Scaling up opioid dependence treatment in low- and middle-income settings

Wu, Zunyou; Clark, N.J.

doi:10.2471/blt.12.110783

Cited by 10 publications

(10 citation statements)

References 11 publications

(8 reference statements)

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“…Among the small proportion of the opioid dependent population accessing OST, median methadone and buprenorphine doses were within the therapeutic ranges recommended by the World Health Organization (Guidelines, 2009). Additional work is urgently needed to move from a more punitive approach to drug use to a more holistic, integrated model of care for PWID, particularly those PWID with HIV and/or other infectious diseases (Wu & Clark, 2013). In particular, the discrimination that many PWID encounter from both law enforcement and government agencies (Booth et al, 2013; Spicer et al, 2011) needs to be addressed through more structured education through the existing systems of training and education for medical and legal professionals.…”

Section: Discussionmentioning

confidence: 99%

“…Adverse attitudes of both government agencies and law enforcement towards PWIDs, and OST programmes, in Ukraine have severely limited OST capacity expansion and overall treatment access (Golovanevskaya et al, 2012; Wu & Clark, 2013). This is despite evidence from several systematic reviews suggesting that: PWID who receive OST have less than half the risk of HIV infection compared with PWID not on OST (MacArthur et al, 2012); OST is associated with greater adherence to ART (Malta, Magnanini, Strathdee, & Bastos, 2010); OST is associated with reductions in illicit opioid use, injecting behaviour, and sharing of injection equipment (Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011); and OST is associated with a reduction by more than half in all-cause mortality among PWID (Degenhardt et al, 2011).…”

Section: Introductionmentioning

confidence: 99%

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Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Zaller

Mazhnaya

Larney

et al. 2015

International Journal of Drug Policy

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Background Ukraine has the highest HIV burden of any European country with much of the current HIV epidemic concentrated among people who inject drugs (PWIDs) and their sexual partners. Opiate substitution therapy (OST) is limited in Ukraine and expansion of OST is urgently needed to help stem the tide of the HIV epidemic. Methods We accessed publicly available data in Ukraine in order to explore geographic variability with respect to prevalence of HIV, PWIDs and OST programmes. Results The regions of Ukraine with the largest number of opioid dependent persons (the south and eastern portions of the country) correspond to the regions with the highest HIV prevalence and HIV incidence. The number of opioid PWIDs per 100,000 population as well as the number of all OST treatment slots per 100,000 varied significantly across the three HIV prevalence categories. Overall, the proportion of individuals receiving either methadone maintenance therapy (MMT) or buprenorphine maintenance therapy (BMT) was quite low: average across categories: 7.3% and 0.4%, respectively. Additionally, less than half of OST patients receiving MMT or BMT were HIV positive patients. Conclusion There is significant geographic variability in both numbers of HIV positive individuals and numbers of PWIDs across Ukraine, however, there may be a more concentrated epidemic among PWIDs in many regions of the country. Scale up of addiction treatment for PWID, especially OST, can have a significant impact on preventing injection related morbidity, such as HIV and HCV infection. Ukraine can learn from the mistakes other nations have made in denying critical treatment opportunities to PWID.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Zaller

Mazhnaya

Larney

et al. 2015

International Journal of Drug Policy

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“…First, the prevalence of opioid dependency in Iran is high [2] and any effort to reduce the harm of drug use would be appreciated. Second, it has been proven that in middle‐income countries such as Iran, opioid agonist maintenance treatment has a significant role in decreasing the risk of HIV and HCV [1,10]; therefore, the continuity of maintenance treatment programs seems to be logical.…”

Section: Discussionmentioning

confidence: 99%

“…Opiates are the third most used class of drugs in the world [1] and Iran has one of the highest prevalence of opioid use [2]. Several hundred years of history of opioid use and its proximity to the largest opium‐producing country in the world (Afghanistan) are key causes [3].…”

Section: Introductionmentioning

confidence: 99%

Outcome evaluation of the opioid agonist maintenance treatment in Iran

Esmaeili

Ziaddinni

Nikravesh

et al. 2014

Drug and Alcohol Review

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“…Recently, considerable attention has been paid to the significant public health effects of opioid use disorder worldwide, in what has been termed an “epidemic” by the World Health Organization . While the anesthetic literature has thoroughly explored the pharmacological aspects of opioids for acute and chronic pain management, almost no discussion exists regarding the implications of the opioid use disorder epidemic in the perioperative pain management of adolescents and young children.…”

Section: Introductionmentioning

confidence: 99%

Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists

Knipper

Banta‐Green

Jimenez

2017

Pediatric Anesthesia

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This educational review presents an overview of opioid use disorder, misuse and overdose among adolescents, and the clinical implications for anesthesiologists. It provides definitions, discusses the epidemiology worldwide, (focusing on North America), and emphasizes the clinical implications of patients with chronic opioid exposure, including perioperative pain management, as well as opioid overdose and prolonged use of opioids after acute exposure. In the USA, opioid use disorder and negative outcomes related to opioids rose dramatically from 1999-2010; concomitantly heroin use and fatal overdoses have increased as heroin use is associated with the disordered use of licit opioids. Among adolescents and young adults, opioid use disorder is significant, with continued increases in disordered use specifically among young adults. Acute opioid intoxication may have multiple medical implications in addition to respiratory depression, and children are susceptible to acute intoxication via accidental ingestion of prescription opioids. Novel opioid formulations, such as acetyl fentanyl, with unpredictable pharmacology may also be present in acute intoxication. Chronically, opioid use presents challenges for safe and adequate pain management, in the presence of opioid-induced hyperalgesia and differential tolerance as well as mental health issues including depression and anxiety. Predictors of prolonged opioid use in adolescents and adults after surgery is an area of ongoing research. Young patients encountered by pediatric anesthesiologists may be involved in diversion and disordered use of opioids. Increased awareness among anesthesiologists is important, as perioperative discussions often provide an opportunity to detect at risk patients.

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Scaling up opioid dependence treatment in low- and middle-income settings

Cited by 10 publications

References 11 publications

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Geographic variability in HIV and injection drug use in Ukraine: Implications for integration and expansion of drug treatment and HIV care

Outcome evaluation of the opioid agonist maintenance treatment in Iran

Opioid use disorder and misuse: A review of the epidemiology and medical implications for pediatric anesthesiologists

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