Long-acting Injectable Naltrexone and Buprenorphine-naloxone Well-tolerated in Youth With Opioid Use Disorder One Month Post-initiation

Medication for opioid use disorder (MOUD) is prescribed at relatively low rates in youth with OUD. This study examined adverse events one month after initiation of MOUD in youth aged 15–21 who were transitioning from residential to outpatient OUD treatment. Participants (N=199) were categorized into one of three groups based on their residential discharge regimen: no medication (n=71), sublingual buprenorphine-naloxone (n=59), or long-acting injectable naltrexone (LAI-naltrexone; n=69).

• The LAI-naltrexone cohort reported the most adverse events overall; 62 percent experienced an injection site reaction, accounting for 43 percent of total adverse events in this group.
• When excluding injection site reactions (since these were unique in this study to the mode of administering LAI-naltrexone), there was no significant difference between adverse events across groups.
• Nonfatal overdoses occurred in six participants: five in the no medication cohort, one in the buprenorphine-naloxone cohort, and none in the LAI-naltrexone cohort.

Comments: Both sublingual buprenorphine-naloxone and LAI-naltrexone appear to be relatively well-tolerated in youth one-month post-initiation, but MOUD remains underutilized in youth despite proven reduction in opioid-related morbidity and mortality in the general population. These medications should be strongly considered by clinicians when treating adolescents and young adults with OUD. Future studies could focus on assessment of adverse events further down respective treatment timelines.

Emily Nields, DO

Reference: Terplan M, O’Grady KE, Monico LB, et al. Adverse events at 1 month following medication initiation for opioid use disorder among adolescents and young adults. Subst Use Addctn J. 2025;46(1):72–77.