Drogový Informační Server - Extended therapy may benefit opioid-addicted youth

Zdroj: www.reuters.com | 4. 11. 2008 |

NEW YORK (Reuters Health) - New research suggests that extended treatment with buprenorphine and naloxone may be superior to short-term detox with these drugs in reducing opioid use in addicted teenagers and young adults. With either approach, however, relapse during long-term follow-up is common.

Opioids refer to number of drugs, such as morphine, codeine and oxycodone, which are used to control severe pain. These drugs which are frequently abused, lead to addiction and dependence with long-term use.

Buprenorphine, a narcotic used for moderate to severe pain, combined with naloxone hydrochloride, a drug that prevents or reverses the effects of opioids, are often used in combination to treat opiate dependence by preventing withdrawal symptoms. The two drugs are sold together as Suboxone and under other trade names.

The investigators conducted a study with 152 opiate-addicted patients, 15 to 21 years of age, who were randomly selected to receive buprenorphine-naloxone at up to 24 milligrams per day for 9 weeks, and then tapered off over 12 weeks. The other half were given the drug combo at up to 14 milligrams per day, and then tapered off for 2 weeks (detox group).

Compared with the detox group, the extended-therapy group had lower rates of opioid-positive urine test results at 4 and 8 weeks, lead author Dr. George E. Woody, from the University of Pennsylvania, Philadelphia, and colleagues report in the Journal of the American Medical Association.

At week 12, however, the relapse rates in the extended therapy and detox groups were not significantly different, at 43 percent and 51 percent, respectively.

Extended therapy patients were significantly more likely to remain in treatment at week 12 than were detox patients: 70 percent vs. 20.5 percent.

Participation in extended therapy was also associated with significant reductions in reports of opioid use, injecting drugs and addiction treatment outside the study.

Despite the gains seen, at 12-month follow-up most patients in each group reported using opioid drugs, the report indicates.

The high relapse rates in both treatment groups, plus the social, legal and infectious disease consequences of opioid dependence - as well as the risk of overdose during relapse - illustrates the "urgent" need for more evidence in this area, Dr. David A. Fiellin, from Yale University School of Medicine, New Haven, Connecticut, notes in a related editorial.

"These findings are another important reminder that there are no quick fixes for opioid dependence."

SOURCE: Journal of the American Medical Association, November 5, 2008.