Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial.
BACKGROUND
The prevalence of heroin and other opioid use has markedly increased among adolescents in the last decade; however, virtually no research has been conducted to identify effective treatments for this population.


OBJECTIVE
To evaluate the relative efficacy of 2 pharmacotherapies, the partial opioid agonist buprenorphine hydrochloride and the centrally active alpha(2)-adrenergic blocker clonidine hydrochloride, in the detoxification of opioid-dependent adolescents.


METHODS
A double-blind, double-dummy, parallel-groups randomized controlled trial conducted in a university-based research clinic from October 2001 to December 2003. Patients were a volunteer sample of 36 adolescents who met DSM-IV criteria for opioid dependence (ages 13-18 years eligible).


METHODS
Participants were randomly assigned to a 28-day, outpatient, medication-assisted withdrawal treatment with either buprenorphine or clonidine. Both medications were provided along with thrice weekly behavioral counseling and incentives contingent on opiate abstinence. Postdetoxification, all participants were offered the opportunity for continued treatment with the opiate antagonist, naltrexone hydrochloride.


METHODS
Treatment retention, opiate abstinence, and human immunodeficiency virus risk behavior, along with measures of withdrawal and medication effects.


RESULTS
A significantly greater percentage of adolescents who received buprenorphine were retained in treatment (72%) relative to those who received clonidine (39%) (P<.05). For those in the buprenorphine group, a significantly higher percentage of scheduled urine test results were opiate negative (64% vs 32%; P = .01). Participants in both groups reported relief of withdrawal symptoms and drug-related human immunodeficiency virus risk behavior. Those in the buprenorphine condition generally reported more positive effects of the medication. No evidence of opioid intoxication or psychomotor impairment was observed. Sixty-one percent of participants in the buprenorphine condition and 5% of those in the clonidine group initiated treatment with naltrexone.


CONCLUSIONS
Combining buprenorphine with behavioral interventions is significantly more efficacious in the treatment of opioid-dependent adolescents relative to combining clonidine and behavioral interventions.
Marsch
Lisa A
LA
Department of Psychiatry, University of Vermont, Burlington, USA. marsch@ndri.org
Bickel
Warren K
WK
Badger
Gary J
GJ
Stothart
Marne E
ME
Quesnel
Kimberly J
KJ
Stanger
Catherine
C
Brooklyn
John
J
D000279:Administration, Cutaneous; D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000317:Adrenergic alpha-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001521:Behavior Therapy; D002047:Buprenorphine / Q000627:therapeutic use*; D003000:Clonidine / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D015658:HIV Infections / Q000635:transmission; D006801:Humans; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000523:psychology / Q000534:rehabilitation*; D011597:Psychomotor Performance; D012309:Risk-Taking; D013375:Substance Withdrawal Syndrome / Q000188:drug therapy / Q000517:prevention & control / Q000523:psychology; D016896:Treatment Outcome
D000316:Adrenergic alpha-Agonists; D000317:Adrenergic alpha-Antagonists; D009292:Narcotic Antagonists; D002047:Buprenorphine; D003000:Clonidine