Buprenorphine‐naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders

Romero-Gonzalez, Mph Mauricio; Shahanaghi, Abtin; DiGirolamo, Gregory J.; González, Gerardo

doi:10.1111/ajad.12641

Cited by 14 publications

(11 citation statements)

References 40 publications

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“…Treatment retention was not significantly different between groups, but memantine 30 mg significantly improved treatment with buprenorphine/naloxone by reducing relapse and opioid use after buprenorphine/naloxone discontinuation. In a secondary outcome study, prescription opioid users had higher retention and compliance rates relative to heroin users, but these differences were not statistically significant (Romero‐Gonzalez et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, the decision to begin tapering off of OAT should be shared between the patient and their provider. Though abstinence is desired and the end‐goal for a lot of patients, treatment duration should be prolonged for as long as the patient wishes and tapering should only begin when deemed appropriate by the patient (Marsch et al, 2016; Romero‐Gonzalez et al, 2017; Woody et al, 2008). Nevertheless, adolescent patients in maintenance programs, along with their parents and staff, do agree that medication alone is insufficient for treatment to be effective, and rather a combination of pharmacological and behavioural approaches is optimal (Guarino et al, 2009; Ranjan et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

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Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Westenberg

Tai

Elsner

et al. 2021

Early Intervention Psych

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Aim First use of opioids often happens in adolescence and an increasing number of opioid overdoses are being reported among youth. The purpose of this narrative review was to present the treatment approaches for youth with high‐risk opioid use, determine whether the literature supports the use of opioid agonist treatment among youth and identify evidence for better treatment outcomes in the younger population. Methods A search of the literature on PubMed using MeSH terms specific to youth, opioid use and treatment approaches generated 1436 references. Following a screening process, 137 papers were found to be relevant to the treatment of high‐risk opioid use among youth. After full‐text review, 19 eligible studies were included: four randomized controlled trials, nine observational studies and six reviews. Results Research for the different treatment options among youth is limited. The available evidence shows better outcomes in terms of retention in care and cost‐effectiveness for opioid agonist treatment than abstinence‐based comparisons. Integrating psychosocial interventions into the continuum of care for youth can be an effective way of addressing comorbid psychiatric conditions and emotional drivers of substance use, leading to improved treatment trajectories. Conclusions From the limited findings, there is no evidence to deny youth with high‐risk opioid use the same treatment options available to adults. A combination of pharmacological and youth‐specific psychosocial interventions is required to maximize retention and survival. There is an urgent need for more research to inform clinical strategies toward appropriate treatment goals for such vulnerable individuals.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Westenberg

Tai

Elsner

et al. 2021

Early Intervention Psych

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“…Seeking to differentiate the ability of buprenorphine to treat opioid withdrawal and depressive symptoms in OUD patients who use heroin vs. prescription opioids, Romero-Gonzalez et al (45) conducted an 8-week open trial of buprenorphine/naloxone. The 63 patients taking prescription opioids and 17 patients using heroin were treated at a fixed dose of 16 mg/4 mg buprenorphine/ naloxone.…”

Section: Open Trialsmentioning

confidence: 99%

“…As MDD and OUD patients have already been exposed to opioids, they can tolerate higher doses of buprenorphine than opioid-naïve patients. Within the patient population with both MDD and OUD, there may also be a difference in optimal dosage between prescription opioid users and heroin users (45).…”

Section: Section Summarymentioning

confidence: 99%

“…Whether an OUD patient primarily uses heroin or prescription opioids may also influence the dosage and efficacy of buprenorphine. The dose of buprenorphine necessary to manage OUD symptoms and achieve an antidepressant effect may be lower for prescription opioid users than heroin users (45). Additionally, current prescription opioid users in the POATS study with any lifetime heroin use were half as likely to have a favorable outcome on buprenorphine treatment (48).…”

Section: Future Directionsmentioning

confidence: 99%

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Buprenorphine as a Treatment for Major Depression and Opioid Use Disorder

Namchuk¹,

Lucki²,

Browne³

2022

Adv. Drug Alcohol Res.

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Rates of major depressive disorder (MDD) are disproportionally high in subjects with opioid use disorder (OUD) relative to the general population. MDD is often more severe in OUD patients, leading to compliance issues with maintenance therapies and poor outcomes. A growing body of literature suggests that endogenous opioid system dysregulation may play a role in the emergence of MDD. Buprenorphine, a mixed opioid receptor agonist/antagonist approved for the treatment of OUD and chronic pain, may have potential as a novel therapeutic for MDD, especially for patients with a dual diagnosis of MDD and OUD. This paper presents a comprehensive review of papers relevant to the assessment of buprenorphine as a treatment for MDD, OUD, and/or suicide compiled using electronic databases per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The principal goal of this literature review was to compile the clinical studies that have interrogated the antidepressant activity of buprenorphine in opioid-naïve MDD patients and OUD patients with comorbid MDD. Evidence supporting buprenorphine’s superiority over methadone for treating comorbid OUD and MDD was also considered. Finally, recent evidence for the ability of buprenorphine to alleviate suicidal ideation in both opioid-naïve patients and opioid-experienced patients was evaluated. Synthesizing all of this information, buprenorphine emerges as a potentially effective therapeutic for the dual purposes of treating MDD and OUD.

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Investigating interventions that lead to the highest treatment retention for emerging adults with substance use disorder: A systematic review

Dalton

Bishop

D’Arcy

2021

Addictive Behaviors

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Buprenorphine‐naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders

Cited by 14 publications

References 40 publications

Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Treatment approaches and outcome trajectories for youth with high‐risk opioid use: A narrative review

Buprenorphine as a Treatment for Major Depression and Opioid Use Disorder

Investigating interventions that lead to the highest treatment retention for emerging adults with substance use disorder: A systematic review

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