Sara J Becker1, Kelli Scott2, Sarah A Helseth3, Kristin J Danko4, Ethan M Balk4, Ian J Saldanha5, Gaelen P Adam4, Dale W Steele6. 1. Department of Behavioral and Social Sciences, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, United States of America. Electronic address: sara_becker@brown.edu. 2. Department of Behavioral and Social Sciences, Brown University School of Public Health, United States of America; Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, United States of America. 3. Department of Behavioral and Social Sciences, Brown University School of Public Health, United States of America. 4. Department of Health Services, Policy and Practice, Brown University School of Public Health, United States of America. 5. Department of Health Services, Policy and Practice, Brown University School of Public Health, United States of America; Department of Epidemiology, Brown University School of Public Health, United States of America. 6. Department of Health Services, Policy and Practice, Brown University School of Public Health, United States of America; Departments of Emergency Medicine and Pediatrics, The Alpert Medical School of Brown University, United States of America.
Abstract
BACKGROUND: Sequalae of opioid misuse constitute a public health emergency in the United States. A robust evidence base informs the use of medication for opioid use disorders (MOUD) in adults, with far less research in transition-age youth. This systematic review evaluates the effectiveness of MOUD for transition-age youth (age 16 to 25). METHODS: This synthesis was part of a larger systematic review focused on adolescent substance use interventions. The study team conducted literature searches in MEDLINE, the Cochrane CENTRAL Registry of Controlled Trials, EMBASE, PsycINFO, and CINAHL through October 31, 2019. We screened studies, extracted data, and assessed risk of bias using standard methods. The primary and secondary outcomes were the effect of MOUD on opioid abstinence and treatment retention, respectively. RESULTS: The study team screened a total of 33,272 records and examined 1831 full-text articles. Four randomized trials met criteria for inclusion in the current analysis. All four trials assessed a combination of buprenorphine plus cognitive behavioral therapy versus a comparison condition. Some trials included additional behavioral interventions, and the specific duration/dosage of buprenorphine varied. Risk of bias was moderate for all studies. Studies found that buprenorphine was more effective than clonidine, effectively augmented by memantine, and that longer medication taper durations were more effective than shorter tapers in promoting both abstinence and retention. Notably, we did not identify any studies of methadone or naltrexone, adjunctive behavioral interventions were sparingly described, and treatment durations were far shorter than recommended guidelines in adults. DISCUSSION: The literature guiding youth MOUD is limited, and more research should evaluate the effectiveness of options other than buprenorphine, optimal treatment duration, and the benefit of adjunctive behavioral interventions. Subgroup analyses of extant randomized clinical trials could help to extend knowledge of MOUD effectiveness in this age cohort.
BACKGROUND: Sequalae of opioid misuse constitute a public health emergency in the United States. A robust evidence base informs the use of medication for opioid use disorders (MOUD) in adults, with far less research in transition-age youth. This systematic review evaluates the effectiveness of MOUD for transition-age youth (age 16 to 25). METHODS: This synthesis was part of a larger systematic review focused on adolescent substance use interventions. The study team conducted literature searches in MEDLINE, the Cochrane CENTRAL Registry of Controlled Trials, EMBASE, PsycINFO, and CINAHL through October 31, 2019. We screened studies, extracted data, and assessed risk of bias using standard methods. The primary and secondary outcomes were the effect of MOUD on opioid abstinence and treatment retention, respectively. RESULTS: The study team screened a total of 33,272 records and examined 1831 full-text articles. Four randomized trials met criteria for inclusion in the current analysis. All four trials assessed a combination of buprenorphine plus cognitive behavioral therapy versus a comparison condition. Some trials included additional behavioral interventions, and the specific duration/dosage of buprenorphine varied. Risk of bias was moderate for all studies. Studies found that buprenorphine was more effective than clonidine, effectively augmented by memantine, and that longer medication taper durations were more effective than shorter tapers in promoting both abstinence and retention. Notably, we did not identify any studies of methadone or naltrexone, adjunctive behavioral interventions were sparingly described, and treatment durations were far shorter than recommended guidelines in adults. DISCUSSION: The literature guiding youth MOUD is limited, and more research should evaluate the effectiveness of options other than buprenorphine, optimal treatment duration, and the benefit of adjunctive behavioral interventions. Subgroup analyses of extant randomized clinical trials could help to extend knowledge of MOUD effectiveness in this age cohort.
Authors: Lisa A Marsch; Sarah K Moore; Jacob T Borodovsky; Ramon Solhkhah; Gary J Badger; Shelby Semino; Kate Jarrett; Kathleen DiGangi Condon; Kate Rossettie; Phillip Vincent; Neda Hajizadeh; Elizabeth Ducat Journal: Addiction Date: 2016-04-21 Impact factor: 6.526
Authors: Sarah M Bagley; Marc R Larochelle; Ziming Xuan; Na Wang; Aneesh Patel; Dana Bernson; Michael Silverstein; Scott E Hadland; Thomas Land; Jeffrey H Samet; Alexander Y Walley Journal: Ann Emerg Med Date: 2019-10-04 Impact factor: 5.721
Authors: Scott E Hadland; Sarah M Bagley; Jonathan Rodean; Michael Silverstein; Sharon Levy; Marc R Larochelle; Jeffrey H Samet; Bonnie T Zima Journal: JAMA Pediatr Date: 2018-11-01 Impact factor: 16.193
Authors: Kelli Scott; Sara J Becker; Sarah A Helseth; Ian J Saldanha; Ethan M Balk; Gaelen P Adam; Kristin J Konnyu; Dale W Steele Journal: Fam Pract Date: 2022-03-24 Impact factor: 2.290