Impact of Interim Methadone Maintenance on HIV Risk Behaviors

Wilson, Marjorie P.; Schwartz, Robert P.; O’Grady, Kevin E.; Jaffe, Jerome H.

doi:10.1007/s11524-010-9451-7

Cited by 20 publications

(21 citation statements)

References 11 publications

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“…The benefits of interim treatment have been shown to persist through at least one year following enrollment into conventional treatment. Additional secondary analyses of data from these randomized trials have demonstrated the ability of interim treatment to reduce criminal (Schwartz et al, 2009) and HIV-risk (Wilson et al, 2010) behavior, as well as demonstrated its general cost-effectiveness (Schwartz et al, 2014). Taken together, when delays to treatment entry are unavoidable, the benefits of bridging these delays with daily medication and barebones clinical support are clear.…”

Section: Discussionmentioning

confidence: 99%

Interim treatment: Bridging delays to opioid treatment access

Sigmon

2015

Preventive Medicine

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Objective Despite the undisputed effectiveness of agonist maintenance for opioid dependence, individuals can remain on waitlists for months, during which they are at significant risk for morbidity and mortality. To mitigate these risks, the Food and Drug Administration in 1993 approved interim treatment, involving daily medication + emergency counseling only, when only a waitlist is otherwise available. We review the published research in the 20 years since the approval of interim opioid treatment. Methods A literature search was conducted to identify all randomized trials evaluating the efficacy of interim treatment for opioid-dependent patients awaiting comprehensive treatment. Results Interim opioid treatment has been evaluated in four controlled trials to date. In three, interim treatment was compared to waitlist or placebo control conditions and produced greater outcomes on measures of illicit opioid use, retention, criminality and likelihood of entry into comprehensive treatment. In the fourth, interim treatment was compared to standard methadone maintenance and produced comparable outcomes in illicit opioid use, retention and criminal activity. Conclusions Interim treatment significantly reduces patient and societal risks when conventional treatment is unavailable. Further research is needed to examine the generality of these findings, further enhance outcomes, and identify the patient characteristics which predict treatment response.

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Section: Discussionmentioning

confidence: 99%

Interim treatment: Bridging delays to opioid treatment access

Sigmon

2015

Preventive Medicine

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“…16, 17 Greater access to methadone treatment, for example, reduces HIV risk behaviour, and decreases HIV incidence rates overall. 18, 19 Researchers also found lower rates for discontinuing antiretroviral treatment among drug using populations receiving health and social services. 23 …”

Section: Introductionmentioning

confidence: 99%

Barriers to health and social services for street-involved youth in a Canadian setting

Barker

Nguyen

Wood

et al. 2015

J Public Health Pol

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Although street-involved youth contend with many health and social problems, the extent to which vulnerable youth engage with supportive services has not been well described. This study sought to examine the prevalence and correlates associated with having difficulty accessing health and social services among a prospective cohort of street-involved youth in Vancouver, Canada. Among 1019 street-involved youth, 650 (64%) reported having difficulty accessing services during the study period. In a multivariate analysis, youth who reported having difficulty accessing services were significantly more likely to be socially and economically vulnerable. Specifically, they were more likely to report severe housing instability, high-intensity drug use, recent interactions with law enforcement, drug dealing, and histories of violence and physical abuse. Study findings point to opportunities to improve access to services among vulnerable youth through removal of blanket age restrictions for youth services, establishing youth-centric social housing, and supporting peer-driven, low-threshold services.

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“…17,18,20 In addition, HIV risk, and arrest appear to be reduced. 21–22 Interim methadone can be scaled up relatively quickly to treat large numbers of patients in numerous programs and at a low cost (estimated at a few dollars per week/patient added to an existing program) that could be subsidized by low payments from the patients themselves. 23 Extant data from three clinical trials with methadone 37,53,54 indicate that early in treatment, patients receiving methadone alone fare as well as those who receive methadone with counseling.…”

Section: Discussionmentioning

confidence: 99%

“…These individuals were randomly assigned to receive interim methadone for up to 120 days, at which time they were transferred to standard methadone treatment, or remained on the usual waiting list. Participants in the interim group compared to those on the waiting list were found, over the course of two follow-up interviews at 4- and 10-months post-study entry, to have an increased likelihood of entering and remaining in standard methadone treatment and of reducing: opioid use 20 ; HIV risk behavior 21 ; criminal behavior 20 ; and, arrest. 22 This randomized trial suggested that interim methadone was an effective approach that suggested greater public health benefits and reductions in criminal activity when waiting lists were a significant barrier to treatment entry…”

Section: Introductionmentioning

confidence: 99%

Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research

Schwartz

Kelly

Gryczynski

et al. 2015

Journal of Addictive Diseases

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This paper reviews research conducted in Baltimore over the past 15 years that examined accessibility and barriers to methadone treatment, compared those who enter treatment to those who do not, studied retention and counseling issues, as well as the impact of treatment on criminality, HIV risk among participants and overdose death in the community. Recommendations to develop policies are presented to reduce heroin use and its negative impact in the community.

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Impact of Interim Methadone Maintenance on HIV Risk Behaviors

Cited by 20 publications

References 11 publications

Interim treatment: Bridging delays to opioid treatment access

Interim treatment: Bridging delays to opioid treatment access

Barriers to health and social services for street-involved youth in a Canadian setting

Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research

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