Low-barrier treatment options with technology-assisted dispensing hold promise for adults ages 18 to 25 years waitlisted for comprehensive opioid treatment. This age group is traditionally less likely to enter or adhere to outpatient interventions, according to a study published in the Drug and Alcohol Dependence.
The investigators developed a low-barrier, technology-assisted interim buprenorphine treatment (IBT) regimen for reducing illicit opioid use during waitlist delays for comprehensive opioid agonist therapy. Then, the investigators conducted a secondary analysis to compare treatment outcomes between emerging adults and older adults who received IBT.
The study included 35 individuals with opioid use disorder, including 10 emerging adults aged 18 to 25 years and 25 older adults aged ≥26 years. All participants received the IBT intervention for 12 weeks; participants ingested medication under nurse observation at scheduled bimonthly clinic visits, provided urine samples, and completed the Beck Anxiety Inventory, Beck Depression Inventory, and Addiction Severity Index at weeks 4, 8, and 12. Participants ingested remaining IBT doses at home, which were administered via a computerized medication dispenser, and received daily calls from an automated voice response system that assessed opioid use, cravings, and symptoms of withdrawal.
At intake, emerging adults reported greater use of intravenous drug administration in the past year than the older adults (80% vs 32%; P =.01) as well as greater baseline psychiatric severity (P <.001) and problems in psychosocial functioning (P <.001) along with employment (P =.019) and legal (P <.001) problems.
During follow-up, there were no significant differences between emerging and older adults in the percentages of urine specimens that tested negative for illicit opioids at week 4 (90% vs 88%; P =.99), week 8 (80% vs 76%; P =.99), or week 12 (60% vs 68%; P =.71). However, compared with older adults, emerging adults demonstrated significant reductions in the Beck Anxiety Inventory (P =.006) and Beck Depression Inventory scores (P =.028). They also reported greater improvements over time in specific problem areas measured by the Addiction Severity Index, including employment, legal, and alcohol subscales.
Limitations to the study included the small sample size, the homogeneous racial background of patients involved, and a relatively short treatment duration.
Although emerging adults reported a higher prevalence of intravenous drug use and more severe employment, legal, and psychiatric problems at intake, they achieved dramatic improvements in response to IBT. The investigators suggest low-burden interventions may hold promise for this demographic in reducing opioid-related morbidity and mortality.
Peck KR, Ochalek TA, Badger GJ, Sigmon SC. Effects of interim buprenorphine treatment for opioid use disorder among emerging adults [published online January 22, 2020]. Drug Alcohol Depend. doi: 10.1016/j.drugalcdep.2020.107879