Teen Opiate Treatment Without Buprenorphine Is Inadequate

Twenty-four percent of US adolescent treatment centers do not use a “lifesaving” medication.

An article appeared today in the Journal of the American Medical Association titled “Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022.” The authors surveyed 160 substance abuse treatment facilities for adolescents across the US and found a frightening lack of adherence to recommended evidence-based medical care. Only 24% offer teens buprenorphine despite the recommendations of the American Society of Addiction Medicine and the Society for Adolescent Health and Medicine.

The Food and Drug Administration approved the use of buprenorphine for adolescents aged 16-18 as long ago as 2003 – 20 years ago! But buprenorphine has still not been adopted as the standard of care in three-quarters of teen treatment centers. The primary explanation theorized for this failure to offer the only approved medication for adolescent opiate use disorder is the antiquated belief that using buprenorphine is merely substituting one drug for another. Such purist beliefs are held by those who would rather be right than be effective. I believe the reason for avoiding buprenorphine includes ignorance of what buprenorphine is, how it works, the data proving its safety and effectiveness, and how it can be used to support recovery.

Buprenorphine is an opiate that has a ceiling effect. It is capable of reducing or eliminating withdrawal symptoms from other opiates such as heroin or fentanyl. When buprenorphine is taken on a daily basis, it provides little or no psychoactive effects while it blocks the effect of any other opiate that is ingested. In other words, buprenorphine removes cravings for an opiate while also making it impossible to get high with heroin or fentanyl. True, buprenorphine is an opiate. And true, discontinuing buprenorphine suddenly causes some withdrawal symptoms. In most cases, gradual withdrawal from buprenorphine greatly minimizes withdrawal. And true, a few people have difficulty eliminating the last small doses of buprenorphine. But the benefits far outweigh these inconveniences.

Foremost, buprenorphine is lifesaving by reducing the number of people who relapse. Detox facilities that only withdrew people from their opiate addiction and did not provide buprenorphine after discharge too frequently found their patients soon overdosed. Once withdrawn, any return to opiate use needs to be done slowly, but too many people relapse to the dose they had been using before detox. Their renewed sensitivity to opiates can not handle the old high dose and they suffocated from the opiate’s suppression of their breathing. Maintenance buprenorphine would have saved their lives. So, the standard of care today is to detox people with buprenorphine and then to provide them with a maintenance dose upon discharge. This is true harm reduction that enables people to re-establish themselves back into productive lives.

MAT is the acronym for medication assisted treatment. Buprenorphine supports people for however long it takes to get established into a recovery lifestyle. MAT keeps people sober so that recovery and ongoing therapy has a chance to work its hard-work miracles. This is especially important for adolescents since they do not have the freedom or resources to avoid returning to the same environments where they first became addicted.

A clever technology is used to prevent misuse of buprenorphine. Medications such as Suboxone combine generic buprenorphine with the opiate blocker naloxone, which is not absorbed through the oral mucosa or stomach. So, if someone tries to dissolve Suboxone and shoot it into a vein, the naloxone will block any buprenorphine effects and will even throw a heroin addict further into withdrawal. Very uncomfortable.

It is well past time for adolescent substance abuse treatment centers to fully medicalize the care they provide. This may require some additional training, additional specialized staff, and additional licensure. But, if parents began demanding scientifically sound, evidence-based treatment for their children, treatment centers will quickly respond.

Adolescent treatment of opiate addiction without buprenorphine is simply inadequate treatment.