Maintenance treatments for opiate dependent adolescent.
BACKGROUND
The scientific literature examining effective treatments for opioid dependent adults clearly indicates that pharmacotherapy is a necessary and acceptable component of effective treatments for opioid dependence. Nevertheless no studies have been published which systematically assess the effectiveness of the pharmacological maintenance treatment among adolescent.


OBJECTIVE
To assess the effectiveness of any maintenance treatment alone or in combination with psychosocial intervention compared to no intervention, other pharmacological intervention or psychosocial interventions on retaining adolescents in treatment, reducing the use of substances and reducing health and social status


METHODS
We searched the Cochrane Drugs and Alcohol Group's trials register (august 2008), MEDLINE (January 1966 to august 2008), EMBASE (January 1980 to august 2008), CINHAL (January 1982 to august 2008) and reference lists of articles


METHODS
Randomised and controlled clinical trials comparing any maintenance pharmacological interventions alone or associated with psychosocial intervention with no intervention, placebo, other pharmacological intervention included pharmacological detoxification or psychosocial intervention in adolescent (13-18 years)


METHODS
Two reviewers independently assessed trial quality and extracted data


RESULTS
Two trials involving 187 participants were included. One study compared methadone with LAAM for maintenance treatment lasting 16 weeks after which patients were detoxified, the other compared maintenance treatment with buprenorphine - naloxone with detoxification with buprenorphine. No meta-analysis has been performed because the two studies assessed different comparisons. Maintenance treatment seems more efficacious in retaining patients in treatment but not in reducing patients with positive urine at the end of the study. Self reported opioid use at 1 year follow up was significantly lower in the maintenance group even if both group reported high level of opioid use and more patients in the maintenance group were enrolled in other addiction treatment at 12 month follow up.


CONCLUSIONS
It is difficult to draft conclusions on the basis of only two trials. One of the possible reason for the lack of evidence could be the difficulty to conduct trial with young people due to practical and ethic reasons.
Department of Epidemiology, ASL RM/E, Via di Santa Costanza, 53, Rome, Italy, 00198. sminozzi1@alice.it
Silvia
S
Minozzi
Laura
L
Amato
Marina
M
Davoli
D000293:Adolescent; D002047:Buprenorphine / Q000627:therapeutic use; D006801:Humans; D008691:Methadone / Q000627:therapeutic use; D008692:Methadyl Acetate / Q000627:therapeutic use; D009270:Naloxone / Q000627:therapeutic use; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D016032:Randomized Controlled Trials as Topic; D055815:Young Adult
D009294:Narcotics; D009270:Naloxone; D002047:Buprenorphine; D008692:Methadyl Acetate; D008691:Methadone