Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection

Abstract

OBJECTIVE:To assess the effects of oral substitution treatment for opioid-dependent injecting drug users on HIV risk behaviors and infections.DATA SOURCES: Multiple electronic databases were searched. Reference lists of retrieved articles were checked. METHODS:Because of varying methodologies of available studies, this systematic review was limited to a descriptive summary, looking at consistency of outcomes across studies. RESULTS:Twenty-eight studies involving methadone treatment were included in the review. Methadone maintenance treatment is associated with statistically significant reductions in injecting use and sharing of injecting equipment. It is also associated with reductions in numbers of injecting drug users reporting multiple sex partners or exchanges of sex for drugs or money, but has little effect on condom use. It appears that the reductions in risk behaviors do translate into fewer cases of HIV infection. CONCLUSIONS:Methadone maintenance treatment for injecting drug users significantly reduces the risk of transmission of HIV and should be provided as a component of a strategic approach to the prevention and control of HIV infection. There is insufficient evidence to determine whether other forms of oral substitution treatment also reduce the risk of HIV transmission.

Impact of Interim Methadone Maintenance on HIV Risk Behaviors

“…2,3 The present study found a significantly greater reduction in drug injection from baseline to follow-up for the IM condition compared to the WL condition. Despite this finding, the condition×time interaction for the overall ARA drug use behavior score was nonsignificant, perhaps because 60.2% of the study sample was non-injectors and the injectors reported low levels of risky injection practices at baseline.…”

“…1 There are limited data from RCTs of standard methadone treatment which incorporated an HIV risk measure 2,3 and even less from trials of methadone alone.…”

The effectiveness of harm reduction in preventing HIV among injecting drug users

“…24 Effectiveness of opioid substitution treatment The best evidence of the effectiveness of drug dependence treatment in preventing HIV transmission among IDUs is for opioid substitution treatment programs using methadone and buprenorphine. [25][26][27] The evidence is much stronger for methadone than for buprenorphine treatment. 27,28 Methadone substantially reduces drug injecting and thereby the sharing of injecting equipment.…”

“…[25][26][27] The evidence is much stronger for methadone than for buprenorphine treatment. 27,28 Methadone substantially reduces drug injecting and thereby the sharing of injecting equipment. 26,29 Seroprevalence studies suggest that reductions in injecting risk behaviour can result in reductions in HIV infection but relatively few (expensive and difficult) seroincidence studies have been published.…”

Inpatient Management of Opioid Use Disorder: A Review for Hospitalists

“…17 Compared to abstinence-based treatment, OAT has been associated with increased retention in addiction treatment and employment, and reductions in incarceration, human immunodeficiency virus transmission, illicit drug use, opioid-overdose events, and mortality. [26][27][28][29][30][31][32] An alternative to OAT is naltrexone, an opioid antagonist. Naltrexone for OUD is administered as a monthly depot injection that prevents the user from experiencing opioid intoxication or dependence, and is associated with sustained abstinence.…”