Understanding Buprenorphine-based Medications for Opioid Addiction in Teens and Young Adults

Welcome to (Recovery Design)

By Dr. Wesley C. Sassaman, DNP, MPH, MSN-NE, MBA, FNP-c, CARN-AP

Fentanyl addiction is a dire issue that affects numerous lives, particularly those of our teens and young adults. Buprenorphine-based medications, a cornerstone of Medication-Assisted Treatment (MAT), can play a fundamental role in tackling opioid use disorder (OUD). Today, I will help parents explore the variations in these medications and their applications. The blog begins by highlighting the growing problem of opioid use among adolescents, which has become a significant concern in recent years.

Importance of Parental Involvement in Treating Adolescents with Buprenorphine

In the journey to help adolescents recover from fentanyl addiction, parents play a pivotal role that extends far beyond mere support. Their involvement is a cornerstone in the effective treatment of adolescents with buprenorphine. By actively participating in their child's treatment plan, parents can significantly impact the outcomes.

One key aspect where parental involvement shines is in enhancing treatment adherence. This active engagement helps ensure that adolescents follow through on their prescribed regimen of buprenorphine, crucial for combating opioid dependence effectively. Parents provide the necessary authority and structure essential for maintaining discipline and consistency in medication intake, fostering a sense of accountability in their child's treatment journey.

Moreover, parents serve as crucial gatekeepers for prompt intervention in case of relapse. Their vigilant presence enables quick identification of warning signs, facilitating immediate steps to realign treatment efforts. By minimizing the risk of medication diversion – a serious concern in opioid dependence treatment – parents help safeguard against misuse or unauthorized distribution of buprenorphine.

Parental supervision also extends to monitoring potential side effects of buprenorphine, such as sedation or drowsiness. By actively monitoring and promptly reporting any concerns to healthcare providers, parents contribute to ensuring the safety and well-being of their adolescent undergoing treatment.

Beyond the medical aspects, emotional and moral support are paramount throughout the treatment journey. Adolescents draw strength from their parents' encouragement and motivation, essential elements for sustaining commitment to the treatment plan. By providing a supportive environment, parents empower their child to navigate the challenges of recovery with resilience and determination.

While respecting the adolescent's confidentiality, involving parents offers a wealth of benefits, including educational support. Parents can educate their child about treatment importance, risks, and benefits, fostering a deeper understanding that ultimately leads to improved treatment outcomes.

Furthermore, parental involvement proves invaluable in addressing co-occurring issues often associated with opioid dependence, such as psychiatric disorders or legal problems. By collaborating with healthcare providers, parents can effectively tackle these complex challenges, ensuring holistic care for their adolescent.

Routine monitoring, another vital aspect, falls within the realm of parental responsibilities. From attending medical appointments to overseeing necessary tests, parents play a crucial role in ensuring the treatment's success by maintaining consistency and continuity in the treatment plan.

In essence, parental involvement is not just a supporting role but a guiding force that shapes the adolescent's journey to recovery, instilling hope, resilience, and unwavering support every step of the way.

Special Considerations for Treating Adolescents with Buprenorphine

Supporting your adolescent through their journey of overcoming opioid dependence is a deeply involved and compassionate process. Understanding the unique considerations for treating adolescents with buprenorphine can empower you as a parent to provide the best possible support.

Adolescents struggling with opioid dependence often face complex co-occurring issues. These may include psychiatric disorders, risky behaviors like injection-drug use, abscesses, Hepatitis-C infection, school drop-out, and legal problems. Addressing these interconnected challenges requires a comprehensive and individualized treatment approach, ensuring that each adolescent receives tailored care that combines both medication and behavioral therapies.

Before starting any medication-assisted therapy, a complete evaluation is essential. This involves a thorough assessment of substance use history, medical and mental health status, vocational and psychosocial backgrounds, and a physical exam. Such detailed evaluations help confirm the diagnosis of opioid dependence and identify any active problems that need immediate attention.

Routine laboratory tests play a crucial role in this treatment process. Regular urine toxicology tests are recommended to confirm ongoing opioid use and check for benzodiazepine dependence and liver function. These tests are essential in ensuring the safety and effectiveness of the treatment.

