Longer Treatment with Buprenorphine-Naloxone Improves Outcomes in Opioid-dependent Young Adults
The use of long-term opioid agonist and partial agonist medication (e.g., methadone or buprenorphine) is often reserved for older opioid-dependent individuals, while short medication tapers or medication-free treatment is offered to younger individuals. In a randomized trial, researchers evaluated the efficacy of buprenorphine-naloxone tapers of 2 versus 12 weeks in 152 younger subjects (mean age, 19 years) at 6 community programs around the country. Subjects had a median of 1 year of opioid dependence. All were offered weekly individual and group counseling. The primary findings were as follows:
- Twelve-week treatment with buprenorphine- naloxone was associated with greater treatment retention and decreased illicit opioid use—but only during the period that medication was provided.
- Patients in the 2-week taper group had higher proportions of opioidpositive urine test results at weeks 4 and 8 but not at week 12.
- Rates of self-reported opioid use were higher in the 2-week taper group than in the 12-week taper group (55% versus 38%) at 12 weeks, but a loss of this difference was seen at 6-month follow-up (63% versus 72%).
This well-designed and well-conducted study demonstrates that young opioid-dependent patients do better with longer, rather than shorter, periods of buprenorphine-naloxone treatment. The relatively high rate of relapse following discontinuation of medication supports longer term use, even in young patients with relatively short durations of opioid dependence. In young patients who undergo buprenorphine-naloxone taper, strategies to improve treatment outcomes, including counseling, contingencies, and alternative pharmacotherapies, may be needed to promote long-term abstinence and avoid the comorbid and fatal complications of opioid dependence.David A. Fiellin, MD
Woody GE, Poole SA, Subramaniam G, et al. Extended vs short-term buprenorphine- naloxone for treatment of opioid-addicted youth: a randomized trial. JAMA. 2008;300(17):2003–2011.