A retrospective study of retention of opioid-dependent adolescents and young adults in an outpatient buprenorphine/naloxone clinic.
OBJECTIVE
Opioid abuse and dependence rates continue to rise among U.S. adolescents. Medication-assisted treatment with buprenorphine/naloxone (BUP/NAL) has been shown to be effective up to 12 weeks. Few data are available regarding extended treatment outcomes. The objective of this study was to describe 1-year retention and compliance of a specific pediatric, outpatient BUP/NAL treatment program for opioid-dependent adolescents and young adults.


METHODS
Retrospective chart review was conducted of all opioid-dependent adolescents and young adults (N = 103) who sought treatment from January 12, 2010, to January 9, 2011. Participants were classified as prescription opioid-dependent or combined heroin/prescription opioid-dependent. Opioid abstinence and BUP/NAL compliance were assessed by urine drug screen (UDS) at each visit. A Kaplan-Meier curve was fit to describe patients' retention time over 1 year.


RESULTS
Mean age was 19.2 ± 1.6 years, 50.5% male, 98.1% white non-Hispanic, and 31.9% prescription opioid-dependent. Overall rates of opioid abstinence and BUP/NAL compliance were high (85.2% and 86.6%, respectively). Seventy-five percent of patients returned for a second visit. Patient retention was 45% at 60 days and 9% at 1 year. Female sex (P < 0.05), negative UDS for opioids (P < 0.001) or tetrahydrocannabinol (P < 0.001), and positive UDS for BUP/NAL (P < 0.001) were associated with longer retention time.


CONCLUSIONS
Although patient retention was the largest barrier to success, a subset of opioid-dependent adolescents and young adults achieved long-term sobriety in our specific clinic program with continued outpatient BUP/NAL therapy. Retention correlated with UDS negative for opioids, negative for tetrahydrocannabinol, and positive for BUP/NAL.
From the Department of Pediatrics (SCM, AEB), The Ohio State University College of Medicine, Columbus, OH; Division of Adolescent Health Medicine (SCM, AEB), Nationwide Children's Hospital, Columbus, OH; Center for Clinical and Translational Research (GH, AEB), The Research Institute at Nationwide Children's Hospital, Columbus, OH; and Center for Biostatistics (MAR), The Ohio State University, Columbus, OH.
Steven C
SC
Matson
Gerrit
G
Hobson
Mahmoud
M
Abdel-Rasoul
Andrea E
AE
Bonny
D000293:Adolescent; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D006556:Heroin Dependence / Q000188:drug therapy; D006801:Humans; D008297:Male; D009270:Naloxone / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012737:Sex Factors; D015813:Substance Abuse Detection / Q000706:statistics & numerical data; D055815:Young Adult
D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine