Limited evidence on effectiveness of maintenance treatments for opiate dependent adolescents

Clinical question: 
How effective are maintenance treatments for opiate dependent adolescents (13 to 18 years)?
Bottom line: 
One study of 37 participants compared methadone with levomethadyl acetate hydrochloride (LAAM) for maintenance treatment. After 16 weeks of maintenance treatment the adolescents were detoxified. The two maintenance treatments gave similar improvements in social functioning. No side effects were reported. The second trial of 150 adolescents compared buprenorphine and naloxone as maintenance treatment, with buprenorphine detoxification over 14 days. The maintenance treatment for 9 weeks followed by tapered doses up to 12 weeks resulted, at 1 year, in more patients retained in treatment (NNT* 2 [2 to 3]); lower self-reported opioid use (NNT 5 [3 to 27]) but no change in the proportion with a positive urine test and no more enrolled in other addiction programmes. The most common side effect in both groups was headache. No participants left the study because of side effects. *NNT = number needed to treat to benefit 1 individual (95% confidence interval)
Caveat: 
It is difficult to draft conclusions on the basis of only 2 trials, one of which is very old (published 1973) and of very low quality. One of the possible reasons for the lack of evidence could be the difficulty of conducting trials with young people, due to practical and ethical reasons.
Context: 
Substance abuse among adolescents (13 to 18 years old) is a serious and growing problem. The most common drugs used by young people worldwide are cannabis and inhalants. Psycho-stimulants (ecstasy and amphetamines), cocaine, LSD, heroin and other opioids are also used. In adults, pharmacotherapy is a necessary and acceptable part of effective treatment for opioid dependence. Among adolescents, medications have been used infrequently and a choice has to be made between detoxification and maintenance treatment.
Review CD#: 
CD007210
PEARLS No: 
184
Date: 
August, 2009
Authored by: 
Brian R McAvoy