Maintenance treatments for opiate dependent adolescents

It is difficult to draw conclusions about the use of maintenance pharmacological interventions from only two trials. Substance abuse among adolescents (13 to 18 years old) is a serious and growing problem. The most common drugs used by young people worldwide are cannabis and inhalants. Psychostimulants (ecstasy and amphetamines), cocaine, LSD, heroin and other opioids are also used. Many adolescents who use heroin start by snorting it but some progress to injection. Heroin is used sporadically by the majority who use it, but it can become an addictive disorder. In adults, pharmacotherapy is a necessary and acceptable part of effective treatment for opioid dependence. Among adolescents, medications have been used infrequently and a choice has to be made between detoxification and maintenance treatment.
The review authors searched the literature and identified two controlled trials from the USA that involved 187 heroin addicts, aged 14 to 21 years; the participants were treated as outpatients. One study of 37 participants compared methadone with LAAM for maintenance treatment. After 16 weeks of maintenance treatment the adolescents were detoxified. The two maintenance treatments gave similar improvements in social functioning. No side effects were reported.
The second trial of 150 adolescents compared buprenorphine and naloxone as maintenance treatment with buprenorphine detoxification over 14 days. The maintenance treatment for nine weeks followed by tapered doses up to 12 weeks seemed to be more effective in retaining patients in treatment but not in reducing the use of drugs of abuse. At one-year follow up, self-reported opioid use was clearly less in the maintenance group and more adolescents were enrolled in other addiction programs. The most common side effect in both groups was headache. No participants left the study because of side effects.
Conducting trials with young people may be difficult for both practical and ethical reasons.