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What Medications Are Used in Medication Assisted Treatment for Teens?

Written by Evolve's Behavioral Health Content Team​:

Alyson Orcena, LMFT, Melissa Vallas, MD, Shikha Verma, MD, Ellen Bloch, LCSW, Lianne Tendler, LMFT, Megan Johnston, LMFT Meet The Team >

Medication-assisted treatment (MAT) is a way for adolescents to detox from, and overcome, their opiate addiction. By taking specific, FDA-approved, physician-prescribed drugs, teens are able to gradually taper off their heroin or opioid addiction without experiencing strong opioid cravings or the painful symptoms of withdrawal. For these reasons, MAT helps limit the risk of relapse. Medication-assisted treatment works best when integrated with behavioral therapy, like DBT or CBT, and counseling. This is why some teens attend an adolescent drug rehab center while on MAT.

Types of Medications Used in MAT

If your teen receives a recommendation for MAT, there are a number of medications you may need to research. Each medication works differently. On their MAT resource page, the Substance Abuse and Health Services Administration (SAMHSA) identifies three drugs as effective for the treatment of opioid use disorders. These should only be used as directed and under guidance by a physician:

  1. Methadone
  2. Buprenorphine
  3. Naltrexone

    Methadone

    Methadone has been used by adults for decades in managing heroin addiction. According to federal regulations, it should be given only to young adults aged 18 and over. (Administration to adolescents under 18 is highly restricted).  While it is an opiate, officially called a complete opioid agonist, meaning it binds itself completely to the brain’s opioid receptors, it doesn’t produce a high. It curbs regular opioid cravings and reduces the painful symptoms of withdrawal. To receive methadone, young adults must travel to a clinic every day to get their single dose. These highly structured clinics are called opioid treatment programs (OTP). Physicians are usually only allowed to provide daily doses, to prevent individuals from abusing or overdosing on the drug.

    Buprenorphine

    Buprenorphine, informally known as “bupe,” is a relatively new medication for the treatment of opioid use disorders. It is the most commonly prescribed medication for teens with opioid use disorder. The FDA approved it for adolescent use in medication-assisted treatment in 2002, but only for teens 16 and up. Buprenorphine is usually known by its brand names: Subutex, Suboxone, and Zubsolv. Unlike methadone, individuals can receive a prescription for buprenorphine at their physician’s office, rather than in a highly regulated clinic. They can then fill the prescription at any pharmacy and take the medicine at home.

    However, the problem is that not all physicians can prescribe buprenorphine. Doctors must participate in specialized training to receive a license to prescribe buprenorphine. In addition, they can only treat 100 patients at a time. To make matters more complicated, physicians must receive a waiver from the U.S. Drug Enforcement Agency to prescribe buprenorphine. These rules and regulations make it challenging to find a doctor in the U.S. available to treat your teen.

    Naltrexone 

    Unlike methadone and buprenorphine, Naltrexone is an opioid antagonist. This means it blocks the euphoric effects of opiates. Research has shown that it reduces opioid cravings and prevents relapse, but it doesn’t offer the same pain relief as opioid agonists do. Naltrexone comes as a daily pill or a monthly injection. The latter, an extended-release injection (Vivitrol), was developed recently, and lasts longer than the oral form. Unlike methadone and buprenorphine, which have the potential to be abused since they are also opioids, Naltrexone can be administered by any physician. Teens must go to the doctor’s office once a month to receive the injection.

    However, adolescents must be fully clean from heroin or other opioids before receiving the medication. They must have a period of abstinence for 7-10 days. This could be hard to achieve. In fact, one qualitative study of more than 20,000 American teens and young adults showed that Naltroxene is not dispensed commonly for teens (Hadland, 2017). Buprenorphine was dispensed 8 times more often than naltrexone.

Medication-Assisted Treatment: Good or Bad?

The concept of medication-assisted treatment is still controversial. Some mental health professionals and doctors feel that it’s a sort of cop-out, since teens are still taking drugs—just legal ones. They feel especially wary about buprenorphine and methadone, the opioid agonists.

However, the opposing camp argues that certain teens can only overcome their opiate addiction with the help of medications like Suboxone. Harm reduction advocates argue that this is the only way adolescents are going to stop taking opioids and possibly overdosing to death. To read more about the controversy surrounding medication-assisted treatment for teens, read our article here.

So, Should My Teen Be Put on MAT?

If you’re wondering whether your teen should start medication-assisted treatment, our answer is:

 It varies on a case-by-case basis.

If your teen lives with a heroin or other opioid addiction, a doctor needs to evaluate them for MAT. Some of the factors involved in this decision include their age, the level of their addiction, and their past history. If your teen’s rate of relapse is very high, or if your teen has tried behavioral therapy/traditional detox unsuccessfully, the physician might recommend MAT.

However, MAT is not a one-size-fits-all approach to opioid addiction treatment. Each teen must be evaluated and placed on a customized plan that fits their clinical needs and matches their past addiction history. One teen might be placed on a short-term Suboxone program to help them detox gradually so they can get back into the real world and can continue therapy. Another adolescent may only take buprenorphine or Vivitrol after the detox phase, to help them curb their opioid use and limit relapse.

As we mentioned above, it varies by the individual.

Medication-Assisted Treatment for Youth with Opioid Use Disorder

Many parents of adolescents still find it hard to access medication-assisted treatment. This is mainly due to the limited availability of doctors working with this population. There are a limited number of doctors and pediatricians that prescribe buprenorphine. Likewise, there are few drug treatment programs in the U.S. that offer medication-assisted treatment to adolescents.

For a handy guide featuring more differences between the three medications used in MAT, see the one on page 3 of this SAMHSA Advisory.

Our Behavioral Health Content Team

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