According to a new study teens addicted to heroin or prescription pain killers had better results at leaving the drugs if they were given extended treatment using a combination of detoxification medications as compared to a short-term detoxification program using the same medication. The study, published in the November 5 issue of JAMA, said buprenorphine and naloxone have both proved to be effective in opioid addiction treatment. Buprenorphine works by easing withdrawal symptoms and naloxone prevents or reverses the effects of injected opioids.

Dr. George Woody, a professor at the University of Pennsylvania's Department of Psychiatry and lead study author said, "If you keep these young kids, average one-and-a-half years of addiction, on buprenorphine-naloxone they did a lot better. When you took them off the buprenorphine-naloxone, their opioid use went up. The usual treatment for opioid-addicted youth is short-term detoxification and individual or group therapy in residential or outpatient settings over weeks or months," the authors wrote. “Clinicians report that relapse is high, yet many programs remain strongly committed to this approach and, except for treating withdrawal, do not use agonist medication."

In the study 152 patients in the ages of 15 to 21 were divided into two groups. The first group was given 12 week’s of treatment with buprenorphine-naloxone while in the detox group patients were given the same combination of medication but for two weeks. Both the groups were offered weekly individual and group counseling. The patients in the detox group had higher proportions of opioid-positive urine test results at weeks 4 and 8 but not at week 12. Measured at week four 61% of detox patients had positive results versus 26% of the 12-week buprenorphine-naloxone patients and at week eight, 54% of detox patients had positive results versus 23% of the 12-week buprenorphine-naloxone patients. By week twelve, 51% of detox patients had positive results versus 43% of buprenorphine-naloxone patients, who by that time had been tapered off their medication.

By the twelfth week only 20.5 % of detox patients remained in treatment as compared to 70% of 12-week buprenorphine-naloxone patients. The extended treatment patients also reported less use of opioids, cocaine and marijuana, less injecting, and less need for additional addiction treatment.    "Taken together, these data show that stopping buprenorphine-naloxone had comparably negative effects in both groups, with effects occurring earlier and with somewhat greater severity in patients in the detox group," the authors write.

Dr. David A. Fiellin, MD, Yale University School of Medicine, New Haven, Connecticut said, "The results of this trial should prompt clinicians to use caution when tapering buprenorphine-naloxone in adolescent patients who receive this medication. Supportive counseling, close monitoring for relapse, and in some cases, naltrexone should be offered following buprenorphine tapers.

The findings are published in the Nov. 5 issue of the Journal of the American Medical Association.