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Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months

BACKGROUND: Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilis...

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Autores principales: Smyth, Bobby P., Elmusharaf, Khalifa, Cullen, Walter
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936020/
https://www.ncbi.nlm.nih.gov/pubmed/29728088
http://dx.doi.org/10.1186/s12887-018-1137-4
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author Smyth, Bobby P.
Elmusharaf, Khalifa
Cullen, Walter
author_facet Smyth, Bobby P.
Elmusharaf, Khalifa
Cullen, Walter
author_sort Smyth, Bobby P.
collection PubMed
description BACKGROUND: Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment. METHODS: We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis. RESULTS: OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9–36%) at month three and it was 46% (95% CI = 30–63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry. CONCLUSIONS: We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-018-1137-4) contains supplementary material, which is available to authorized users.
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spelling pubmed-59360202018-05-11 Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months Smyth, Bobby P. Elmusharaf, Khalifa Cullen, Walter BMC Pediatr Research Article BACKGROUND: Opioid dependence is a major health concern across the world and does also occur in adolescents. While opioid substitution treatment (OST) has been thoroughly evaluated in adult populations, very few studies have examined its use in adolescents. There are concerns that OST is underutilised in adolescents with heroin dependence. We sought to measure changes in drug use among adolescents receiving OST and also to examine treatment attrition during the first 12 months of this treatment. METHODS: We included all heroin dependent patients aged under 18.5 years commencing OST at one outpatient multidisciplinary adolescent addiction treatment service in Dublin, Ireland. Psycho-social needs were also addressed during treatment. Drug use was monitored by twice weekly urine drugs screens (UDS). Change in the proportion of UDS negative for heroin was examined using the Wilcoxon signed rank test. Attrition was explored via a Cox Regression multivariate analysis. RESULTS: OST was commenced by 120 patients (51% female and mean age 17.3 years). Among the 39 patients who persisted with OST until month 12, heroin abstinence was 21% (95% confidence interval [CI] = 9–36%) at month three and it was 46% (95% CI = 30–63%) at month 12. Heroin use declined significantly from baseline to month three (p < 0.001) and from month three to month 12 (p = 0.01). Use of other drugs did not change significantly. People using cocaine during month 12 were more likely to be also using heroin (p = 0.02). Unplanned exit occurred in 25% patients by 120 days. The independent predictors of attrition were having children, single parent family of origin, not being in an intimate relationship with another heroin user and evidence of cocaine use just before treatment entry. CONCLUSIONS: We found that heroin dependent adolescent patients achieved significant reductions in heroin use within three months of starting OST and this improved further after a year of treatment, about half being heroin abstinent at that stage. Patient drop out from treatment remains a challenge, as it is in adults. Cocaine use before and during treatment may be a negative prognostic factor. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12887-018-1137-4) contains supplementary material, which is available to authorized users. BioMed Central 2018-05-04 /pmc/articles/PMC5936020/ /pubmed/29728088 http://dx.doi.org/10.1186/s12887-018-1137-4 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Smyth, Bobby P.
Elmusharaf, Khalifa
Cullen, Walter
Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title_full Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title_fullStr Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title_full_unstemmed Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title_short Opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
title_sort opioid substitution treatment and heroin dependent adolescents: reductions in heroin use and treatment retention over twelve months
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5936020/
https://www.ncbi.nlm.nih.gov/pubmed/29728088
http://dx.doi.org/10.1186/s12887-018-1137-4
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