Dose–response relationship between methadone dose and adherence to antiretroviral therapy among HIV‐positive people who use illicit opioids

Lappalainen, Leslie; Nolan, Seonaid; Dobrer, Sabina; Puscas, Cathy; Montaner, Julio S. G.; Ahamad, Keith; Dong, Huiru; Kerr, Thomas; Wood, Evan; Milloy, M.‐J.

doi:10.1111/add.12970

Cited by 49 publications

(41 citation statements)

References 74 publications

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“…83 In Vancouver, Canada, several longitudinal studies showed not only that OST continuation improved ART adherence over time, 84 but also the converse – that OST discontinuation significantly increased the risk of ART non-adherence 85 – and that OST patients with higher opioid agonist doses had the strongest adherence to ART. 86 In China, the understanding of the importance of the OST-ART link led to an effort to integrate ART services in methadone clinics. 87 While a number of practical challenges were encountered, the effort showed an appreciation for the value of integrating these areas of care.…”

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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“…In addition to standalone NSPs, pharmacies are a common source of syringes for prescription opioid injectors (Zaller et al, 2012). Medication-assisted treatment (MAT) with opioid agonists (methadone and buprenorphine) and antagonists (short- or long-acting naltrexone) have been shown to be highly effective at diminishing opioid use (Mattick, Breen, Kimber, & Davoli, 2009), decreasing the risk of HIV infection (Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011), improving adherence with HIV medications (Lappalainen et al, 2015), and reducing the risk of mortality (Cornish, Macleod, Strang, Vickerman, & Hickman, 2010). Unfortunately, these medications are highly underutilized in the United States: of the 2.5 million persons with opioid dependence in 2012, fewer than one million received MAT (Volkow, Frieden, Hyde, & Cha, 2014).…”

Section: Harm Reduction For Extra-medical Prescription Opioid Usersmentioning

confidence: 99%

Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

Marshall

Green

Yedinak

et al. 2016

International Journal of Drug Policy

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Extra-medical prescription opioid (EMPO) use—intentional use without a prescription or outside of prescribed parameters—is a public health crisis in the United States and around the world. Epidemiological evidence suggests that the prevalence of EMPO use and adverse sequelae, including opioid overdose and hepatitis C infection, are elevated among people aged 18 to 25. Despite these preventable health risks, many harm reduction interventions are underutilized by, or inaccessible to, EMPO-using youth. In this commentary, we describe key harm reduction strategies for young people who use prescription opioids. We examine individual, social, and policy-level barriers to the implementation of evidence-based approaches that address EMPO use and related harms among young people. We highlight the need for expanded services and new interventions to engage this diverse and heterogeneous at-risk population. A combination of medical, social, and structural harm reduction interventions are recommended. Furthermore, research to inform strategies that mitigate particularly high-risk practices (e.g., polysubstance use) is warranted. Finally, we discuss how the meaningful involvement of youth in the implementation of harm reduction strategies is a critical component of the public health response to the prescription opioid epidemic.

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“…Evidence-based harm reduction may mitigate risk of death among HIV-positive PWID by reducing fatal overdose, as well as facilitating adherence to life-saving ART [48]. Studies undertaken in Vancouver, Canada, between 1996 and 2011 report a marked decline in rates of all-cause mortality among PWID [3**,29].…”

Section: Drug-related Fatalitiesmentioning

confidence: 99%

“…Such evidence highlights the sociostructural factors – including punitive laws, severe human rights abuse, inadequate prevention services, and stigma associated with IDU – impeding access to harm reduction worldwide [1**]. It is important to note that even in settings with access to OST, barriers to initiate OST (e.g., rigid intake criteria and lengthy waitlists) and maintain treatment (e.g., no individualization of treatment and no patient choice on medication and dose) [49] remain, which impacts ART adherence for HIV-positive PWID [48]. In light of the evidence of the efficacy of OST reducing drug-related fatalities, and facilitating access to life-saving ART, these impediments urgently need to be addressed.…”

Section: Drug-related Fatalitiesmentioning

confidence: 99%

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

Parashar

Collins

Montaner

et al. 2016

Current Opinion in HIV and AIDS

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Purpose of review The modern antiretroviral therapy (ART) era has seen substantial reductions in mortality among people living with HIV. However, HIV-positive people who inject drugs (PWIDs) continue to experience high rates of suboptimal HIV-related outcomes. We review recent findings regarding factors contributing to premature and preventable mortality among HIV-positive PWID, and describe the promise of interventions to improve survival in this group. Recent findings The current leading causes of death among HIV-positive PWID are HIV/AIDS-related causes, overdose, and liver-related causes, including infection with hepatitis C virus. Elevated mortality levels in this population are driven by social–structural barriers to ART access and adherence, particularly criminalization and stigmatization of drug use. In contexts where opioid substitution therapy and ART adherence support programs are widely accessible, evidence highlights comparable levels of survival among HIV-positive PWID and people living with HIV who do not inject drugs. Summary The life-saving benefits of ART can be realized among HIV-positive PWID when it is paired with strategies that address barriers to evidence-based medical care. Joint administration of ART and opioid substitution therapy, as well as repeal of punitive laws that criminalize drug users, are urgently needed to reduce HIV and injection-related mortality among PWID.

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Dose–response relationship between methadone dose and adherence to antiretroviral therapy among HIV‐positive people who use illicit opioids

Cited by 49 publications

References 74 publications

Public health and international drug policy

Public health and international drug policy

Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

Reducing rates of preventable HIV/AIDS-associated mortality among people living with HIV who inject drugs

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