Parental involvement cannot be overstated in this context. Clinicians often emphasize the importance of parents or guardians in providing authority and structure, which can significantly improve treatment adherence. As a parent, your vigilance can facilitate prompt interventions in case of relapse and reduce the risk of medication diversion, where the adolescent might misuse or sell the medication.

Confidentiality laws allow adolescents to seek treatment without parental consent in some states. While this respects their privacy and encourages them to seek help without fear, your involvement remains crucial whenever possible. Striking a balance between respecting their confidentiality and being involved in their treatment can create a supportive environment that fosters trust and openness.

Observed induction is another critical aspect, ensuring proper dosing during the initial phase of treatment. Educating both adolescents and parents about the importance of adherence and awareness of potential side effects, like sedation and drowsiness, can enhance treatment effectiveness.

Extended treatment with buprenorphine/naloxone has shown significant benefits, including improved treatment retention, reduced opioid use, and decreased risky behaviors like injection drug use. This, in turn, lowers the risk of infections such as HIV.

Continuous monitoring and support throughout the treatment journey are paramount. Ensuring that your adolescent adheres to their treatment plan and addressing any emerging issues promptly can greatly enhance the overall effectiveness of the treatment.

In essence, your role as a parent extends beyond mere oversight; it involves being a pillar of support, structure, and understanding. By being actively involved and informed about these special considerations, you can help your adolescent navigate the challenging path to recovery with compassion and resilience.

Buprenorphine an  Effective Treatment for Opioid Dependence for Adolescent Teens

Replacement therapy has been proven effective in treating opioid dependence. While methadone has been safely and effectively used with adults, it often doesn’t appeal to teenagers. Introducing buprenorphine, a newer replacement therapy that has shown to be as effective as high-dose methadone, offers a promising alternative. Buprenorphine's different properties and potentially fewer side effects make it better suited for younger patients.

The experiences of several adolescent patients receiving buprenorphine treatment at an outpatient adolescent substance abuse program within a children's hospital highlight the importance of considering developmental issues in treatment plans. Effective treatment options for adolescents with opioid dependence are crucial, and buprenorphine emerges as a particularly promising solution for this age group.

Effectiveness of Buprenorphine: Buprenorphine, approved by the FDA for treating opioid dependence in individuals aged 16 and older, has been shown to be effective when combined with psychosocial treatments. This combination leads to higher treatment retention and better outcomes compared to other treatments like clonidine.

Increased Treatment Retention: Studies demonstrate that buprenorphine/naloxone maintenance is associated with increased treatment retention among opioid-dependent adolescents. This retention is vital for achieving long-term recovery and reducing opioid use.

Improvement in Behavioral and Emotional Conditions: Treatment retention with buprenorphine is linked to significant improvements in various behavioral and emotional conditions. These improvements help adolescents manage their addiction more effectively and enhance their overall well-being.

Reduction in HIV Risk Behaviors: Extended use of buprenorphine/naloxone has been found to reduce HIV risk behaviors in opioid-dependent youth. This reduction is vital for preventing the spread of HIV and other related health issues among this vulnerable population.

Decrease in Hepatitis-C Related Issues: Stabilization on buprenorphine has been shown to decrease the frequency of transaminase abnormalities associated with Hepatitis-C in opioid-dependent adolescents and young adults. This indicates a positive impact on liver health.

Comprehensive and Tailored Treatment: No single approach suits all individuals. Treatment should be comprehensive and tailored to meet the individual needs of each adolescent, combining opioid agonist medication with behavioral therapies for the best outcomes.

Importance of Parental Involvement: Clinicians encourage parental involvement whenever possible. Your role is crucial for improving treatment adherence, allowing prompt intervention in case of relapse, and minimizing the risk of medication diversion.

Thorough Evaluation Before Treatment: A complete evaluation before starting medication-assisted therapy is essential. This evaluation includes substance use history, medical, mental health, vocational, and psychosocial histories, and physical exams. Such thorough assessments ensure that all active problems are addressed and do not interfere with recovery.

By understanding these special considerations, you can play a more informed and supportive role in your adolescent's recovery journey. Your involvement and awareness are vital in navigating the challenges of opioid dependence treatment with compassion and resilience (Levy,,Vaughan, Knight, 2007).

