Treatment of opioid dependence in adolescents and young adults with extended release naltrexone: preliminary case-series and feasibility Marc J. Fishman 1,2 , Erin L. Winstanley 3,4 , Erin Curran 1,2 , Shannon Garrett 2 & Geetha Subramaniam 1,2 Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, MD, USA, 1 Mountain ManorTreatment Center, MD, USA, 2 University of Cincinnati College of Medicine, Department of Psychiatry, OH, USA 3 and Lindner Center of HOPE, OH, USA 4 ABSTRACT Background Opioid dependence is an increasing problem among adolescents and young adults, but in contrast to the standard in the adult population, adoption of pharmacotherapies has been slow. Extended-release naltrexone (XR- NTX) is a promising treatment that has been receiving increasing interest for adult opioid dependence. Clinical chart abstractions were performed on a convenience sample of 16 serial adolescent and young adult cases (mean age 18.5 years) treated for opioid dependence with XR-NTX who attended at least one out-patient clinical follow-up visit. Case descriptions Of these 16 cases, 10 of 16 (63%) were retained in treatment for at least 4 months and nine of 16 (56%) had a ‘good’ outcome defined as having substantially decreased opioid use, improvement in at least one psychosocial domain and no new problems due to substance use. Conclusions These descriptive results suggest that XR-NTX in the treatment of adolescents and young adults with opioid dependence is well tolerated over a period of 4 months and feasible in a community-based treatment setting, and associated with good outcomes in a preliminary, small non- controlled case-series.This probably reflects an overall trend towards greater adoption of medication treatments for this population. Keywords Adolescents, extended-release naltrexone, naltrexone, opioid dependence, medication assisted treat- ment, pharmacotherapy, young adults. Correspondence to: Marc J. Fishman, Mountain ManorTreatment Center, 3800 Frederick Road, Baltimore, MD 21229, USA. E-mail: mjfishman@comcast.net Submitted 29 November 2009; initial review completed 5 February 2010; final version accepted 3 March 2010 INTRODUCTION Opioid use among adolescents has risen dramatically in the past decade. Past-year heroin use among 12th graders in the decade from 1995–2005 averaged 1%, while past-year non-medical use of prescription opioids nearly doubled from 4.7% to 9% during the same period. Non-medical use of prescription opiates is now the second most frequently used illicit drug among 12–17- year-olds, following marijuana [1,2,3]. Correspondingly, treatment admissions for opioid use disorders increased 196% between 1995 and 2005 [4]. Despite advances in adolescent substance abuse treat- ments and research over the past decade [5], there is rela- tively little documentation of treatment outcomes among the high-severity subpopulation of adolescent and young adult opioid users. Opioid-using adolescents have very high rates of relapse and treatment dropout in out- patient treatment [6] and greater severity and worse post- residential treatment outcomes compared to their non- opioid-using counterparts [7]. The effectiveness of maintenance pharmacotherapy for opioid dependence in adults is well documented, and has become the treatment standard of care. Four medi- cations are approved by the Food and Drug Administra- tion (FDA) for the treatment of opioid dependence in adults—the pure agonist methadone, the pure antagonist naltrexone, the partial agonist buprenorphine and a buprenorphine/naloxone combination. However, there is very little information about the use and effectiveness of pharmacotherapies for opioid dependence in adolescents and young adults. CASE REPORT doi:10.1111/j.1360-0443.2010.03015.x © 2010 The Authors. Journal compilation © 2010 Society for the Study of Addiction Addiction, 105, 1669–1676