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Rehab may be best option for young adult opiate addicts


(Reuters Health) – Young adults addicted to opiates like oxycodone and heroin may have the best chance at long-term abstinence in residential treatment – often known as rehab – programs, according to a recent study.

“Given evidence that outpatient treatment for opioid dependence in young adults is not as effective as it is in older adults, we need alternatives to protect this vulnerable population,” said lead author Dr. Zev Schuman-Olivier.

According to the U.S. National Institutes of Health, the most commonly abused opiate drugs are heroin and methadone, although the opiate painkillers morphine and oxycodone (Oxycontin) are also widely misused.

Opiate abuse has risen sharply in the last 15 years, especially among young people between the ages of 18 and 25, according to the Centers for Disease Control and Prevention.

The rate of chronic opiate use in that age group is nearly double that of 35- to 49-year-olds, write Shuman-Olivier, an addiction psychiatrist at Cambridge Health Alliance in Massachusetts, and his colleagues in the journal Drug and Alcohol Dependence.

Aside from the dangers of overdose, people who inject opiates are also at high risk for hepatitis C and HIV. “Hepatitis C rates of transmission have been increasing rapidly,” said Schuman-Olivier, who is also on the faculty of Harvard Medical School.

Past studies have found that outpatient treatment using opioid replacement therapy, such as the combination of buprenorphine and naloxone (Suboxone, Subutex), is more successful than rapid-detoxification approaches, the authors note. But after 12 months, just 17 percent of young adults, versus 45 percent of older adults, remain in treatment.

To gauge the long-term results of residential treatment for young opiate addicts, the study team followed 292 adults between 18 and 24 years old in a rehab program based on a 12-step approach. One quarter of the patients met criteria for opiate dependence, 20 percent for opiate misuse and 55 percent were in treatment for abusing other substances, such as alcohol and non-opiate drugs.

The study found that rehab was more effective for 18-24 year olds who were addicted to opiates than for those who merely abused opiates.

Six months after rehab, 43 percent of the dependent opiate users remained abstinent, which compares well with a 38-percent six-month retention rate in this age group in an outpatient Suboxone-therapy program.

At 12 months, 29 percent of the opiate-dependent group was still abstinent, compared to 22 percent of the opiate misusers and 32 percent of those in treatment for other substances.

People who are addicted may have better outcomes because they take the treatment more seriously, Schuman-Olivier said. “Previous studies suggest those who are willing and ready to go to treatment make the most benefit of residential treatment.”

“This study is important because it stresses the need for parents to advocate for residential treatment when that moment arises for an emerging adult when they think about going into treatment,” Schuman-Olivier said.

He described a “window of willingness” after an event such as a minor overdose. “If someone can be encouraged to go into residential treatment at that time, then there is a likelihood that it will have a longer lasting effect than if they go to outpatient treatment.”

Dr. Mark Albanese, also an addiction psychiatrist at Cambridge Health Alliance but not involved in the study, said “We have known for a long time that there are advantages to a residential level of care. (One is) it gets you out of the environment in which you’re using and gets you into a safe environment.”

Rehab programs also offer treatment for any psychiatric disorders the patient may have, he noted.

Schuman-Olivier cautioned that for the first month after people leave residential treatment, they are at the highest risk of overdose. Taking Suboxone can help because it keeps opiate tolerance up, making it harder to overdose, he said.

Rehab programs may also be unavailable to some people because they can be very expensive. Schuman-Olivier said residential rehab treatment is usually only covered by private insurers and only after other levels of outpatient care have failed to work. “It can still be difficult for young adults to gain access to residential treatment if they are uninsured or receive benefits from subsidized Medicaid insurance products.”

The risk of not getting proper treatment outweighs the often high price of rehab, he said. “With more than 40,000 overdose deaths in the U.S. in 2012 and hepatitis C transmission rates increasing rapidly among young adults, it’s important to think about what works, not just costs.”

SOURCE: Drug and Alcohol Dependence, online September 18, 2014.

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