Effectiveness of medication for opioid use disorders in transition-age youth: A systematic review

Sara J. Becker; Kelli Scott; Sarah A. Helseth; Kristin J. Danko; Ethan M. Balk; Ian J. Saldanha; Gaelen P. Adam; Dale W. Steele

doi:10.1016/j.jsat.2021.108494

Effectiveness of medication for opioid use disorders in transition-age youth: A systematic review

Sara J. Becker^*, Kelli Scott, Sarah A. Helseth, Kristin J. Danko, Ethan M. Balk, Ian J. Saldanha, Gaelen P. Adam, Dale W. Steele

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

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.

Original language	English (US)
Article number	108494
Journal	Journal of Substance Abuse Treatment
Volume	132
DOIs	https://doi.org/10.1016/j.jsat.2021.108494
State	Published - Jan 2022

Funding

This review was funded under contract HHSA 290-2015-00002-I, Task Order HHSA29032011T, Agency for Healthcare Research and Quality, US Department of Health and Human Services. The authors of this article are responsible for its content. Statements in the article do not necessarily represent the official views of or imply endorsement by Agency for Healthcare Research and Quality or the Department of Health and Human Services. The effort of Dr. Helseth was supported by K23DA048062. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funder.

Keywords

Buprenorphine
Medication for opioid use disorder
Opioid use
Youth

ASJC Scopus subject areas

Psychiatry and Mental health
Clinical Psychology
Phychiatric Mental Health
Medicine (miscellaneous)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1016/j.jsat.2021.108494

Cite this

@article{8fab32de654e4670aafa6bce8c3360d8,

title = "Effectiveness of medication for opioid use disorders in transition-age youth: A systematic review",

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.",

keywords = "Buprenorphine, Medication for opioid use disorder, Opioid use, Youth",

author = "Becker, {Sara J.} and Kelli Scott and Helseth, {Sarah A.} and Danko, {Kristin J.} and Balk, {Ethan M.} and Saldanha, {Ian J.} and Adam, {Gaelen P.} and Steele, {Dale W.}",

note = "Publisher Copyright: {\textcopyright} 2021 Elsevier Inc.",

year = "2022",

month = jan,

doi = "10.1016/j.jsat.2021.108494",

language = "English (US)",

volume = "132",

journal = "Journal of Substance Abuse Treatment",

issn = "0740-5472",

publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Effectiveness of medication for opioid use disorders in transition-age youth

T2 - A systematic review

AU - Becker, Sara J.

AU - Scott, Kelli

AU - Helseth, Sarah A.

AU - Danko, Kristin J.

AU - Balk, Ethan M.

AU - Saldanha, Ian J.

AU - Adam, Gaelen P.

AU - Steele, Dale W.

PY - 2022/1

Y1 - 2022/1

N2 - 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.

AB - 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.

KW - Buprenorphine

KW - Medication for opioid use disorder

KW - Opioid use

KW - Youth

UR - http://www.scopus.com/inward/record.url?scp=85111012724&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85111012724&partnerID=8YFLogxK

U2 - 10.1016/j.jsat.2021.108494

DO - 10.1016/j.jsat.2021.108494

M3 - Article

C2 - 34098208

AN - SCOPUS:85111012724

SN - 0740-5472

VL - 132

JO - Journal of Substance Abuse Treatment

JF - Journal of Substance Abuse Treatment

M1 - 108494

ER -

Effectiveness of medication for opioid use disorders in transition-age youth: A systematic review

Abstract

Funding

Keywords

ASJC Scopus subject areas

UN SDGs

Access to Document

Other files and links

Fingerprint

Cite this