A National Institutes of Health study has found that treating opioid-addicted youth with counseling plus 12 weeks of buprenorphine and naloxone (Suboxone) therapy yields better results than the usual short-term detoxification course of Suboxone and counseling.
   The study involved 154 participants ages 15 to 21, who had been addicted to opioids for an average of 1½ years. All participants were offered group or individual counseling for 12 weeks and were randomly assigned to either 2 weeks or 12 weeks of Suboxone treatment. In the latter group, the dose was gradually tapered starting at week 9, with the drug discontinued at week 12.
   Those who took Suboxone for 12 weeks were less likely to use opioids, cocaine, and marijuana; to inject drugs; or to drop out of treatment than those who received short-term detoxification and counseling. They also were less likely to have opioid-positive urine specimens when tested at weeks 2, 8, and 12. Officials said they hoped the results of this study would encourage practitioners who have been unsure about using long-term Suboxone therapy to consider this treatment option.
   Suboxone combines buprenorphine and naloxone in a single tablet. Buprenorphine, a Schedule III controlled drug, acts on the brain's opiate receptors, reducing withdrawal and cravings without producing an intense high or dangerous adverse effects. The naloxone component reduces the risk of abuse of the drug. If the patient attempts to inject the drug, the combination causes severe withdrawal symptoms. However, taken orally, as prescribed, these effects don't occur. A few patients complained of sedation, a common problem with methadone and other drugs used to reduce opioid dependence.
   Suboxone and Subutex (buprenorphine alone) are the first drugs available for treating opioid dependence that can be prescribed in a provider's office by specially trained and licensed physicians. Opioids include heroin, morphine, and such prescription drugs as the hydrocodone and acetaminophen combination (Vicodin) and oxycodone (OxyContin). (JAMA 2008; 300[17]:2003-2011)

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