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NIDA Targets Young Opioid Abusers


 

Significant differences exist, too, between abusers of any opioid and those youth who use marijuana and/or alcohol. Opioid users were more likely to be white, non-urban school drop-outs and were more likely than problem users of marijuana and/or alcohol to also have cocaine and/or sedative use disorders, and 3 or more non-opioid substance use disorders (Drug and Alcohol Depend. 2009;99:141–9).

Opioids' Added Risks

Dr. Subramaniam's recent analysis of data from 88 studies showed that the added risks of opioid use among marijuana and alcohol users were substantial. The opioid users had significantly more major clinical problems than those using marijuana and alcohol (5.1 vs. 3.4), and also demonstrated greater psychiatric comorbidity, victimization, and treatment utilization (Addiction 2010;105:686–98).

Clearly, young opioid users are a population in need, Dr. Subramaniam said.

Medication/counseling programs may help to meet that need, if office-based physicians are willing to go through the government-sponsored training program that enables them to prescribe buprenorphine and ensure that appropriate counseling is available.

In some cases, office-based physicians provide counseling themselves, she said. Others establish close collaborative relationships with neighboring counseling programs.

In either case, patients require “very close monitoring in the early days of treatment as one aims to find the most optimal dose of buprenorphine during the induction phase.” Regular follow-up monitoring and counseling over the ensuing weeks and months is advised.

Family Support and Buy-In

As a child psychiatrist who specialized in addiction medicine before assuming her government post, Dr. Subramaniam has had years of hands-on clinical experience treating opioid-dependent youths with buprenorphine.“I always recommended that a supportive adult monitor compliance,” she said. “You need family support and buy-in.”

Office-based physicians who become qualified to prescribe buprenorphine through the waiver program can provide the agent to patients as young as age 16 years.

“What if the adolescent is younger?”

Dr. Subramaniam noted that research supports use of the drug in children as young as 15, since that was the youngest patient recruited for the NIDA sponsored clinical trial, she said.

Direction and guidance for thorny clinical issues are currently available through no-cost mentoring by senior physicians experienced in using buprenorphine through a Physician Clinical Support System sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA), noted Dr. Subramaniam. Information can be found at

www.pcssmentor.org

At NIDA, “We are trying to make a very concerted effort to provide training to clinicians and to educate them about why this is a good thing to do,” she said.

Office-based physicians “can have a tremendous impact,” echoed Dr. Woody.

“It's to everyone's advantage to become more familiar with this approach to addiction. The field is going in this direction.”

Dr. Subramaniam reported having no conflicts of interest. Dr. Woody disclosed that he has received a consulting fee from Alkermes Pharmaceuticals Inc., and serves on the RADARS system scientific advisory board.

For more information about receiving a waiver to practice opioid addiction therapy, go to

http://buprenorphine.samhsa.gov/waiver_qualifications

By Betsy Bates. Share your thoughts at

cpnews@elsevier.com

There is “robust evidence” that buprenorphine combined with counseling is a viable treatment option for opioid dependence, Dr. Geetha Subramaniam says.

Source Catherine Harrell/Elsevier Global Medical News

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