Reduction in Injection–Related HIV Risk After 6 Months in a Low-Threshold Methadone Treatment Program

Abstract

This study assessed injection-related HIV risk behavioral changes among opioid users 6 months after enrollment in low-threshold (harm reduction based) metha-done maintenance treatment (MMT) programs within needle exchange services in Kingston and Toronto, Ontario, Canada. Changes were assessed for all participants (whole cohort), participants who continued to use illicit drugs by any route (drug-using subcohort); and those who continued to inject drugs (injecting subcohort). In this prospective observational cohort study, an interviewer-administered questionnaire examining injection-related HIV risk behaviors was administered to 183 study participants at entry to treatment and 6 months later. Changes in risk behaviors were analyzed using conditional logistic regression which took into account the paired nature of the data. We found that the proportion of participants injecting drugs, sharing needles, sharing drug equipment, indirectly sharing and using shooting galleries declined with follow-up for the whole cohort. Within the drug-using subcohort, there was a decrease in the proportion of individuals who injected drugs, while within the injecting subcohort the sharing of injection equipment and the use of shooting galleries declined. Our findings suggest that low-threshold MMT programs can reduce the risk of HIV without the enforcement of abstinence-based policies.

Opioid pharmacotherapy: Treatment, regimes, constructions and control

“…In alignment with the literature (Klingemann, 1996;Langendam et al, 2001;Millson et al, 2007;Ward et al, 1998) none of the programs required abstinence from opioids or other drugs as criteria for admission. Programs expected that all clients would likely continue to use illicit drugs (e.g., crack cocaine) whilst in treatment.…”

“…Empirical comparisons to higher threshold MMT programs (i.e., programs with strict policies governing continued use of any illicit drug during treatment) show that low threshold MMT attract different types of clients (Ryrie, Dickson, Robbins, Maclean, & Climpson, 1997); have higher retention rates (Torrens, Castillo, & Pérez-Solá, 1996) and are associated with reductions in heroin use (Yancovitz et al, 1991), injection related HIV risk behaviors (Finch, Groves, Feinman, & Farmer, 1995;Millson et al, 2007), injectionrelated mortality (van Ameijden, Langendam, & Coutinho, 1999) criminal charges (Ryrie et al, 1997) and mortality (Langendam, van Brussel, Coutinho, & van Ameijden, 2001).…”

Hepatitis C and human immunodeficiency virus risk behaviors in polydrug users on methadone maintenance

“…In a recent study by Millson et al (2007), an analysis similar to ours was performed (but participants were not categorized by HCV status). They assessed drug risk behaviors in a subcohort of participants who continued to inject after enrollment in MMT.…”

Is opioid substitution treatment beneficial if injecting behaviour continues?

“…There are documented effects on the reduction of morbidity and mortality risk also among those who continue to use drugs while in treatment (Gervasoni et al, 2012;Kerr et al, 2005;Kidorf et al, 2011;Millson et al, 2007). Many of these studies have recruited subjects that are willing and able to participate in specific interventions and follow-up evaluations (Kidorf et al, 2011;Van Ameijden et al, 1999).…”