Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth A Randomized Trial Flashcards Preview

Health Psychology 2301 Midterm #2 > Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth A Randomized Trial > Flashcards

Flashcards in Extended vs Short-term Buprenorphine-Naloxone for Treatment of Opioid-Addicted Youth A Randomized Trial Deck (9)
Loading flashcards...
1

What is Buprenorphine

  • Schedule III opioid partial agonist with a greater margin of safety than full agonists and a less intensive withdrawal
  • Approved for use with 16+ years old
  • combined wtih naloxone in 4:1 ratio to reduce abuse if crushed & injected
  • studied mainly in adults addicted 5-10 years

2

Who participated

  • individuals aged 14-21
  • met DSM-IV criteria for opiois dependence with physiologic features
  • seeking out-patient treatment
  • Excluded: psychiatric or medical conditions likely to make participation difficult or unsafe / alcohol or sedative abuse + tons of others (not imp)

3

Randomnized

  • rendomnized to 14 day outpatient detox or 12 weeks of treatment with buprenorphine-naloxone
  • 78 patients to detox
  • 74 patients to receive 12 weeks of buprenorphine-naloxone

4

Drug Counseling

  • 1 individual and 1 group session per week, more if needed
  • counseling
    • encouraged making positive relationships
    • ceasing drug use
    • taking meds as prescribed
    • tolerating stressful events without drugs
    • keeping appointments
    • teaching ways to avoid drug use situations
    • addiction education
    • positive feedback for achieving goals
    • referrals for treatment for associated conditions
    •  self-help groups

5

Results

  • of 236 patients screened, 154 were randomnized and 152 entered treatment
  • most common exclusion: use of benzodiazapines and failure to return
  • patients in detox group less likely to remain in the assigned treatment then those in 12 week program (16 of 78 completed vs. 52 of 74 completed)
  • most common reason noncompletion: missed 2 weeks of counseling
  • detox patiens more likely to report enrollment in another addiction treatment but actually patients in 12 week program attended more counseling sessions

6

Post-Treatment Outcomes

  • Detox group: higher proportions of positive urine tests results than patients in 12 week program
  • no difference in rates of self-reported alcohol use
  • no serious adverse events re naloxone 
  • 4 of 83 patients who tested negative for HepC at beggining were positive at week 12 (2 each group)
  • patients 12 week prgrm:less use of opiods, cocaine, marijuana / better treatment retention, less injecting and need for additional treatment while on meds
  • stopping naloxone: negative effects both groups, but earlier and more severe with detox group

7

Reducing Risk of HIV

  • Methadone or Buprenorphine maintenance reduces risk of infection with HIV and overdose death
  • therefore shows a benefit of naloxone for extended periods as part of standard outpatient treatment
  • clinicians should not be in a hurry to stop an effective medication simply because the patient is young and has been addicted for a short time

8

Limitations to Study

  • low follow-up rate made it difficult to estimate the number of patients who achieved recovery
  • almost total absence of African American individuals (though consistent with data showing they are less addictted to opioids than young white individuals)
  • lack of blinding of evaluators BUT assessments were objective (urine tests, dropout)
  • number patients too small to adequately capture adverse effects and nothing assessed beyond 12 months

9

Clinical Implications

  • would improve outcomes if this treatmen were available in primary care, family practice and adolescent programs
  • other effective meds or longer and more intensive psychosocial treatments may have similarly positive results