Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder

Abstract

Background Opioid misuse and dependence rates among emerging adults have increased substantially. While office-based opioid treatments (e.g., buprenorphine/naloxone) have shown overall efficacy, discontinuation rates among emerging adults are high. Abstinence-based residential treatment may serve as a viable alternative, but has seldom been investigated in this age group. Methods Emerging adults attending 12-step-oriented residential treatment (N=292; 18–24yrs, 74% Male, 95% White) were classified into opioid dependent (OD; 25%), opioid misuse (OM; 20%), and no opiate use (NO; 55%) groups. Paired t-tests and ANOVAs tested baseline differences and whether groups differed in their during-treatment response. Longitudinal multilevel models tested whether groups differed on substance use outcomes and treatment utilization during the year following the index treatment episode. Results Despite a more severe clinical profile at baseline among OD, all groups experienced similar during-treatment increases on therapeutic targets (e.g., abstinence self-efficacy), while OD showed a greater decline in psychiatric symptoms. During follow-up relative to OM, both NO and OD had significantly greater Percent Days Abstinent, and significantly less cannabis use. OD attended significantly more outpatient treatment sessions than OM or NO; 29% of OD was completely abstinent at 12-month follow-up. Conclusions Findings here suggest residential treatment may be helpful for emerging adults with opioid dependence. This benefit may be less prominent, though, among non-dependent opioid misusers. Randomized trials are needed to compare more directly the relative benefits of outpatient agonist-based treatment to abstinence-based, residential care in this vulnerable age-group, and to examine the feasibility of an integrated model.

Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

“…One retrospective study found that emerging adults (aged 18 to 25) were significantly less likely to be retained in an office-based buprenorphine program than older adults (17% versus 45% at 12 months, respectively) (Schuman-Olivier, Weiss, Hoeppner, Borodovsky, & Albanese, 2014). Further research is needed to compare and combine abstinence-based residential treatment with outpatient care (including office-based buprenorphine therapy) for opioid-using young adults (Schuman-Olivier, Claire Greene, Bergman, & Kelly, 2014). …”

Youth OUD treatment during and after COVID: Increasing family involvement across the services continuum

“…Medication for opioid use disorders (MOUD), in the form of opioid agonist or antagonist medication, is the only evidence-based treatment for youth OUD ( Committee on Substance Use and Prevention, 2016 ). Unfortunately, it has proven enormously difficult to engage youth in OUD treatment ( Hadland et al, 2017 ), and they drop out of care at alarmingly high rates (e.g., Schuman-Olivier et al, 2014 ). To address this challenge we propose a conceptual framework to organize efforts to engage and retain youth and families across the continuum of MOUD services.…”

Buprenorphine Treatment for Adolescents and Young Adults With Opioid Use Disorders: A Narrative Review

“…For example, Matson et al 2014 reported rates of illicit opioid abstinence of up to 85% for those youth who are able to remain in treatment and continue to receive buprenorphine (Matson et al, 2014). Conversely, observational data on young adults with OUD who received a short (3-day) buprenorphine detoxification in an outpatient setting, indicate lower rates of abstinence (12% abstinent at six months)(Gandhi et al, 2003) although these rates are higher when detoxification is implemented in residential treatment settings (approximately 31-43% at six months) (Schuman-Olivier et al, 2014b). In terms of retention, published observational studies have generally reported six-month retention rates ranging from 25% (Matson et al, 2014) to 40 % (Schuman-Olivier et al, 2014a; Vo et al, 2016) and one-year retention rates between 9-17% (Smyth et al, 2012; Matson et al, 2014; Schuman-Olivier et al, 2014a; Mutlu et al.).…”