Should Teens Use Suboxone? Exploring the Pros and Cons of Adolescent Suboxone Use

Suboxone is approved to treat opiate dependent users over the age of 16 – but should people in their mid to late teens consider such a serious medication, especially since most teens have relatively short abuse histories?

Well, the answer is...it depends, but for some opiate dependent adolescents, Suboxone – when combined with age-appropriate behavioral therapies – makes a lot of sense.

Read on to learn:

• More about the benefits of Suboxone and the different kinds of treatment.
• Why Suboxone can work well for adolescent users.
• About the situations that indicate appropriateness or inappropriateness for Suboxone treatment.
• About treatment length.
• About research demonstrating its effectiveness among adolescent users.

What Is Suboxone and What Does It Do?

Suboxone is an opiate substitution medication that’s prescribed to treat opiate dependence. After taking a once or twice daily Suboxone dose, a person:

• No longer feels opiate withdrawal symptoms.
• No longer experiences opiate cravings.
• Won’t be able to get high on other opiates.
• Won’t get intoxicated and will be able to function completely normally in life.

When to Consider Suboxone

Why Suboxone?

One compelling argument for the use of Suboxone, even in younger opiate dependent users, is that people under 18 are at heightened risk for some of the most serious dangers associated with opiate abuse – overdose death, HIV infection, suicide and other infectious diseases.¹

Who Is Eligible?

Suboxone is FDA approved for use by adolescents. According to National Institute of Drug Addiction funded BupPractice, teens are potentially good candidates for Suboxone treatment when:²

• They are 16 years of age or older.
• They meet the criteria for opiate dependence.
• They have a history of at least 2 previous failed treatment attempts.
• They have at least a 1 year history of opiate dependence.

Suboxone Benefits

Some of the key benefits of office-based Suboxone treatment (combined with outpatient behavioral therapies) when compared to residential treatment, include:³

• Less life-disruption – As a general rule, adolescent substance abusers should receive treatment in the least restrictive setting that is safe and effective. Suboxone treatment is not a restrictive form of care - no interruption with school or work or other important activities.
• Less costly, than expensive residential treatment.
• Allows for more parental involvement.
• Treatment is confidential.

When Suboxone Doesn’t Make Sense

Suboxone is probably not a good fit for adolescents who:

• Haven’t yet tried other forms of non-opioid treatments.
• Have a very short history of opiate use (a few months only).
• Are not opiate dependent.
• Have uncontrolled symptomatic mental illness that compromises the ability to comply with treatment directives.
• Aren’t willing or able to follow dosing directions and safety instructions.
• Are allergic to buprenorphine or nalxone or have other health issues, such as liver dysfunction, paralytic ileus or respiratory problems that would complicate treatment.

Progressive Modes of Treatment

Suboxone can be used in 2 primary ways:

1. As a short course of treatment to reduce the difficulties of opiate withdrawal.
2. As a longer course of substitution maintenance treatment (many months to open-ended).

Though younger opiate users are at higher risk for overdose and other serious consequences, since teen users rarely have lengthy use histories, they aren't necessarily great candidates for long-term Suboxone maintenance treatment.

According to a SAMHSA expert consensus panel, for adolescent opiate dependent users:¹

1. A short course of Suboxone for detoxification followed by continuing treatment with naltrexone is the preferred treatment to start with.
2. If, after detox with Suboxone and continuing treatment with naltrexone, relapse occurs, then Suboxone maintenance treatment becomes more appropriate.

How Long Does Treatment Take?

If Suboxone (or Subutex) is used as an aid to detoxification only, then medication treatment ends after a few days or weeks, but if Suboxone is used as a maintenance medication, then treatment generally lasts for much longer.

There are few absolutes and patient wishes guide treatment length (if you want to stop no one will make you keep taking your medication) but in general, experts recommend that Suboxone maintenance patients stay on the medication for at least 1 year and then re-assess the situation at the end of this period.

Although once stabilized on Suboxone a young person might feel very positive and confident about future abstinence and want to end treatment, research shows that people who end treatment quickly have higher relapse rates than patients who stick with treatment for at least a year. A longer period on Suboxone gives you enough time to:⁴

• Build a strong recovery program that you can turn to when faced with the challenges that generally arise with tapering and cessation.
• Make significant life-changes and address social, academic or familial issues that could otherwise pull you back to relapse.

There’s no prize for an accelerated end to treatment – there’s only a greater risk of treatment failure. 

Does Research Support Suboxone’s Effectiveness?

There is limited data on the use of Suboxone for adolescent users, though what little research we do have shows strong effectiveness for Suboxone over alternative forms of treatment.

Evidence Supporting Suboxone over Clonidine (Traditional Detoxification)

When researchers compared clonidine (traditional detox) and Suboxone in a 4 week adolescent detox protocol they found that teens given Suboxone stayed in treatment longer (lower drop-out rate), had fewer positive urine tests and were more likely to continue on with naltrexone treatment at the end of the 4 week detox period.⁵

Evidence for Longer Treatment Durations

In a study which compared a 12 week program with Suboxone vs. a 2 week detox-only program with Suboxone, researchers found that by 12 weeks, almost 80% of teens in the detox-only protocol failed an opiate drug test. By contrast, only 40% of teens in the 12 week protocol failed that same drug test.⁵

Is Parental Consent Required?

Laws vary by state. In some states (more than half) adolescents may consent to substance abuse treatment – including Suboxone, without parental consent.

If Considering Suboxone – Take-Home Info

If Suboxone makes sense for you or your adolescent son or daughter, then you should know that this medication has greatly improved outcome rates for people dealing with opiate addictions – so this is cause for optimism!

To get the most benefit from adolescent treatment with Suboxone:

• Don’t rely solely on Suboxone – outcomes improve dramatically when you combine Suboxone with intensive behavioral therapies. Suboxone is best considered a useful adjunct to treatment - not a stand-alone treatment.
• Make sure that behavioral therapies are age-appropriate and address age-specific issues.
• Make sure to get a mental health needs assessment – and if necessary, begin treatment for any co-occurring disorders.
• Parental and family involvement in treatment is very important, an example of this involvement is family therapy.
• Teens with opiate dependencies often need support coping with some of the consequences of their addictive histories – legal consequences, problems at school or work, medical problems and others. Providing assistance for these tasks reduces relapse risk.