School-aged children and adolescents are increasingly abusing and becoming dependent on heroin and opioids. Heroin use by 12th graders has increased by over 100 percent since the beginning of this decade. Additionally, the mean age of first use of heroin in the United States decreased from 27 years in 1988 to 18 years in 1997. Most adolescents initiate heroin use by snorting it; however, many often then progress to injection of heroin. This trend of increased injection drug use by adolescent heroin users increases their risk of contracting and spreading hepatitis, HIV and other serious diseases. Despite the critical need to identify efficacious treatments for this population, substance abuse treatment research has largely focused on adults, and virtually no research has focused on the unique status of the opioid-dependent adolescent.
The aim of this R03 proposal is to systematically evaluate the efficacy of several pharmacotherapies as detoxification agents along with intensive behavioral interventions in the treatment of the growing population of opioid-dependent adolescents. In particular, we propose to compare in opioid-dependent adolescents the efficacy of opiate detoxification with buprenorphine to clonidine. Both pharmacotherapies will be provided with a common behavioral contingency management intervention. The behavioral intervention will include 1) the demonstrably efficacious behavioral therapy employed by Azrin and colleagues in the treatment of adolescent substance abusers, 2) voucher-based contingency management interventions to primarily promote opioid abstinence and, to a lesser degree, to promote clinic attendance and the completion of assessments 3) an outreach component as employed in the CRA approach designed to increase non-drug sources of reinforcement. This study will be, to our knowledge, the first controlled study to evaluate the relative efficacy of buprenorphine and clonidine when combined with behavioral treatment of opioid-dependent adolescents. Outcome measures will include opiate and other drug abstinence, treatment retention, opiate withdrawal symptoms, HIV risk behavior, as well as a variety of other secondary outcome measures. We plan to collect these outcome measures at intake, during treatment and for 6 months post-treatment. Data from the long-term follow-up period of the study will provide information regarding the extent to which pharmacological-assisted detoxification procedures reduce opioid-use among opioid-dependent adolescents. Overall, this research will contribute new empirical information pertinent to developing effective treatment interventions for opioid-dependent youth. As the number of opioid-dependent adolescents continues to dramatically increase, identifying effective treatments to meet the unique needs of this population is critical.
| 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 |
| Marsch, Lisa A; Bickel, Warren K; Badger, Gary J et al. (2005) Comparison of pharmacological treatments for opioid-dependent adolescents: a randomized controlled trial. Arch Gen Psychiatry 62:1157-64 |
