Suboxone Treatment for Opioid-Addicted Youth in San Diego County

Short-term detoxification coupled with individual and/or group therapy in either a residential or outpatient facility for a few weeks or months is the current treatment as usual for opioid-addicted youth. Except for treating withdrawal during detoxification the typical program does not use agonist medications like suboxone on young addicts. Relapse rates for the current treatment as usual is quite high.

In a recent study in JAMA, Woody and his colleagues reported the results of a randomized trial that compared a 14-day outpatient detoxification using suboxone (detox) vs 12 weeks of outpatient treatment with suboxone (extended treatment). The study was open to young people between the ages of 14 and 21 years but less than 18% of the participants were below the age of 18; no 14 year-old and only one 15 year-old was enrolled in the study. The typical participant was about 19 years old. In addition to receiving suboxone, participants were scheduled for one individual and one group therapy session per week for 12 weeks.

The participants in the detox group had poorer outcomes than the participants in the extended treatment group. Less than 20% of the detox participants completed the study vs 70% of the participants in the extended treatment group. The detox participant on average attended 5 counseling sessions while the extended treatment participants attended 12 counseling sessions. The detox participants also had poorer post treatment outcomes at 6, 9 and 12 month follow-up. Among the detox participants between 17 and 28% produced negative urine tests for opioids, while 29 to 52% of the extended treatment participants produced negative tests.

Woody and colleagues noted that the small study size and the short study duration made it impossible to estimate the number of participants who actually recovered, which they defined as a "voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship." Their study suggests that higher rates of true recovery may be possible with longer use of effective medications coupled with longer and more intensive psychosocial treatment.

Reference: Woody GE, Poole SA, Subramaniam G, et al. Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth: A Randomized Trial. JAMA. 2008;300(17):2003-2011.