Home > Study findings on opiate substitution programme for adolescents.

Lyons, Suzi (2012) Study findings on opiate substitution programme for adolescents. Drugnet Ireland, Issue 41, Spring 2012, pp. 14-15.

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There is not a lot of Irish or international research to inform or guide service providers on treatment pathways for adolescents receiving opiate substitution treatment (OST). Smyth and colleagues recently conducted a retrospective cohort study looking at the outcomes for heroin-dependent adolescents receiving OST in Dublin, and the incidence of hepatitis C, HIV and mortality among this group.1 

The Young Persons Programme (YPP), a multidisciplinary adolescent treatment service provided by the Drug Treatment Centre Board (DTCB), accepts adults aged 17 years or under (and 18-year-olds occasionally). Based in Dublin, it also provides treatment to young people from surrounding counties. The programme is ‘harm reduction orientated’ but overall the aim is to assist clients to abstinence through detoxification.
The authors studied the records of heroin-dependent adolescents who were referred to the YPP between May 2000 and July 2008. Adolescents with a dependence on prescription opioids and those who dropped out of the assessment process before starting on medication were excluded from the study. The study cohort comprised the first 100 patients who met the inclusion criteria. Information on participation in the programme was recorded at 3, 6 and 12 months.
Doctors working at the DTCB were permitted to prescribe buprenorphine when it became available as a treatment option in 2005. Nineteen of the cohort were prescribed buprenorphine at the start of treatment, while all others received methadone. The mean peak methadone dose prescribed over the treatment period was 53mg (range 15mg to 90mg).
Three quarters of the 100 adolescents were aged 16 or 17, and 13 were aged 15 or under. There were more girls (54, 54%) than boys (46, 46%). There were statistically significant differences between the boys and the girls.
Boys were more likely than girls:
·         to have left school at a younger age (13.8 years versus 14.9 years [mean]);
·         to report that a sibling abused opiates (56% versus 32%);
·         to have previous criminal convictions (59% versus 29%);
·         to have ever been imprisoned (41% versus 14%).
Girls were more likely than boys:
·         to have a current partner who used heroin (16% versus 64%).
The final progression route of the adolescents was the primary outcome of interest for the authors. The route of exit was recorded for 92 clients who left or moved on from the treatment programme:
·         22% (20) had a planned discharge following detox;
·         32% (29) dropped out;
·         8% (7) were imprisoned;
·         39% (36) transferred to another service to continue opiate substitution.
Twenty-eight adolescents dropped out during their first year of treatment, 19 of whom left within the first three months. Boys were significantly more likely than girls to leave treatment because of imprisonment (14% versus 2%).
Of the 49 adolescents who remained in treatment for 12 months and for whom urinalysis results in the 12th month were available, 39% (19) were completely abstinent from heroin. There was no statistically significant difference between boys and girls.
The study also looked at the incidence of blood-borne viruses and mortality:
·         20% were hepatitis C positive (17 of the 84 tested);
·         33% of injectors were hepatitis C positive (12 out of 36 tested);
·         no clients were HIV positive (0 out of 69 tested);
·         no deaths were recorded during treatment.
The authors noted the relatively long assessment process for admission to the treatment programme. They point out that, while only 12 adolescents dropped out during the assessment phase, ‘a faster route into treatment may have resulted in more study participants and may have altered the detected outcome profile’. Boys were significantly more likely than girls not to progress from assessment to treatment, which may be linked to the finding that slightly more girls than boys were treated in the programme over the study period. This differs from what is shown in the national data, where the majority (73%) of cases in treatment for problem opiate use are male.2
While the adolescents who remained in treatment showed reductions in heroin use, the authors caution that, ‘heroin dependence represents a complex and serious clinical problem and poses major treatment challenges’. These challenges include high drop-out rates, especially in the early months of treatment, along with the proportion who never complete detoxification or who relapse. The authors conclude that many adolescents with heroin dependence will require opiate substitution treatment for at least a year or more.  
1. Smyth B, Fagan J and Kernan K (2012) Outcome of heroin-dependent adolescents presenting for opiate substitution treatment. Journal of Substance Abuse Treatment, 42(2): 35–44.
2. Carew AM, Bellerose D, Lyons S and Long J (2009) Trends in treated problem opiate use in Ireland, 2002 to 2007. HRB Trends Series 7. Dublin: Health Research Board. www.drugsandalcohol.ie/12371

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