Relapse prevention medications in community treatment for young adults with opioid addiction

ABSTRACT

Background: Despite the well-known effectiveness and widespread use of relapse prevention medications such as extended release naltrexone (XR-NTX) and buprenorphine for opioid addiction in adults, less is known about their use in younger populations. Methods: This was a naturalistic study using retrospective chart review of N = 56 serial admissions into a specialty community treatment program that featured the use of relapse prevention medications for young adults (19–26 years old) with opioid use disorders. Treatment outcomes over 24 weeks included retention and weekly opioid-negative urine tests. Results: Patients were of mean age 23.1, 70% male, 86% Caucasian, 82% with history of injection heroin use, and treated with either buprenorphine (77%) or XR-NTX (23%). The mean number of XR-NTX doses received was 4.1. Retention was approximately 65% at 12 weeks and 40% at 24 weeks, and rates of opioid-negative urine were 50% at 12 weeks and 39% at 24 weeks, with missing samples imputed as positive. There were no statistically significant differences in retention (t = 1.87, P = .06) or in rates of weekly opioid-negative urine tests (t = 1.96, P = .06) between medication groups, over the course of 24 weeks. The XR-NTX group had higher rates of weekly negative urine drug tests for other nonopioid substances (t = 2.83, P < .05) compared with the buprenorphine group. Males were retained in treatment longer and had higher rates of opioid-negative weeks compared with females. Conclusions: These results suggest that relapse prevention medications including both buprenorphine and XR-NTX can be effectively incorporated into standard community treatment for opioid addiction in young adults with good results. Specialty programming focused on opioid addiction in young adults may provide a promising model for further treatment development.

KEYWORDS:

• Buprenorphine
• community treatment
• extended release naltrexone
• medication-assisted therapy
• opioid dependence
• relapse prevention medication
• Vivitrol
• young adults

Acknowledgments

The authors wish to thank Maryland Treatment Centers for facilitating this work and the numerous counselors, nursing staff, and physicians who contributed to treating these patients and to our programming at Avery Road Treatment Center. In particular, we thank our research assistants Polly Ingram and Gabriela Barnett for assisting with chart abstractions necessary to complete this project.

Author contributions

Dr. Hoa Vo contributed to the writing and data analysis. Erika Robbins collected most of the data and also assisted in the statistical analysis. Meghan Westwood and Debra Lezama contributed to the data collection and discussions regarding programming. Dr. Marc Fishman contributed to the writing and discussion of data analysis presented.

Funding

Although the project did not require funding, the authors are employed by the Maryland Treatment Centers and received salary from the agency while working on this project. Dr. Fishman is the Medical Director of Maryland Treatment Centers (MTC), which operates the program where patients were treated in this study. Dr. Fishman is a part-time faculty member of the Johns Hopkins University. He has an equity interest as a beneficiary of the trust, which owns MTC. Dr. Fishman also serves on the governing board of the trust and the Board of Directors of MTC. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies.