is a co-investigator. MF received salary support from NIDA R01 DA02455301, NIDA-VA CS #1030, and NIDA-VA CS #1031. MF participated in a CTN study on buprenorphine among adolescents in which the medication was supplied by Reckitt-Benckiser, and Alkermes has provided XR-NTX for a study in which he is a co-investigator. GP is a co-investigator of a study of Suboxone® and methadone for HIV risk reduction, funded by National Institute on Drug Abuse grants R21-DA-026754, U10 DA-13043, and KO5 DA-17009. Reckitt Benckiser supplied Suboxone® for the trial. MM and AP report no conflicts of interest.
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