Substitution treatment of injecting opioid users for prevention of HIV infection

Gowing, Linda; Farrell, Michael; Bornemann, Reinhard; Ali, Robert

doi:10.1002/14651858.cd004145.pub2

Cited by 75 publications

(5 citation statements)

References 92 publications

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“…Medications are a proven component of comprehensive substance abuse treatment plans that reduce drug use and provide an opportunity for improvement in health and social functioning for individuals with opioid dependence ( Fig. 7 ; Gowing et al 2004 ; Johnson and McCaugh, 2000 ; NIDA, 2000a ). Two recent TIPs from SAMHSA, TIP 40 and TIP 43, provide the best practices guidelines for the use of either methadone or buprenorphine as part of a comprehensive treatment plan for opioid abuse/dependence ( SAMHSA, 2004 ; SAMHSA, 2005 ).…”

Section: Treatment Of Viral Hepatitis Infection In the Context Of Phamentioning

confidence: 99%

Hepatitis Infection in the Treatment of Opioid Dependence and Abuse

et al. 2008

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Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.

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Section: Treatment Of Viral Hepatitis Infection In the Context Of Phamentioning

confidence: 99%

Hepatitis Infection in the Treatment of Opioid Dependence and Abuse

et al. 2008

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“…MAT is effective in treating heroin dependence thereby reducing associated risks including Hepatitis C, HIV and death (Amato, Davoli, Ferri, Gowing, & Perucci, 2004; Gowing, Farrell, Bornemann, & Ali, 2004). By making clean needles and syringes available, NSP decreases drug-related risk behaviors such as sharing of injection equipment (Strathdee, 2001).…”

Section: Introductionmentioning

confidence: 99%

Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users’ experiences

Mital

Miles

McLellan-Lemal

et al. 2016

International Journal of Drug Policy

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Introduction While relatively rare events, abrupt disruptions in heroin availability have a significant impact on morbidity and mortality risk among those who are heroin dependent. A heroin shortage occurred in Coast Province, Kenya from December 2010 to March 2011. This qualitative analysis describes the shortage events and consequences from the perspective of heroin users, along with implications for health and other public sectors. Methods As part of a rapid assessment, 66 key informant interviews and 15 focus groups among heroin users in Coast Province, Kenya were conducted. A qualitative thematic analysis was undertaken in Atlas.ti. to identify salient themes related to the shortage. Results Overall, participant accounts were rooted in a theme of desperation and uncertainty, with emphasis on six sub-themes: (1) withdrawal and strategies for alleviating withdrawal, including use of medical intervention and other detoxification attempts; (2) challenges of dealing with unpredictable drug availability, cost, and purity; (3) changes in drug use patterns, and actions taken to procure heroin and other drugs; (4) modifications in drug user relationship dynamics and networks, including introduction of risky group-level injection practices; (5) family and community response; and (6) new challenges with the heroin market resurgence. Conclusions The heroin shortage led to a series of consequences for drug users, including increased risk of morbidity, mortality and disenfranchisement at social and structural levels. Availability of evidence-based services for drug users and emergency preparedness plans could have mitigated this impact.

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“…The most evaluated secondary prevention intervention is the prescribing of non-injected substitute drugs, in particular oral methadone [ 8 ]. There is evidence that this can reduce injection frequency and illicit drug consumption and is also associated with reductions in morbidity and mortality [ 9 - 12 ]. It is uncertain whether and how drug treatment modifies overall duration of drug dependence and injecting.…”

Section: Introductionmentioning

confidence: 99%

The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

Macleod

Copeland²,

Hickman

et al. 2010

BMC Public Health

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BackgroundInjection drug use is an important public health problem. Epidemiological understanding of this problem is incomplete as longitudinal studies in the general population are difficult to undertake. In particular little is known about early life risk factors for later drug injection or about the life course of injection once established including the influence of medical and social interventions.MethodsIndividuals thought to be drug injectors were identified through a single primary medical care facility in Edinburgh between 1980 and 2006 and flagged with the General Registry Office. From October 2005 - October 2007, these cases were traced and invited to undergo interview assessment covering early life experience, substance use, health and social histories. Age and sex matched controls for confirmed cases (alive and dead) were later recruited through the same health facility. Controls for living cases completed the same structured interview schedule. Data were also collected on cases and controls through linkage to routine primary care records, death registrations, hospital contact statistics and police and prison records. All interviews were conducted with the knowledge and permission of the current GP.ResultsThe initial cohort size was 814. At start of follow up 227 had died. Of the remaining 587: 20 had no contact details and 5 had embarked from the UK; 40 declined participation; 38 did not respond to invitations; 14 were excluded by their GP on health or social grounds and 22 had their contact details withheld by administrative authorities. 448 were interviewed of whom 16 denied injection and were excluded. Of 191 dead cases with medical records 4 were excluded as their records contained no evidence of injection. 5 interviewed cases died before follow up was concluded though these individuals were counted as "live" cases. 1 control per case (dead and alive) was recruited. Linkage to Scottish Morbidity Records data (available from 1981 onwards) on general acute inpatient and day cases, mental health inpatient and day cases and cancer was provided by Information Services, NHS Scotland, for all cases interviewed and all dead cases. The Scottish Prison Service provided records for 198 (46%) of cases interviewed, 48 cases not interviewed and 34 (18%) of dead cases. For a sub-sample of 100 interviewees a search of the Lothian and Borders police database was made for official criminal records and 94 had criminal records. Data linkage for controls is ongoing.ConclusionsInjecting drug users recruited from a community setting can be successfully followed-up through interviews and record linkage. Information from injecting cases is being analysed in terms of injecting patterns and possible influences on these. Comparisons between cases and controls will allow identification of possibly modifiable early life risk factors for drug injection and will also clarify the burden of disease associated with injection and the influence on this of different health and social interventions.

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Substitution treatment of injecting opioid users for prevention of HIV infection

Cited by 75 publications

References 92 publications

Hepatitis Infection in the Treatment of Opioid Dependence and Abuse

Hepatitis Infection in the Treatment of Opioid Dependence and Abuse

Heroin shortage in Coastal Kenya: A rapid assessment and qualitative analysis of heroin users’ experiences

The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls

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