The Role of Pharmacotherapy in the Treatment of Adolescent Substance Use Disorders

Abstract

Summary Adolescent substance use disorders (SUDs) are associated with elevated morbidity and mortality, and represent a significant public health cost. While psychosocial interventions for adolescent SUDs have demonstrated short-term efficacy, many youth relapse after treatment. A potential approach to improve treatment response is to use adjunctive pharmacotherapy. An increasing number of medications have been shown to improve SUD treatment outcomes for alcohol, tobacco, and opioid use disorders in adults. Although relatively few randomized controlled medication trials have been conducted in adolescents, results suggest that pharmacotherapies when added to psychosocial interventions may hold similar promise for improving outcomes for adolescents with SUDs. This article provides a review of current research on the safety and efficacy of pharmacotherapies used in the treatment of adolescent SUDs.

Psychosocial interventions among children and adolescents

“…Tobacco- Trials of the nicotine patch or bupropion SR 15 may be considered in adolescents who fail to respond to psychosocial treatments, and must be given in combination with a psychosocial intervention. More RCTs are required to assess for long-term efficacy.…”

“…Methadone may be considered in cases of treatment failures, but more evidence needs to be obtained for both methadone and naltrexone 19 before it can be recommended. 15 The evidence can be taken as level 3 or lower.…”

“… Moderate to severe SUD Comorbid/co-occurring psychiatric disorders Youth has failed psychosocial interventions (e.g. 2 prior detoxification attempts for adolescent SUDs to consider methadone) Youth is engaged in psychosocial interventions but is not improving (no change in drug use, no functional improvement) High risk for morbidity and mortality (intravenous drug use, drunk or drugged driving, unprotected sexual intercourse, accidents) Family or parents/guardians are engaged in treatment planning and willing to monitor medication What factors should be considered in choosing a medication Patient's past experience with SUD maintenance medications Patient and family's opinions and beliefs Family and parent/guardian involvement in treatment plan (for monitoring) Level of motivation for abstinence Health status (medical and psychiatric history, and allergies) Contraindications for medications Safety profile of medication and drug-to-drug interactions between medication and drugs of abuse History of medication compliance.” 15 …”

Neurobiology of substance use in adolescents and potential therapeutic effects of exercise for prevention and treatment of substance use disorders

“…The Food and Drug Administration (FDA) has approved nicotine replacement therapy, sustained‐release bupropion, and varenicline for tobacco use disorders, benzodiazepines, disulfiram, naltrexone, and acamprosate for alcohol use disorders and, methadone, naltrexone, and buprenorphine/naloxone for opioid use disorders (Hammond, ). No medications are currently FDA indicated for cannabis use disorder (Hammond, ), but the efficacy of N‐acetylcysteine (NAC) compared to placebo has been shown in one trial of cannabis dependent adolescents (Gray et al, ). However, interestingly, NAC did not significantly reduce cannabis use in a subsequent trial of adults with cannabis dependence (Gray et al, ).…”

“…Recently, the American Academy of Pediatrics recommended medication‐assisted treatment for adolescents with severe opioid use disorders, however, only 0.4% (95% CI: 0.2%–0.7%) of adolescents in treatment for prescription opioids actually received medication, compared to 12.0% (95% CI: 11.7%–12.2%) of adults (Feder, Krawczyk, & Saloner, ). Furthermore, the pharmacokinetic and pharmacodynamic responses to many of these agents and their potential side effects when taken during adolescence, a sensitive period of development, are not fully understood (Hammond, ).…”