Drug Treatment Outcomes Among HIV-Infected Opioid-Dependent Patients Receiving Buprenorphine/Naloxone

Abstract

Background Buprenorphine/naloxone allows the integration of opioid dependence and HIV treatment. Methods We conducted a prospective study in HIV-infected opioid dependent patients to investigate the impact of buprenorphine/naloxone treatment on drug use. Self-report and chart review assessments were conducted every 3 months (Quarters 1 through 4) for one year. Outcomes were buprenorphine/naloxone treatment retention, drug use, and addiction treatment processes. Results Among 303 patients enrolled between July 2005 and December 2007, retention in buprenorphine/naloxone treatment was 74%, 67%, 59% and 49% during Quarters 1,2 3, and 4, respectively. Past 30 day illicit opioid use decreased from 84% of patients at baseline to 42% in retained patients over the year. Patients were 52% less likely to use illicit opioids for each quarter in treatment (OR = .66; 95% CI 0.61–0.72). Buprenorphine/naloxone doses and office visits approximated guidelines published by the United States Department of Health and Human Services. Urine toxicology monitoring was less frequent than recommended. Conclusions Buprenorphine/naloxone provided in HIV treatment settings can decrease opioid use. Strategies are needed to improve retention and address ongoing drug use in this treatment population.

Hepatic Safety and Lack of Antiretroviral Interactions With Buprenorphine/Naloxone in HIV-Infected Opioid-Dependent Patients

“…Our data, collected prospectively by clinical staff and using standard and regularly scheduled assessments, represent the most complete, detailed information on the use of bup/nx among HIV-infected patients. These findings on safety augment those regarding drug abuse treatment effectiveness, 17 HIV, 18 and cost 19 outcomes described in this supplement.…”

Engagement and Substance Dependence in a Primary Care-Based Addiction Treatment Program for People Infected with HIV and People at High-Risk for HIV Infection

“…For the overall onsite primary care group, there were better abstinence rates at 5-year follow-up, after no benefit was detected at 6-month follow-up (Mertens, Flisher, Satre, & Weisner, 2008). Studies of buprenorphine/naloxone treatment integrated into primary care for people with and without HIV have demonstrated reduced opioid use (Fiellin et al, 2006(Fiellin et al, , 2011Lucas et al, 2010). and a study of HIVinfected patients with opioid dependence, primary care-based buprenorphine treatment versus referral to off-site buprenorphine treatment was associated with greater receipt of buprenorphine treatment, reduced heroin and cocaine use, and more HIV primary care visits (Lucas et al, 2010).…”

Retention in buprenorphine treatment is associated with improved HCV care outcomes

“…The implications of our findings are consistent with other studies conducted in methadone programs, in which HCV care was integrated into those settings and, even in the era of interferon, PWUDs were able to be successfully linked to HCV care, initiate treatment, and even achieve HCV cure (Bonkovsky et al, 2008; Litwin et al, 2009; Litwin et al, 2015; Stein et al, 2012). Additionally, co-location of HIV and buprenorphine treatment has also been associated with improved outcomes for both HIV and opioid use (Altice et al, 2011; Fiellin et al, 2011). Given the ease of the new, all oral HCV regimens, we have an unprecedented opportunity to treat PWUDs within medical settings that they are already accessing, that are culturally appropriate, and that also provide simultaneous treatment for opioid use disorder.…”