HIV Risk Reduction With Buprenorphine–Naloxone or Methadone

Abstract

Objectives Compare HIV injecting and sex risk in patients being treated with methadone (MET) or buprenorphine-naloxone (BUP). Methods Secondary analysis from a study of liver enzyme changes in patients randomized to MET or BUP who completed 24-weeks of treatment and had 4 or more blood draws. The initial 1:1 randomization was changed to 2:1 (BUP: MET) after 18 months due to higher dropout in BUP. The Risk Behavior Survey (RBS) measured past 30-day HIV risk at baseline and weeks 12 and 24. Results Among 529 patients randomized to MET, 391 (74%) were completers; among 740 randomized to BUP, 340 (46%) were completers; 700 completed the RBS. There were significant reductions in injecting risk (p< 0.0008) with no differences between groups in mean number of times reported injecting heroin, speedball, other opiates, and number of injections; or percent who shared needles, did not clean shared needles with bleach, shared cookers, or engaged in front/back loading of syringes. The percent having multiple sex partners decreased equally in both groups (p<0.03). For males on BUP the sex risk composite increased; for males on MET, the sex risk decreased resulting in significant group differences over time (p<0.03). For females, there was a significant reduction in sex risk (p<0.02) with no group differences. Conclusions Among MET and BUP patients that remained in treatment, HIV injecting risk was equally and markedly reduced, however MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but increased for males on BUP, and decreased for males on MET.

“I Kicked the Hard Way. I Got Incarcerated.” Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments

“…In 2013, more than 2 million Americans met criteria for opioid use disorder, including 1.9 million endorsing opioid analgesic abuse or dependence and 517,000 endorsing heroin abuse or dependence (Substance Abuse and Mental Health Services Administration, 2014). Medication assisted treatments (MAT) for opioid use disorders, including maintenance treatment with methadone or buprenorphineare effective at reducing illicit opioid use, HIV risk behaviors, and overall mortality, and may reduce criminal recidivism rates (Marsch, 1998;Mattick, Breen, Kimber, & Davoli, 2014; Woody et al, 2014). Despite the strong evidence base supporting its use, MAT remains underutilized in community settings, as well as within penal facilities, such as jails and prisons (Chandler, Fletcher, & Volkow, 2009; Fiscella, Moore, Engerman, & Meldrum, 2004; Kinlock, Gordon, Schwartz, & Fitzgerald, 2010; Larney, Toson, Burns, & Dolan, 2011).…”

HIV Risk Reduction Interventions Among Substance-Abusing Reproductive-Age Women: A Systematic Review

“…A summary of the sample, location, intervention, outcome variables, and main findings for the 10 HIV risk-reduction studies is presented in Table 3 (Barry, Weinstock, & Petry, 2008; El-Bassel et al, 2014; Hien et al, 2010; Knudsen, Staton-Tindall, Oser, Havens, & Leukefeld, 2014; Koblin et al, 2010; Strathdee et al, 2013; Tross, Campbell, & Cohen, 2008; Wechsberg, Luseno, Lam, Parry, & Morojele, 2006; Wechsberg et al, 2013; Woody et al, 2014). Studies that met the inclusion criteria for this systematic review enrolled a total of 3,796 participants at baseline.…”

“…Two were conducted in South Africa (Wechsberg et al, 2006, 2013) and one in Mexico (Strathdee et al, 2013). Most studies examined samples of only female participants; however, one study examined both male and female participants, but was included in our review because findings were stratified by sex (Woody et al, 2014). Recruitment occurred within drug treatment centers (i.e., methadone maintenance clinics), correctional facilities, community supervision settings, via outreach work in locations such as bars, brothels, and shooting galleries, and within communities such as at beauty parlors and corner shops.…”

“…In three studies, participants’ drug of choice was cocaine (Barry et al, 2008; Tross et al, 2008; Wechsberg et al, 2006). In five studies, participants reported using a variety of drugs including marijuana, cocaine, crack, heroin, oxycodone, benzodiazepines, other opiates, and/or alcohol (El-Bassel et al, 2014; Knudsen et al, 2014; Koblin et al, 2010; Wechsberg et al, 2013; Woody et al, 2014). Two studies did not report the specific type of drug(s) used by participants (Barry et al, 2008; Hien et al, 2010).…”

“…However, some of the studies also measured other outcome variables including incidence of HIV and infection (El-Bassel et al, 2014; Strathdee et al, 2013), STD symptoms (Wechsberg et al, 2006), any drug use (El-Bassel et al, 2014; Wechsberg et al, 2006), and HIV testing history (Woody et al, 2014). Three studies measured biological outcomes: abstinence from drug (methamphetamine, cocaine, opiates, THC, methaqualone) use (Wechsberg et al, 2013) and incidence of HIV and STD’s (El-Bassel et al, 2014; Strathdee et al, 2013).…”