Extended vs. Short-Term Buprenorpine-Naloxone for Opioid Addicted Youth

Aim: Evaluate the efficacy of continuing buprenorphine-naloxone vs. detoxification for opioid addicted youth. Methods: Trial of 152 opioid addicted patients aged 15-21 randomized to 12 weeks of buprenorphine-naloxone (BUP) or a 14-day taper (DETOX). BUP patients were prescribed up to 24 mg/day for 9 weeks then tapered to week 12; DETOX patients received up to 14 mg/day then tapered to day 14. All were offered weekly individual and group counseling. Primary outcome was opioid positive urine at weeks 4, 8 and 12. Results: DETOX patients had higher proportions of opioid-positive urine at weeks 4 and 8, but not week 12 (X2 [2] = 4.93, p=0.09). At week 4, 61% (95% CI = .47 to .75) in DETOX were positive vs. 26% (95% CI = .14 to .38) in BUP. At week 8, 54% (95% CI = .38 to .70) in DETOX were positive vs. 23% (95% CI = .11 - .35) in BUP. At week 12, 51% (95% CI = .35 - .67) in DETOX were positive vs. 43% (95% CI = .29 - .57) in BUP. By week 12, 21% (16/78) randomized to DETOX remained in treatment vs. 70% (52/74) in BUP (p< .001). During weeks 1-12, BUP patients reported less opioid use (p< .001), less injecting (p = .01), and less non-study addiction treatment (p<. 004). High levels of opioid use occurred in both groups at follow-up. Conclusions: Continuing buprenorphine-naloxone improved outcome. Detoxification, either short- or longer-term, was not effective.