Supporting your teen through opioid dependence treatment with buprenorphine involves understanding the induction, dosing, and duration of treatment. Here’s what you need to know:

Induction and Initial Dosing

When starting buprenorphine treatment, it’s highly recommended to have an observed in-clinic induction process. This means that healthcare providers will supervise the initial dosing to ensure it’s adequate and safe. Education about the importance of sticking to the treatment plan and monitoring for potential side effects like sedation or drowsiness is crucial. As a parent, you play a vital role in overseeing your teen’s adherence to the medication and watching out for any adverse effects

Dosing Frequency:Buprenorphine has a relatively long half-life, which allows for once-daily dosing. However, if needed, the doses can be split into 2-3 times a day. In practice, maintenance dosing for teenagers has varied widely, from 2 to 24 mg per day, with most patients stabilizing on 9-16 mg daily. If your teen experiences pain, they might require higher doses, but studies show that their overall opioid use outcomes are similar to those without pain (Chakrabarti et al. 2010)

Tailoring the Dose:The goal is to adjust the dose until your teen no longer reports withdrawal symptoms or cravings for opioids. There’s no one-size-fits-all approach, and dosing should be personalized to meet your teen’s specific needs.

Duration of Treatment:Currently, there’s no definitive scientific evidence on the optimal duration of buprenorphine treatment. Therefore, there’s no rush to wean your teen off the medication. The length of treatment can extend up to a year or longer, depending on their progress. Decisions about when to taper the medication should be made collaboratively between healthcare providers, your teen, and you as their legal guardian.

Tapering Off:When it’s time to discontinue buprenorphine/naloxone, it should be done gradually. Tapering the medication slowly helps avoid withdrawal symptoms and prevents the resurgence of cravings

By understanding these aspects of buprenorphine treatment, you can better support your teen’s recovery journey, ensuring they receive the right care tailored to their individual needs.

Different Buprenorphine Formulations

Suboxone

Suboxone, constituting buprenorphine and naloxone, is used as a sublingual film and is one of the most popular MATs for OUD. Buprenorphine in Suboxone minimally activates opioid receptors to curb cravings and withdrawal symptoms. Naloxone acts as a deterrent to misuse but is not absorbed by the body if taken correctly. Suboxone is usually the initial choice for MAT OUD treatment, especially for long-term recovery and relapse prevention (Suboxone. n.d.).

How Suboxone is Taken

Suboxone is administered as a sublingual film or tablet, meaning it is placed under the tongue and allowed to dissolve. This delivery method ensures that the medication is absorbed into the bloodstream efficiently, providing prompt relief from withdrawal symptoms. It is essential to follow the prescribed dosing instructions carefully; usually, a healthcare provider will advise starting with a specific dose and then adjusting it based on the patient's response. Patients must avoid eating, drinking, or talking until the film or tablet has completely dissolved, typically within 5 to 10 minutes. Proper administration is crucial for the medication to be effective and to maximize its benefits in the treatment of opioid use disorder (Suboxone. n.d.).

Zubsolv

Zubsolv, although similar to Suboxone in containing buprenorphine and naloxone, is a newer, more expensive formulation. It is not as widely used due to its cost and possible requirement of special approval from doctors. However, Zubsolv works equally well as Suboxone and is preferred by some for its tablet form and taste. Zubsolv is administered as a sublingual tablet, placed under the tongue to dissolve completely. Users must ensure they do not chew, swallow, or move the tablet around during this process, as these actions can interfere with proper absorption. Typically, the tablet dissolves within 5 to 10 minutes. Similar to Suboxone, it is important for patients to avoid eating, drinking, or talking until the tablet has fully dissolved. The ease of use and taste are often cited as advantages of Zubsolv, contributing to patient adherence to the medication regimen (zubsolv, n.d.)

Switching from Suboxone to Zubsolv

For patients who find the taste of Suboxone intolerable, switching to Zubsolv can be a viable option. Thus, a direct one-to-one conversion is not always accurate. A dose converasion calculator for a Suboxone to Zubsolv conversion can be found at https://www.zubsolv.com website. The transition should be managed by a healthcare provider to ensure the dosage equivalence and patient's response are monitored. Generally, the provider will assess the patient's current dosage of Suboxone and convert it to an appropriate dosage of Zubsolv (Orexo US, Inc., n.d.). 

