Pubdate: Tue, 02 Dec 2014
Source: Globe and Mail (Canada)
Copyright: 2014 The Globe and Mail Company
Author: Madeline Kennedy
Page: L5


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 past 15 years, especially among 
young people between the ages of 18 and 25, according to the U.S. 
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, writes 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 per cent of young adults, versus 45 per cent 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 per cent for 
opiate misuse and 55 per cent were in treatment for abusing other 
substances, such as alcohol and non-opiate drugs.

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

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

At 12 months, 29 per cent of the opiate-dependent group was still 
abstinent, compared with 22 per cent of the opiate misusers and 32 
per cent 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 that] 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.
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