Maintenance treatments for opiate dependent adolescent

Minozzi S, Amato L, Davoli M

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Summary

Maintenance treatments for opiate dependent adolescents

It is difficult to draw conclusions about the use of maintenance pharmacological interventions from only two trials. Substance abuse among adolescents (13 to 18 years old) is a serious and growing problem. The most common drugs used by young people worldwide are cannabis and inhalants. Psychostimulants (ecstasy and amphetamines), cocaine, LSD, heroin and other opioids are also used. Many adolescents who use heroin start by snorting it but some progress to injection. Heroin is used sporadically by the majority who use it, but it can become an addictive disorder. In adults, pharmacotherapy is a necessary and acceptable part of effective treatment for opioid dependence. Among adolescents, medications have been used infrequently and a choice has to be made between detoxification and maintenance treatment.
The review authors searched the literature and identified two controlled trials from the USA that involved 187 heroin addicts, aged 14 to 21 years; the participants were treated as outpatients. One study of 37 participants compared methadone with LAAM for maintenance treatment. After 16 weeks of maintenance treatment the adolescents were detoxified. The two maintenance treatments gave similar improvements in social functioning. No side effects were reported.
The second trial of 150 adolescents compared buprenorphine and naloxone as maintenance treatment with buprenorphine detoxification over 14 days. The maintenance treatment for nine weeks followed by tapered doses up to 12 weeks seemed to be more effective in retaining patients in treatment but not in reducing the use of drugs of abuse. At one-year follow up, self-reported opioid use was clearly less in the maintenance group and more adolescents were enrolled in other addiction programs. The most common side effect in both groups was headache. No participants left the study because of side effects.
Conducting trials with young people may be difficult for both practical and ethical reasons.

This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Minozzi S, Amato L, Davoli M. Maintenance treatments for opiate dependent adolescent. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD007210. DOI: 10.1002/14651858.CD007210.pub2.

This version first published online: April 15. 2009

Abstract

Background

The scientific literature examining effective treatments for opioid dependent adults clearly indicates that pharmacotherapy is a necessary and acceptable component of effective treatments for opioid dependence. Nevertheless no studies have been published which systematically assess the effectiveness of the pharmacological maintenance treatment among adolescent.

Objectives

To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions on retaining adolescents in treatment, reducing the use of substances and reducing health and social status

Search strategy

We searched the Cochrane Drugs and Alcohol Group's trials register (august 2008), MEDLINE (January 1966 to august 2008), EMBASE (January 1980 to august 2008), CINHAL (January 1982 to august 2008) and reference lists of articles

Selection criteria

Randomised and controlled clinical trials comparing any maintenance pharmacological interventions alone or associated with psychosocial intervention with no intervention, placebo, other pharmacological intervention included pharmacological detoxification or psychosocial intervention in adolescent (13-18 years)

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data

Main results

Two trials involving 187participants were included. One study compared methadone with LAAM for maintenance treatment lasting16 weeks after which patients were detoxified, the other compared maintenance treatment with buprenorphine - naloxone with detoxification with buprenorphine. No meta-analysis has been performed because the two studies assessed different comparisons. Maintenance treatment seems more efficacious in retaining patients in treatment but not in reducing patients with positive urine at the end of the study. Self reported opioid use at 1 year follow up was significantly lower in the maintenance group even if both group reported high level of opioid use and more patients in the maintenance group were enrolled in other addiction treatment at 12 month follow up.

Authors' conclusions

It is difficult to draft conclusions on the basis of only two trials. One of the possible reason for the lack of evidence could be the difficulty to conduct trial with young people due to practical and ethic reasons.

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