Science-Based Treatment for Opioid-Dependent Adolescents

Adolescents are increasingly abusing and becoming dependent on heroin and other opioids. The
number of emergency room visits related to heroin among 12-17 year olds rose almost 600%,
and the self-reported prevalence of heroin use among this group more than doubled in the
last decade. As a result of the increased availability of high-potency, low-cost heroin,
many adolescents initiate heroin use by snorting it; however, many often then progress to
injection of heroin. Despite the critical need to identify efficacious treatments for this
population, virtually no research has been conducted to systematically characterize or
evaluate treatment interventions for adolescent heroin and opioid abusers. We recently
conducted the first controlled study funded by NIDA to systematically evaluate the efficacy
of several pharmacotherapies as detoxification agents along with intensive behavioral
interventions in the treatment of this population. The purpose of this study is to evaluate
ways to further improve on the promising outcomes from our initial study via combined
behavioral-buprenorphine treatment for opioid-dependent youth. The primary aim is to examine
if improved treatment outcomes can be achieved if the duration of buprenorphine
detoxification is lengthened (when the rate of decrease in buprenorphine dose is slower,
withdrawal symptoms may be of reduced intensity and youth are provided with a greater
opportunity to learn new skills and behaviors addressing how they might best discontinue
their opiate use, prevent relapse, and meet treatment goals). A secondary aim is to examine
if the provision of monetary voucher-based incentives contingent on consumption of the
opioid antagonist, naltrexone, reduces rates of relapse to opiate use in adolescents
post-detoxification compared to when no such incentives are provided. This analysis may
provide critical empirical information regarding how to best prevent relapse to opioid use
among opioid-dependent youth. Another secondary aim is to identify significant predictors of
treatment outcome. We will thus conduct an exploratory evaluation of demographic, baseline
drug use, psychological and other history variables that may predict successful treatment
outcomes. This work may help inform the refinement of treatment interventions for various
sub-populations of opioid-dependent youth. Outcome measures will include opiate and other
drug abstinence, retention, opiate withdrawal symptoms, HIV risk behavior, family
relationships, as well as a variety of other secondary outcome measures. We plan to collect
these measures at intake, during treatment and at several post-treatment follow-up
timepoints. Overall, this research will contribute new empirical information that will
inform the development of effective treatment interventions for the largely unstudied and
rapidly expanding population of opioid-dependent youth.

Inclusion Criteria:

- clinical diagnosis of opioid dependence

- ages 13-18 years

Exclusion Criteria:

- active psychosis

- active suicidality

- major medical problems (e.g., cardiovascular disease)

- pregnancy

- require inpatient detoxification from non-opiate drugs