 Buprenorphine-Naloxone

The market also presents generic formulations of buprenorphine/naloxone medications. These cost-effective alternatives can be found as sublingual film strips or tablets and work similarly to Suboxone or Zubsolv. Depending on your insurance, these generics might be the only covered options (Drugs.com (n.d.).

Subutex

Subutex is another option that is a buprenorphine tablet, offering another form and method of administration for those in treatment. Unlike Suboxone and Zubsolv, Subutex does not contain naloxone, making it an option for those with allergies or sensitivities to naloxone. However, because of the lack of naloxone, there is a higher potential for misuse and diversion (Drugs.com. (n.d.).).

Sublocade

Sublocade is a monthly injectable form of buprenorphine used to treat opioid use disorder in teens and young adults. Doses are available in 100 mg or 300 mg injections. It is recommended to begin with 300 mg injections for the first two months, followed by 100 mg injections for as many months as needed. Sublocade offers a significant advantage due to its extended-release formula, which continuously delivers its effects over a month, ensuring consistent medication levels in the bloodstream. This can be particularly beneficial for teens and young adults who may struggle with the daily adherence required by other buprenorphine-based treatments like Suboxone or Subutex (https://www.sublocade.com/.

One of the key benefits of Sublocade is its ability to reduce the risk of misuse or diversion, as it is administered by a healthcare professional rather than being taken home by the patient. This ensures that the medication is taken precisely as prescribed. Furthermore, the long-acting nature of Sublocade helps maintain stability in the patient's daily life, reducing the highs and lows often associated with opioid dependency and withdrawal symptoms. However, parents should discuss with healthcare providers to determine if Sublocade is the appropriate choice, considering factors like the specific needs of the patient and any potential side effects (Indivior Inc.,  n.d.).

Brixadi

Brixadi is weekly or monthly injectable form of buprenorphine, similar to Sublocade. However, Brixadi offers a more flexible dosing option, with 4 different strengths available depending on the patient's needs. This can be beneficial for teens and young adults who may require a higher or lower dose of buprenorphine at different points in their recovery journey. Brixadi offers more flexible treatment options than Sublocade. It has wider dosing ranges that can be administered both weekly and monthly.  Weekly doses of Brixadi are 8 mg, 16 mg, 24 mg, or 32 mg, while monthly doses are 64 mg, 96 mg, or 128 mg. By offering varying doses, individuals who may not tolerate higher doses well can still safely take the medication. (Brixadi, n.d.).

In conclusion, buprenorphine-based

Choosing the right Buprenorphine-based medication depends on various factors such as personal preference, insurance coverage, and potential for misuse. Suboxone has proven to be a reliable first line of treatment, but certain situations might warrant the use of alternatives such as Zubsolv, Subutex, Sublocade, or a generic equivalent. Always consult with a healthcare professional when deciding on the best course of treatment. Together, we can guide our teens and young adults towards a brighter, healthier future, free of opioid addiction.

References

Levy, S, Vaughan, B.,  Knight, J (2007). Children's Hospital-Based Outpatient Treatment Program. Journal of Adolescent Health, 40(2), 150-155. Society for Adolescent Medicine.

Chakrabarti, A., Woody, G. E., Griffin, M. L., Subramaniam, G., & Weiss, R. D. (2010). Predictors of buprenorphine-naloxone dosing in a 12-week treatment trial for opioid-dependent youth: secondary analyses from a NIDA Clinical Trials Network study. Drug and Alcohol Dependence, 107(2-3), 253-256.

Suboxone. (n.d.). Retrieved from https://www.suboxone.com/.

Zubsolv. (n.d.). Retrieved from https://www.zubsolv.com/.

Orexo US, Inc. (n.d.). Dose Conversion Calculator | Zubsolv. Retrieved from https://www.zubsolv.com/healthcareprofessionals/about-zubsolv/dose-conversion-calculator/

Drugs.com. (n.d.). Buprenorphine and naloxone oral/sublingual. Retrieved from https://www.drugs.com/mtm/buprenorphine-and-naloxone-oral-sublingual.html.

Drugs.com. (n.d.). Generic Subutex Availability. Retrieved from https://www.drugs.com/availability/generic-subutex.html.

Indivior Inc. (n.d.). Sublocade® (buprenorphine extended-release) injection, for subcutaneous use. Retrieved from https://www.sublocade.com/.

Brixadi. (n.d.). Retrieved from https://www.brixadi.com/.

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