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 proposal 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.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA018297-02
Application #
6953631
Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Biswas, Jamie
Project Start
2004-09-29
Project End
2008-05-31
Budget Start
2005-06-01
Budget End
2006-05-31
Support Year
2
Fiscal Year
2005
Total Cost
$474,308
Indirect Cost
Name
National Development & Research Institutes
Department
Type
DUNS #
080481880
City
New York
State
NY
Country
United States
Zip Code
10010
Borodovsky, Jacob T; Levy, Sharon; Fishman, Marc et al. (2018) Buprenorphine Treatment for Adolescents and Young Adults With Opioid Use Disorders: A Narrative Review. J Addict Med 12:170-183
Marsch, Lisa A; Moore, Sarah K; Borodovsky, Jacob T et al. (2016) A randomized controlled trial of buprenorphine taper duration among opioid-dependent adolescents and young adults. Addiction 111:1406-15
Moore, Sarah K; Guarino, Honoria; Marsch, Lisa A (2014) ""This is not who I want to be:"" experiences of opioid-dependent youth before, and during, combined buprenorphine and behavioral treatment. Subst Use Misuse 49:303-14
Guarino, Honoria; Moore, Sarah K; Marsch, Lisa A et al. (2012) The social production of substance abuse and HIV/HCV risk: an exploratory study of opioid-using immigrants from the former Soviet Union living in New York City. Subst Abuse Treat Prev Policy 7:2
Moore, Sarah K; Marsch, Lisa A; Badger, Gary J et al. (2011) Improvement in psychopathology among opioid-dependent adolescents during behavioral-pharmacological treatment. J Addict Med 5:264-71
Guarino, Honoria M; Marsch, Lisa A; Campbell 3rd, Willard S et al. (2009) Methadone maintenance treatment for youth: experiences of clients, staff, and parents. Subst Use Misuse 44:1979-89