Historique
Article de Périodique
Extended vs short-term buprenorphine-naloxone for treatment of opioid-addicted youth: a randomized trial (2008)
Auteur(s) :
WOODY, G. E. ;
POOLE, S. A. ;
SUBRAMANIAM, G. ;
DUGOSH K. ;
BOGENSCHUTZ, M. ;
ABBOTT, P. ;
PATKAR, A. A. ;
PUBLICKER M. ;
MCCAIN K. ;
SHARPE POTTER, J. ;
FORMAN, R. ;
VETTER V. ;
McNICHOLAS, L. ;
BLAINE, J. ;
LYNCH, K. G. ;
FUDALA, P. J.
Année
2008
Page(s) :
2003-2011
Langue(s) :
Anglais
Refs biblio. :
36
Domaine :
Drogues illicites / Illicit drugs
Thésaurus mots-clés
ETUDE RANDOMISEE
;
JEUNE
;
TRAITEMENT DE MAINTENANCE
;
BUPRENORPHINE
;
NALOXONE
;
OBSERVANCE DU TRAITEMENT
;
EFFICACITE
;
OPIACES
;
ADOLESCENT
Thésaurus géographique
ETATS-UNIS
Note générale :
Editorial: "Treatment of adolescent opioid dependence: No quick fix", D.A. Fiellin, JAMA 2008;300(17):2057-2059.
Correction :
Correction :
Résumé :
Context: The usual treatment for opioid-addicted youth is detoxification and counseling. Extended medication-assisted therapy may be more helpful.
Objective: To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth.
Design, Setting, and Patients: Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper (detox).
Interventions: Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg per day and then tapered to day 14. All were offered weekly individual and group counseling.
Main Outcome Measure: Opioid-positive urine test result at weeks 4, 8, and 12.
Results: The number of patients younger than 18 years was too small to analyze separately, but overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12 ({chi2}2 = 4.93, P = .09). At week 4, 59 detox patients had positive results (61%; 95% confidence interval [CI] = 47%-75%) vs 58 12-week buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 53 detox patients had positive results (54%; 95% CI = 38%-70%) vs 52 12-week buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 53 detox patients had positive results (51%; 95% CI = 35%-67%) vs 49 12-week buprenorphine-naloxone patients (43%; 95% CI = 29%-57%). By week 12, 16 of 78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week buprenorphine-naloxone patients (70%; {chi2}1 = 32.90, P < .001). During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less opioid use ({chi2}1 = 18.45, P < .001), less injecting ({chi2}1 = 6.00, P = .01), and less nonstudy addiction treatment ({chi2}1 = 25.82, P < .001). High levels of opioid use occurred in both groups at follow-up. Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12.
Conclusions: Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification. Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence. Trial Registration clinicaltrials.gov Identifier: NCT00078130. (Author' s abstract)
Objective: To evaluate the efficacy of continuing buprenorphine-naloxone for 12 weeks vs detoxification for opioid-addicted youth.
Design, Setting, and Patients: Clinical trial at 6 community programs from July 2003 to December 2006 including 152 patients aged 15 to 21 years who were randomized to 12 weeks of buprenorphine-naloxone or a 14-day taper (detox).
Interventions: Patients in the 12-week buprenorphine-naloxone group were prescribed up to 24 mg per day for 9 weeks and then tapered to week 12; patients in the detox group were prescribed up to 14 mg per day and then tapered to day 14. All were offered weekly individual and group counseling.
Main Outcome Measure: Opioid-positive urine test result at weeks 4, 8, and 12.
Results: The number of patients younger than 18 years was too small to analyze separately, but overall, patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12 ({chi2}2 = 4.93, P = .09). At week 4, 59 detox patients had positive results (61%; 95% confidence interval [CI] = 47%-75%) vs 58 12-week buprenorphine-naloxone patients (26%; 95% CI = 14%-38%). At week 8, 53 detox patients had positive results (54%; 95% CI = 38%-70%) vs 52 12-week buprenorphine-naloxone patients (23%; 95% CI = 11%-35%). At week 12, 53 detox patients had positive results (51%; 95% CI = 35%-67%) vs 49 12-week buprenorphine-naloxone patients (43%; 95% CI = 29%-57%). By week 12, 16 of 78 detox patients (20.5%) remained in treatment vs 52 of 74 12-week buprenorphine-naloxone patients (70%; {chi2}1 = 32.90, P < .001). During weeks 1 through 12, patients in the 12-week buprenorphine-naloxone group reported less opioid use ({chi2}1 = 18.45, P < .001), less injecting ({chi2}1 = 6.00, P = .01), and less nonstudy addiction treatment ({chi2}1 = 25.82, P < .001). High levels of opioid use occurred in both groups at follow-up. Four of 83 patients who tested negative for hepatitis C at baseline were positive for hepatitis C at week 12.
Conclusions: Continuing treatment with buprenorphine-naloxone improved outcome compared with short-term detoxification. Further research is necessary to assess the efficacy and safety of longer-term treatment with buprenorphine for young individuals with opioid dependence. Trial Registration clinicaltrials.gov Identifier: NCT00078130. (Author' s abstract)
Affiliation :
USA