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Reuters Health Information (2008-11-04): Extended therapy may benefit opioid-addicted youth


Extended therapy may benefit opioid-addicted youth

Last Updated: 2008-11-04 16:00:32 -0400 (Reuters Health)

NEW YORK (Reuters Health) - New research suggests that extended treatment with buprenorphine-naloxone may be superior to short-term detox with these drugs in reducing opioid use in addicted teenagers and young adults. With either approach, however, relapse on long-term follow-up is common.

In the a study, 152 patients, 15 to 21 years of age, were randomized to receive buprenorphine-naloxone at up to 24 mg per day for 9 weeks with a taper to 12 weeks, or the drug combo at up to 14 mg per day with a taper to 14 days (detox group).

Compared with the detox group, the extended therapy group had lower rates of opioid-positive urine test results at both 4 weeks (26% vs. 61%) and 8 weeks (23% vs. 54%), lead author Dr. George E. Woody, from the University of Pennsylvania, Philadelphia, and colleagues report in the Journal of the American Medical Association for November 5.

At week 12, however, the rates in the extended therapy and detox groups were not significantly different, 43% and 51%, respectively.

Extended therapy patients were more likely to remain in treatment at week 12 than were detox patients: 70% vs. 20.5% (p < 0.001).

Participation in extended therapy was also associated with significant reductions in reported opioid use, injecting behavior, and addiction treatment outside the study (p < 0.05 for all).

Despite the gains seen, at 12-month follow-up, most patients in each group reported opioid use, the report indicates.

"The high rate of relapse seen with both medication taper protocols in the current trial ... combined with the adverse social, legal, and infectious consequences of opioid dependence -- and the risk for overdose with relapse -- makes the need for rigorous evidence in this area urgent," Dr. David A. Fiellin, from Yale University School of Medicine, New Haven, Connecticut, writes in a related editorial.

"These findings are another important reminder that there are no quick fixes for opioid dependence."

JAMA 2008;300:2003-2011,2057-2059.

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