The use of long-term opioid agonist and partial agonist medication (e.g., methadone or buprenorphine-naloxone) is often reserved for older opioid-dependent individuals, while a brief detoxification with medication or medication-free treatment is offered to younger individuals. In a randomized trial, researchers evaluated the efficacy of buprenorphine-naloxone tapers of 2 versus 12 weeks in 152 younger subjects (mean age, 19 years) at 6 community programs around the country. Subjects had a median of 1 year of opioid dependence. All were offered weekly individual and group counseling. The primary findings were as follows:
- Twelve-week treatment with buprenorphine-naloxone was associated with greater treatment retention and decreased illicit opioid use, but only during the period that medication was provided.
- Patients in the 2-week taper group had more opioid-positive urine tests at weeks 4 and 8 but not at week 12.
- Self-reported opioid use was higher in the 2-week taper group than in the 12-week taper group (55% versus 38%) at 12 weeks, but not at 6-month follow-up (63% versus 72%).
Comments by Tommie Ann Bower, MA
This important work clearly demonstrates that opioid dependent youth do better on buprenorphine-naloxone — until it is discontinued. As the authors conclude, neither youth nor shorter periods of dependence should be a barrier to extended buprenorphine-naloxone support. Because relapse was the most likely outcome for tapers of 2-12 weeks, treatment providers should consider longer maintenance use.