Marc Fishman1, Kevin Wenzel2, Jennifer Scodes3, Martina Pavlicova4, Joshua D Lee4, John Rotrosen4, Edward Nunes5. 1. Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland. Electronic address: mfishman@marylandtreatment.org. 2. Mountain Manor Treatment Center/Maryland Treatment Centers, Baltimore, Maryland. 3. Division of Mental Health Data Science, New York State Psychiatric Institute, New York, New York. 4. Department of Psychiatry, NYU Grossman School of Medicine, New York, New York. 5. Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York.
Abstract
PURPOSE:Young adults are disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. METHODS: This secondary analysis compared young adults (aged 18-25 years) with older adults (aged ≥26 years) in a large comparative effectiveness trial ("XBOT") that randomized subjects to extended-release naltrexone or sublingual buprenorphine-naloxone for 6 months. Opioid relapse was defined by opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. RESULTS: Among subjects in the intention-to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%) compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08-2.70), p = .02. In the per-protocol sample (n = 474, only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds ratio of 1.91 (95% confidence interval = 1.19-3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected. CONCLUSIONS:Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults.
RCT Entities:
PURPOSE: Young adults are disproportionately affected by the current opioid crisis. Although medications for opioid use disorder are broadly effective, with reductions in morbidity and mortality, the particular effectiveness of medications for opioid use disorder among young adults is less well understood. METHODS: This secondary analysis compared young adults (aged 18-25 years) with older adults (aged ≥26 years) in a large comparative effectiveness trial ("XBOT") that randomized subjects to extended-release naltrexone or sublingual buprenorphine-naloxone for 6 months. Opioid relapse was defined by opioid use over four consecutive weeks or seven consecutive days, using urine testing and self-report. RESULTS: Among subjects in the intention-to-treat sample (n = 570, all randomized participants), a main effect of age group was found, with higher relapse rates among young adults (70.3%) compared with older adults (58.2%), with an odds ratio of 1.72 (95% confidence interval = 1.08-2.70), p = .02. In the per-protocol sample (n = 474, only participants who started medication), relapse rates were higher among young adults (66.3%) compared with older adults (50.8%), with an odds ratio of 1.91 (95% confidence interval = 1.19-3.06). Among the intention-to-treat sample, survival analysis revealed a significant time-by-age group interaction (p = .01) with more relapse over time in young adults. No significant interactions between age and medication group were detected. CONCLUSIONS: Young adults have increased rates of relapse compared with older adults, perhaps because of vulnerabilities that increase their risk for treatment dropout and medication nonadherence, regardless of medication assignment. These results suggest that specialized, developmentally informed interventions may be needed to improve retention and successful treatment of opioid use disorder among young adults.
Authors: Adam Bisaga; Paolo Mannelli; Miao Yu; Narinder Nangia; Christine E Graham; D Andrew Tompkins; Thomas R Kosten; Sarah C Akerman; Bernard L Silverman; Maria A Sullivan Journal: Drug Alcohol Depend Date: 2018-04-10 Impact factor: 4.492
Authors: Joshua D Lee; Edward V Nunes; Patricia Novo Mpa; Genie L Bailey; Gregory S Brigham; Allan J Cohen; Marc Fishman; Walter Ling; Robert Lindblad; Dikla Shmueli-Blumberg; Don Stablein; Jeanine May; Dagmar Salazar; David Liu; John Rotrosen Journal: Contemp Clin Trials Date: 2016-08-10 Impact factor: 2.226
Authors: Joshua D Lee; Edward V Nunes; Patricia Novo; Ken Bachrach; Genie L Bailey; Snehal Bhatt; Sarah Farkas; Marc Fishman; Phoebe Gauthier; Candace C Hodgkins; Jacquie King; Robert Lindblad; David Liu; Abigail G Matthews; Jeanine May; K Michelle Peavy; Stephen Ross; Dagmar Salazar; Paul Schkolnik; Dikla Shmueli-Blumberg; Don Stablein; Geetha Subramaniam; John Rotrosen Journal: Lancet Date: 2017-11-14 Impact factor: 79.321
Authors: Mohammad Sibai; Kaitlyn Mishlen; Edward V Nunes; Frances R Levin; John J Mariani; Adam Bisaga Journal: Am J Drug Alcohol Abuse Date: 2019-12-20 Impact factor: 3.829
Authors: Marc Fishman; Kevin Wenzel; Jennifer Scodes; Martina Pavlicova; Aimee N C Campbell; John Rotrosen; Edward Nunes Journal: Am J Addict Date: 2021-06-01