Medications for Maintenance Treatment of Opioid Use Disorder in Adolescents: A Narrative Review and Assessment of Clinical Benefits and Potential Risks

by | Addiction

https://www.jsad.com/doi/10.15288/jsad.2019.80.393

Comment; As expected, Buprenorphine is safe for adolescents, seems a safer/better choice than either Methadone or Naltrexone–all of which are effective

Journal of Studies on Alcohol and Drugs, 80(4), 393–402 (2019).
      Article Tools              Add to Favorites                        Email to a Friend                   Download Citation                   Track Citations           Deepa R. Camenga , M.D. M.H.S.a,*Hector A. Colon-Rivera , M.D.b,cSrinivas B. Muvvala , M.D., M.P.H.d+ Affiliations*Correspondence may be sent to Deepa R. Camenga at the Department of Emergency Medicine, Yale School of Medicine, 464 Congress Ave., Suite 260, New Haven, CT 06519, or via email at: deepa.camenga@yale.edu.https://doi.org/10.15288/jsad.2019.80.393Received: September 14, 2018Accepted: April 11, 2019Published Online: September 10, 2019

Abstract

Objective:

Methadone, buprenorphine, and naltrexone are evidence-based treatments for opioid use disorder (OUD). A large body of evidence supports their effectiveness in adults with OUD. However, few studies have tested their efficacy in adolescents. This study summarizes the clinical benefits and risks of three medications for the treatment of OUD in adolescents.Method:

We review and synthesize the published evidence about the efficacy and potential risks (including safety concerns) associated with methadone, buprenorphine, or naltrexone for the treatment of OUD in adolescents and compare their benefits and risks with that of no treatment or treatment without medications. We also discuss adolescent-specific treatment needs and strategies to overcome potential challenges in prescribing medications for adolescents with OUD.Results:

Methadone appears to be effective in promoting treatment retention among adolescents with heroin use disorder. Data from three randomized controlled trials suggest that buprenorphine treatment improves the likelihood of opioid abstinence and treatment retention. Although these medications have a potential risk of overdose when misused or used illegally, evidence suggests this risk is much lower for buprenorphine than methadone. Emerging data also suggest that naltrexone is a safe and feasible option for adolescents. Vast evidence demonstrates that the risks of untreated OUD far outweigh the risks of any of the previously discussed medications.Conclusions:

Little published evidence specifically examines the efficacy and safety of using medications for OUD in adolescents, and more research is needed. It is essential for healthcare professionals to determine whether their adolescent patients may benefit from medications for the treatment of OUD.

Dr. Raymond Oenbrink
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