Adolescents addicted to opioids responded better to buprenorphine than clonidine in a clinical trial in which all patients also received behavioral therapy. In the NIDA-supported comparison trial at the University of Vermont, adolescents who received buprenorphine attended more scheduled counseling sessions than peers who received clonidine and had higher rates of successful induction to a relapse prevention regimen of naltrexone. The study, led by Dr. Lisa Marsch, is the first published randomized controlled study of treatments for adolescents addicted to opioids.
"Heroin abuse among American teens has doubled over the past decade, and abuse of prescription opioids such as OxyContin and Vicodin has increased even more," says Dr. Marsch. "In light of those figures, it's important to have a scientific basis for selecting treatments for opioid-dependent teens. We know from previous research and clinical experience that buprenorphine and, to a lesser extent, clonidine are among the medications that have been shown to be effective for treating opioid-addicted adults, but we haven't known how helpful they can be for adolescents."
Dr. Marsch and colleagues enrolled 36 opioid-addicted adolescents, aged 13 to 18, in a 28-day outpatient treatment program. Half the participants (9 male, 9 female) received buprenorphine in tablet form, the rest (5 male, 13 female) clonidine via transdermal patch; each patient also was given a placebo resembling the other treatment. Medication dosages varied depending on each participant's weight and the amount of drug he or she reported abusing before beginning treatment; dosages of buprenorphine were in the low to moderate range of those typically given to opioid-addicted adults.
All participants also received behavioral therapy based on the Community Reinforcement Approach: three 1-hour sessions each week of counseling on methods to minimize involvement in situations that might lead to drug-taking, training to help recognize and control urges to abuse opioids, and encouragement to recruit family members as allies for abstinence. Participants earned vouchers worth $2.50 for the first opioid-negative urine sample, plus an additional $1.25 for each subsequent one, and a $10 bonus for each set of three consecutive negative samples. Continuous abstinence could earn participants $152.50 in vouchers redeemable for rewards such as ski passes, CDs, gym passes, and clothing.
Buprenorphine and clonidine both supported high rates of abstinence. Among participants who completed treatment, rates were 78 percent and 81 percent, respectively, confirmed by urine samples provided at the thrice-weekly sessions. However, nearly twice as many buprenorphine as clonidine recipients completed the 4-week treatment (72 percent compared with 39 percent). "The high rate of retention in the buprenorphine group is particularly noteworthy," Dr. Marsch says, "because long-term success in recovery is directly related to the amount of time patients spend in treatment." And, she adds, the willingness of most patients who received buprenorphine to continue treatment with naltrexone following completion of the 28-day program is similarly encouraging. Sixty-one percent of the buprenorphine group, but only 5 percent of those who received clonidine accepted naltrexone.
"Dr. Marsch's research is an important first step in systematically studying adolescents who are addicted to opioids," says Dr. Ivan Montoya of NIDA's Division of Pharmacotherapies and Medical Consequences of Drug Abuse. "We know that there are differences in the patterns of opiate abuse and addiction in young people compared with adults. We need dedicated studies like this one to understand how teens are affected by opiate drugs and how best to treat them."
The next step in Dr. Marsch's research will involve a larger sample of young opioid abusers. "We want to evaluate buprenorphine's effectiveness if treatment is extended to 2 months rather than 28 days," she says. "We will also examine the most effective doses and dosing regimens for various subgroups of young patients."
Marsch, L.A., et al. Comparison of pharmacological treatments for opioid-dependent adolescents: A randomized controlled trial. Archives of General Psychiatry 62(10):1157-1164, 2005. [Abstract]