Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth

CONTEXT
The prevalence of heroin and other opioid use has markedly increased among adolescents in the last decade; however, virtually no research has been conducted to identify effective treatments for this population.


OBJECTIVE
To evaluate the relative efficacy of 2 pharmacotherapies, the partial opioid agonist buprenorphine hydrochloride and the centrally active alpha(2)-adrenergic blocker clonidine hydrochloride, in the detoxification of opioid-dependent adolescents.


DESIGN, SETTING, AND PATIENTS
A double-blind, double-dummy, parallel-groups randomized controlled trial conducted in a university-based research clinic from October 2001 to December 2003. Patients were a volunteer sample of 36 adolescents who met DSM-IV criteria for opioid dependence (ages 13-18 years eligible).


INTERVENTIONS
Participants were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Both medications were provided along with thrice weekly behavioral counseling and incentives contingent on opiate abstinence. Postdetoxification, all participants were offered the opportunity for continued treatment with the opiate antagonist, naltrexone hydrochloride.


MAIN OUTCOME MEASURES
Treatment retention, opiate abstinence, and human immunodeficiency virus risk behavior, along with measures of withdrawal and medication effects.


RESULTS
A significantly greater percentage of adolescents who received buprenorphine were retained in treatment (72%) relative to those who received clonidine (39%) (P<.05). For those in the buprenorphine group, a significantly higher percentage of scheduled urine test results were opiate negative (64% vs 32%; P = .01). Participants in both groups reported relief of withdrawal symptoms and drug-related human immunodeficiency virus risk behavior. Those in the buprenorphine condition generally reported more positive effects of the medication. No evidence of opioid intoxication or psychomotor impairment was observed. Sixty-one percent of participants in the buprenorphine condition and 5% of those in the clonidine group initiated treatment with naltrexone.


CONCLUSION
Combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions.

Comparison of Pharmacological Treatments for Opioid-Dependent Adolescents

The aim of this study was to compare retention and re-entry to treatment between adolescent subjects treated with methadone, those treated with buprenorphine, and those treated with symptomatic (non-opioid) medication only. We used a retrospective file review of all patients aged less than 18 at first presentation for treatment for opioid dependence. The study was conducted at the Langton Centre, Sydney, Australia, an agency specialising in the treatment of alcohol and other drug dependency. Sixty-one adolescents (age range 14 – 17 years at the time of commencing treatment); mean reported age of initiation of heroin use was 14 ± 1.3 years (range 11 – 16). Sixty-one per cent were female. The first episode of treatment was methadone maintenance in 20 subjects, buprenorphine in 25, symptomatic medication in 15; one patient underwent assessment only. These 61 subjects had a total of 112 episodes of treatment. Subjects treated with methadone had significantly longer retention in first treatment episode than su...

Treatment retention in adolescent patients treated with methadone or buprenorphine for opioid dependence: a file review.

Much progress has been made in terms of improved diagnostic techniques for individual disorders, i.e. substance misuse or psychiatric disorders. Some progress has been made for the application of these assessment procedures for combined disorders, thereby providing prevalence rates which vary widely due to the methodological problems. Far less progress has been made in the understanding of the natural history and outcome of combined disorders. Relatively little research has been carried out on treatment strategies for people with dual disorders (including polysubstance abuse and dependence). As a consequence, appropriate multidisciplinary and multispecialty service developments, training and research have not been a focus. Awareness of the scale and nature of the problem is important for commissioners and providers so that resources are targeted appropriately.

Substance Misuse and Psychiatric Comorbidity: towards improved service provision

Outcome of heroin-dependent adolescents presenting for opiate substitution treatment.

In 1996 an innovative multidisciplinary community drug service for adolescents was established in Stoke on Trent, UK. For the first time the profile of adolescent heroin dependents who access the service is described. A picture of extreme vulnerability emerges: early age (mean = 11.8 years) of initiation into substance use, rapid development of heroin dependence, concurrent polypro use, injecting behavior and deliberate self-harm. Retention in treatment was achieved in 80%, despite a background of social deprivation and criminality. This local information extends and confirms national data. The policy response must be the establishment and outcome evaluation of n few pilot projects.

Tip of the National Iceberg?: profile of adolescent patients prescribed methadone in an innovative community drug service

This paper describes the initiation and development of the first designated service for adolescent drug misusers in the UK between 1995 and 1997. The priorities and objectives of the multi-agency partnership and multi-professional team were to provide the first recognized designated methadone service for adolescent drug misusers, to identify and treat psychiatric comorbidity and to co-ordinate and liaise with other agencies and professionals. The objectives to attract, engage and retain adolescent drug misusers into treatment were achieved with 272 young people attending. The project has provided a service in an appropriate environment, staffed by personnel competent in responding effectively to the complex needs with which these young people present. Protocols have been developed which ensure a focused and timely response, and highlight the frustrations inherent in the absence of a designated service. Since there are few models of good practice nationally, and, as a result, even less outcome research, th...

The Development of a Unique Designated Community Drug Service for Adolescents: policy, prevention and education implications

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Tip of the National Iceberg?: profile of adolescent patients prescribed methadone in an innovative community drug service

The Development of a Unique Designated Community Drug Service for Adolescents: policy, prevention and education implications