Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
- Gowing L, Farrell M, Bornemann R, Ali R. Substitution treatment of injecting opioid users for prevention of HIV infection [Cochrane Review]. In: The Cochrane Library, Issue 4. Chichester, UK: John Wiley & Sons; 2004.
- Centre for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2003. Atlanta: U.S. Department of Health and Human Services, 2004. Available from: http://www.cdc.gov/hiv/stats/hasrlink.htm
- Dolan KA, Shearer J, MacDonald M, Mattick RP, Hall W, Wodak AD. A randomised controlled trial of methadone maintenance treatment versus wait list control in an Australian prison system. Drug Alcohol Depend. 2003;72:59–65. CrossRef
- Sees KL, Delucchi KL, Masson C, et al. Methadone maintenance vs 180-day psychosocially enriched detoxification for treatment of opioid dependence: a randomized controlled trial. JAMA. 2000;283:1303–10. CrossRef
- Camacho LM, Bartholomew NG, Joe GW, Cloud MA, Simpson DD. Gender, cocaine and during-treatment HIV risk reduction among injection opioid users in methadone maintenance. Drug Alcohol Depend. 1996;41:1–7. CrossRef
- Chatham LR, Hiller ML, Rowan-Szal GA, Joe GW, Simpson DD. Gender differences at admission and follow-up in a sample of methadone maintenance clients. Subst Use Misuse. 1999;34:1137–65. CrossRef
- Gossop M, Marsden J, Stewart D, Rolfe A. Patterns of improvement after methadone treatment: 1 year follow-up results from the National Treatment Outcome Research Study (NTORS). Drug Alcohol Depend. 2000;60:275–86. CrossRef
- King VL, Kidorf MS, Stoller KB, Brooner RK. Influence of psychiatric comorbidity on HIV risk behaviors: changes during drug abuse treatment. J Addict Dis. 2000;19:65–83. CrossRef
- Magura S, Siddiqi Q, Freeman RC, Lipton DS. Changes in cocaine use after entry to methadone treatment. J Addict Dis. 1991;10:31–45. CrossRef
- Batki SL, Sorensen JL, Gibson DR, Maude-Griffin P. HIV-infected i.v. drug users in methadone treatment: outcome and psychological correlates—a preliminary report. NIDA Res Monogr. 1989;95:405–6.
- Brooner R, Kidorf M, King V, Beilenson P, Svikis D, Vlahov D. Drug abuse treatment success among needle exchange participants. Public Health Rep. 1998;113:129–39.
- Kwiatkowski CF, Booth RE. Methadone maintenance as HIV risk reduction with street-recruited injecting drug users. J Acquir Immune Defic Syndr. 2001;26:483–9.
- Simpson DD, Joe GW, Rowan-Szal G, Greener J. Client engagement and change during drug abuse treatment. J Subst Abuse. 1995;7:117–34. CrossRef
- Strang J, Marsden J, Cummins M, et al. Randomized trial of supervised injectable versus oral methadone maintenance: report of feasibility and 6-month outcome. Addiction. 2000;95:1631–45. CrossRef
- Meandzija B, O’Connor PG, Fitzgerald B, Rounsaville BJ, Kosten TR. HIV infection and cocaine use in methadone maintained and untreated intravenous drug users. Drug Alcohol Depend. 1994;36:109–13. CrossRef
- Metzger DS, Woody GE, McLellan AT, et al. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993;6:1049–56.
- Grella CE, Anglin D, Rawson R, Crowley R, Hasson A. What happens when a demonstration project ends. Consequences for a clinic and its clients. J Subst Abuse Treat. 1996;13:249–56. CrossRef
- Margolin A, Avants SK, Warburton LA, Hawkins KA, Shi J. A randomized clinical trial of a manual-guided risk reduction intervention for HIV-positive injection drug users. Health Psychol. 2003;22:223–8. CrossRef
- Stark K, Muller R, Bienzle U, Guggenmoos-Holzmann I. Methadone maintenance treatment and HIV risk-taking behaviour among injecting drug users in Berlin. J Epidemiol Community Health. 1996;50:534–7. CrossRef
- Thiede H, Hagan H, Murrill CS. Methadone treatment and HIV and hepatitis B and C risk reduction among injectors in the Seattle area. J Urban Health. 2000;77:331–45. CrossRef
- Abbott PJ, Weller SB, Delaney HD, Moore BA. Community reinforcement approach in the treatment of opiate addicts. Am J Drug Alcohol Abuse. 1998;24:17–30. CrossRef
- Avants SK, Margolin A, Sindelar JL, et al. Day treatment versus enhanced standard methadone services for opioid-dependent patients: a comparison of clinical efficacy and cost. Am J Psychiatry. 1999;156:27–33.
- Baker A, Kochan N, Dixon J, Wodak A, Heather N. HIV risk-taking behaviour among injecting drug users currently, previously and never enrolled in methadone treatment. Addiction. 1995;90:545–54. CrossRef
- Moss AR, Vranizan K, Gorter R, Bacchetti P, Watters J, Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985–1990. AIDS. 1994;8:223–31. CrossRef
- Williams AB, McNelly EA, Williams AE, D’Aquila RT. Methadone maintenance treatment and HIV type 1 seroconversion among injecting drug users. AIDS Care. 1992;4:35–41. CrossRef
- Serpelloni G, Carrieri MP, Rezza G, Morganti S, Gomma M, Binkin N. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study. AIDS Care. 1994;6:215–20. CrossRef
- Marsch LA, Bickel WK, Badger GJ, Jacobs EA. Buprenorphine treatment for opioid dependence: the relative efficacy of daily, twice and thrice weekly dosing. Drug Alcohol Depend. 2005;77:195–204. CrossRef
- Mattick RP, Breen C, Kimber J, Davoli M. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Library; 2002.
- Mattick RP, Kimber J, Breen C, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2003;CD002207.
- Brief report: Methadone treatment of injecting opioid users for prevention of HIV infection
Journal of General Internal Medicine
Volume 21, Issue 2 , pp 193-195
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- HIV infections: prevention and control
- substance abuse, intravenous: drug therapy
- opioid-related disorders: drug therapy
- methadone: therapeutic use
- Industry Sectors
- Author Affiliations
- 1. University of Adelaide and Drug and Alcohol Services, South Australia, Australia
- 3. National Addiction Centre, UK
- 4. Universitaet Bielefeld, Bielefeld, Germany
- 5. Yale University School of Medicine, New Haven, CT, USA