Counselling as well as drug treatment needed to reduce risky behaviour in opioid-using youth

Extended treatment with buprenorphine/naloxone helps reduce levels of injecting drug use and sexual activity in opioid-using youth, according to US research published in the online edition of the Journal of Acquired Immune Deficiency Syndromes.

However, therapy did not reduce rates of injecting practices involving a risk of HIV transmission, nor did it reduce levels of unprotected sex.

“Additional risk reduction counselling may be needed to promote greater decreases in both drug and sex risk behaviors”, comment the investigators.

In the US, the number of young people illicitly using opioids has increased in recent years. One of the potential consequences of illicit opioid use is exposure to HIV and other infectious diseases such as hepatitis B and/or hepatitis C.

Research conducted amongst adult drug users suggests that women are more likely than men to share injecting equipment and to have high-risk sex.

However, it is not known if such gender differences are present for younger opioid users, nor is it known if treatment for opioid dependence using buprenorphine/naloxone reduces HIV risk behaviours in young people.

Therefore, investigators from the US National Institute on Drug Abuse Clinical Trials Network undertook a study involving opioid users aged between 15 and 21.

They were randomised to receive either two weeks of detoxification with buprenorphine/naloxone or twelve weeks of therapy with buprenorphine/naloxone.

The effects of these two treatments on drug use and sexual behaviour were compared and the results were stratified according to gender.

A total of 150 people with a mean age of 19 were recruited to the study. The majority (89) were male, and most (72%) were white.

All were opioid users. At baseline, 51% of females injected opioids compared to 45% of males. Moreover, 77% of females engaged in injecting behaviours that involved an HIV transmission risk, compared to 35% of males (p < 0.001).

Sexual activity was reported at baseline by 82% of females and 74% of males. Equal proportions of females (68%) and males (64%) reported unprotected anal or vaginal sex in the 30 days before entry to the study.

By the end of the study, only 57% of participants reported using opioids. Greater reductions in opioid use were seen amongst those in the extended treatment arm of the study. For example, at week eight, 67% of the patients in the detoxification arm reported using opiods compared to 33% of those receiving longer duration of buprenorphine/naloxone therapy. There was no gender difference in opioid use throughout the study.

Injecting drug use reduced in both arms of the study, but a greater decrease was seen amongst those receiving extended therapy (p = 0.03). At week eight, 9% of those receiving extended buprenorphine/naloxone treatment reported injecting drug use, compared to 30% of those who received two weeks of detoxification.

Furthermore, there was a significantly greater reduction in the proportion of females, compared to males, reporting injecting drug use (p < 0.05).

However, there was no overall reduction in injecting behaviour that involved a risk of exposure to HIV or other infections. Moreover, throughout the study females were significantly more likely than males to report injecting practices that involved a risk of HIV or viral hepatitis (p = 0.001).

Although there was an overall reduction in sexual activity during the study (p < 0.01), this was not matched by a reduction in sexual risk behaviour. At the end of the study 70% of females and 65% of males reported unprotected penetrative sex.

“Extended buprenorphine/naloxone was associated with significantly greater reductions in opiod use and injecting drug use, and it should be considered as a safe and effective treatment option for opioid-dependent youth”, comment the investigators.

However, they add, “it seems that adjunctive risk reduction counselling may be needed to promote greater decreases in injection and sex risk behaviours.”

The investigators call for additional studies to determine the optimal length of buprenorphine/naloxone therapy and to “identify effective behavioral risk reduction interventions for opioid-dependent youth that can be combined with extended buprenorphine/naloxone treatment and drug counselling.”