Extended vs Short-term Buprenorphine for Young Opiate Addicts

In a study with subjects receiving low intensity outpatient treatment, those who received buprenorphine for 12 weeks did significantly better than those receiving it for 2 weeks.

The difference in retention is striking 70% for extended detox, compared with 20% for short term detox. There were also improved short term and 12 month outcomes in opiate and cocaine use. Outcomes related to alcohol and marijuana use were comparable and pretty low in both groups.

One of the reported limitations was this:

We had no way to compare these results with intensive outpatient therapy, residential treatment, therapeutic community, or naltrexone. It was impossible to design a random assignment study including the first 3 options because they are in limited supply, and the programs we contacted did not feel comfortable using an agonist medication with this population except for short-term detoxification.

What, exactly, was responsible for the improved outcomes? I suspect that most of the benefits, particularly long term, are related to enhanced treatment retention. (As a treatment provider, of course I’d think this!)

Other questions:

  • To what degree are these benefits a function of the low intensity of treatment?
  • What would the disparity be like if more recovery support been provided? If they were provided intense treatment?
  • Unfortunately, we have to ask, what have unpublished studies found?