BRIEF REPORT: Methadone Treatment of Injecting Opioid Users for Prevention of HIV Infection

Journal of General Internal Medicine (Impact Factor: 3.42). 01/2006; 21(2):193 - 195. DOI: 10.1111/j.1525-1497.2005.00287.x
Source: PubMed


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.

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Available from: Linda Gowing
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    • "Regrettably, it was not possible to engage in a gender analysis of narratives, as some participants may have been identifiable. MMT has been evaluated with regard to its efficacy in reducing heroin and other forms of substance use, reducing risk behaviors associated with injecting drug use and the transmission of blood borne viruses such as HIV and Hepatitis, reducing criminal activity and overdoses, with psychosocial improvements in MMT client individual and social functioning relating to family relationships, employment, education and community integration (Sheerin et al. 2004; Teesson et al. 2006; Simoens et al. 2005; Gowing et al. 2006; Mattick et al. 2009; Corsi et al. 2009; Coviello et al. 2011; De Maeyer et al. 2011). Prescribing doctors supported these claims and observed MMT's effectiveness in reducing a range of patient harms in the form of injecting drug use, continued opiate use, transmission of blood borne viruses, and stimulating recovery processes. "
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    ABSTRACT: Methadone maintenance treatment [MMT] is recognized as an effective treatment for opiate dependence. It is provided in Ireland in addiction clinics and for stabilized patients in primary care. The aim of the study was to explore doctor’s experiences of methadone prescribing, therapeutic alliance and methadone treatment pathways. Semi structured interviews were conducted with a convenience sample of prescribing doctors (n = 16). Thematic analysis of narratives was undertaken. Observations around MMT were positive in reducing harm associated with injecting drug use and opiate dependence, and represented an important turning point for patients. Doctor efforts to assist their patients were grounded in positive, empathic relationships. Some concerns were relayed with regard to prescribing restrictions. Participants commented on the need for policy makers to consider the expansion of MMT provision to include alternative pharmacological approaches, improved interagency, psychosocial and detoxification supports, community based nurse prescribing and adjunct treatment for poly drug and alcohol use.
    Full-text · Article · Jun 2013 · International Journal of Mental Health and Addiction
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    • "Methadone maintenance treatment remains the most common form of treatment for opiate dependency in Ireland and is generally provided by specialized clinics under medical supervision. It is an important component of community-based approaches to treating opiate dependency insofar that the treatment is offered on an out-patient basis, resulting in significant treatment retention rates and capacity to successfully address health risk issues, poly drug using patterns, psychological problems, family relationships, vocational training, employment and housing issues [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]. However, although methadone maintenance treatment has been proven to be cost effective [16], successful outcomes depend on timely treatment entry, adequate methadone dosage, duration, support and continuity of treatment, levels of engagement in psycho social modalities (concurrent counseling and contingency management) and presence of cohesive support networks of adjunctive medical, social and community services [17] [18]. "
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    ABSTRACT: Specialist vocational training for ex-drug users include employment skills training, supported placements and thera-peutic work programmes. The research was peer led by Client Forum representatives of five 'Special Community Employment' schemes and aimed to explore participant experiences of Methadone Stabilization; 'Special Community Employment' schemes, and Vocational Outcomes. A Client Forum consultation (n = 11) and Client Forum representative focus groups (n = 2) were used to finalize interview questions. In depth interviews with a convenience sample of participants from 'Special Community Employ-ment' schemes (n = 25) were conducted. Content and thematic analysis of narratives was undertaken with Client Forum (n = 11) interpretative support. The findings are indicative of 'Special Community Employment' schemes offering methadone maintenance participants' the opportunity to commence recovery, engage in vocational training and reintegrate into the community. However, participation in these schemes appeared restrictive and operated primarily as therapeutic medium, with little individual vocational care planning, training or supported work placements. Many participants reported leaving these schemes unqualified, unemployed and experiencing little aftercare. The research underscores the need for extensive revision of 'Special Community Employment' schemes within an interagency approach, so as to provide specific therapeutic supports dependent on individual recovery stage, and client specific vocational training needs, certification, work placement and supportive aftercare.
    Full-text · Article · Jan 2012 · Journal of Vocational Rehabilitation
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    • "" ; and (10) " Medically assisted detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug abuse. " Principle 7 ( " Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies " ) was not investigated using the EPT approach to meta-analysis because (a) due to ethical requirements, primary research studies do not withhold methadone from a comparison group while it is being provided to an experimental group and (b) studies of approved medications for addiction treatment have evaluated types of services or dosing schedules, which relate to the optimal use of the medication, not with its effectiveness (for meta-analyses supporting medicationassisted treatment using different selection criteria than EPT's, see Farre, Mas, Torrens, Moreno, & Cami, 2002; Gowing, Farrell, Bornemann, Sullivan, & Ali, 2006; Mattick, Breen, Kimber, & Davoli, 2009). Principle 9 ( " …and when these problems [addiction and mental disorders] co-occur, treatment should address both [or all], including the use of medications as appropriate…. "
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    ABSTRACT: Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders.
    Full-text · Article · Nov 2011 · Journal of substance abuse treatment
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