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Psychiatric Symptoms in Youth with Opioid Use Disorder Differ by Sex but Improve During Buprenorphine/Naloxone Treatment

October 1, 2021
Meg Brunner, MLIS
Hammond CJ, et al. Sex-based differences in psychiatric symptoms and opioid abstinence during buprenorphine/naloxone treatment in adolescents with opioid use disorders. Journal of Substance Abuse Treatment 2021 (in press).
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Addiction Science Made Easy
October 2021
CTN Research Briefs

Opioid use during adolescence is associated with a range of negative health outcomes, including opioid use disorder (OUD), medical and psychiatric disorders, socioeconomic challenges, legal problems, academic and work-related issues, high-risk sexual behavior, and elevated risk for opioid-related overdose and death.

Sitting Side by Side on the beachPsychiatric symptoms and disorders commonly co-occur with opioid use and OUD and this co-morbidity is associated with increased risk of death. Young people who use opioids and who meet criteria for OUD have higher rates of psychiatric symptoms and disorders compared to youth without OUD, including hopelessness, major depression, and suicide. 

But is opioid use associated with psychiatric symptoms/disorders aside from depression in adolescents, and, if present, are these associations specific to females or males, or do they generally impact both sexes?

This study examined sex-based differences in psychiatric symptoms and relationships among sex, psychiatric symptoms, and opioid use outcomes in youth with OUD receiving buprenorphine/naloxone (Bup/Nal) and psychosocial treatment.

Using data from CTN-0010, in which 152 youth aged 15-21 diagnosed with OUD were randomized to either 12 weeks of treatment with Bup/Nal to up to 2 weeks of Bup/Nal detoxification (with both groups receiving weekly drug counseling), researchers compared psychiatric symptoms at baseline and week 12 across male and female OUD participants. 

Results found that compared to males, females with OUD reported more psychiatric symptoms at baseline, including anxious depression, withdrawn depression, somatic complaints, thought problems, attention problems, aggressive behavior, and delinquent behavior. 

However, during treatment, psychiatric symptom scores declined for both males and females, and by week 12, females only differed from males on anxious-depressive symptom scores. Females in general and youth of both sexes presenting to treatment with higher anxious-depression scores were less likely to have a week-12 opioid positive urine. 

Conclusions: Clinically significant sex-based differences in psychiatric symptoms are present at baseline among youth with OUD receiving Bup/Nal, but they mostly resolve during treatment. Associations among opioid abstinence, sex, and psychiatric symptoms suggest that sex-specific interventions and interventions tailored to youth with OUD with and without co-occurring psychiatric disorders may improve outcomes.

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