A Cochrane review [Abstract] 1 included 2 studies with a total of 190 adolescents. One study compared 28-day treatment with buprenorphine to wearing a clonidine patch in 36 opiate dependent adolescents who were treated as outpatients. No difference was found for drop out rate (RR 0.45, 95% CI 0.20 to 1.04, favours buprenorphine) and for withdrawals symptom score (WMD 3.97, 95% CI -1.38 to 9.32). More participants in the buprenorphine group initiated naltrexone treatment (RR 11.00, 95% CI 1.58 to 76.55). Side effects were not reported.
The other study (n=154) compared maintenance treatment with buprenorphine - naloxone for 9 weeks then tapered to 12 week vs. buprenorphine detoxification 14 days. Maintenance treatment seemed more efficacious in retaining patients in treatment (RR 2.67, 95% CI 1.85 to 3.86) but not in reducing patients with positive urine at the end of the study (RR 1.03, 95% CI 0.82 to 1.28). Self reported opioid use at 1 year follow up was significantly lower in the maintenance group (RR 1.36, 95% CI 1.05 to 1.76) even if both group reported high level of opioid use and more patients in the maintenance group were enrolled in other addiction treatment at 12 month follow up.
No studies were found considering the efficacy of methadone that is still the most frequent drug utilized for the treatment of opioid withdrawal.
Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment), by inconsistency (heterogeneity in interventions and outcomes), and by imprecise results (few patients and wide confidence intervals).
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