Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach

Harm Reduction Journal

Sandra D Comer⁴  Michael Gossop¹  Bruno Spire³  Isabelle Ravaux²  Julien Cohen³  Patrizia M Carrieri³  Perrine Roux³ 

[1] King's College London, 4 Windsor Walk, London, SE5 8BB, UK;Hôpital La Conception, Service des Maladies Infectieuses, 147 boulevard Baille, 13005 Marseille, France;ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France;Division on Substance Abuse, New York State Psychiatric Institute and Columbia University, NY, USA

关键词: antiretrovirals;    withdrawal;    HIV;    non-medical use;    methadone;    buprenorphine;    opioid maintenance treatment;   

Others  :  810092
DOI  :  10.1186/1477-7517-8-31

 received in 2011-05-04, accepted in 2011-11-28,  发布年份 2011

【 摘 要 】

Background

Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes among HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIV-infected opioid-dependent individuals treated with buprenorphine or methadone.

Methods

The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent individuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised all patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data on adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having reported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate route of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model based on GEE was then used to identify predictors of non-medical use of opioids.

Results

Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and methadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual patients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and benzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation.

Conclusions

Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids.

【 授权许可】

   
2011 Roux et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Bobrova N, Sarang A, Stuikyte R, Lezhentsev K: Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: a regional overview. Int J Drug Policy 2007, 18(4):313-318.
• [2]Krupitsky E, Zvartau E, Karandashova G, Horton NJ, Schoolwerth KR, Bryant K, Samet JH: The onset of HIV infection in the Leningrad region of Russia: a focus on drug and alcohol dependence. HIV Med 2004, 5(1):30-33.
• [3]van Beek I: Case study: accessible primary health care--a foundation to improve health outcomes for people who inject drugs. Int J Drug Policy 2007, 18(4):329-332.
• [4]Gossop M, Marsden J, Stewart D, Treacy S: Reduced injection risk and sexual risk behaviours after drug misuse treatment: results from the National Treatment Outcome Research Study. AIDS Care 2002, 14(1):77-93.
• [5]Emmanuelli J, Desenclos JC: Harm reduction interventions, behaviours and associated health outcomes in France, 1996-2003. Addiction 2005, 100(11):1690-1700.
• [6]Lawrinson P, Ali R, Buavirat A, Chiamwongpaet S, Dvoryak S, Habrat B, Jie S, Mardiati R, Mokri A, Moskalewicz J, Newcombe D, Poznyak V, Subata E, Uchtenhagen A, Utami DS, Vial R, Zhao C: Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS. Addiction 2008, 103(9):1484-1492.
• [7]Roux P, Carrieri MP, Villes V, Dellamonica P, Poizot-Martin I, Ravaux I, Spire B: The impact of methadone or buprenorphine treatment and ongoing injection on highly active antiretroviral therapy (HAART) adherence: evidence from the MANIF2000 cohort study. Addiction 2008, 103(11):1828-1836.
• [8]Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ, Cooper C: Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 2006, 3(11):e438.
• [9]Malta M, Strathdee SA, Magnanini MM, Bastos FI: Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction 2008, 103(8):1242-1257.
• [10]Maggiolo F, Airoldi M, Kleinloog HD, Callegaro A, Ravasio V, Arici C, Bombana E, Suter F: Effect of adherence to HAART on virologic outcome and on the selection of resistance-conferring mutations in NNRTI- or PI-treated patients. HIV Clin Trials 2007, 8(5):282-292.
• [11]Lucas GM, Cheever LW, Chaisson RE, Moore RD: Detrimental effects of continued illicit drug use on the treatment of HIV-1 infection. J Acquir Immune Defic Syndr 2001, 27(3):251-259.
• [12]Carrieri MP, Moatti JP, Vlahov D, Obadia Y, Reynaud-Maurupt C, Chesney M: Access to antiretroviral treatment among French HIV infected injection drug users: the influence of continued drug use. MANIF 2000 Study Group. J Epidemiol Community Health 1999, 53(1):4-8.
• [13]Bouhnik AD, Chesney M, Carrieri P, Gallais H, Moreau J, Moatti JP, Obadia Y, Spire B: Nonadherence among HIV-infected injecting drug users: the impact of social instability. J Acquir Immune Defic Syndr 2002, 31(Suppl 3):S149-153.
• [14]Carrieri MP, Rey D, Loundou A, Lepeu G, Sobel A, Obadia Y: Evaluation of buprenorphine maintenance treatment in a French cohort of HIV-infected injecting drug users. Drug Alcohol Depend 2003, 72(1):13-21.
• [15]Gallant JE, Somani J, Chaisson RE, Stanton D, Smith M, Quinn TC: Diagnostic accuracy of three clinical case definitions for advanced HIV disease. Aids 1992, 6(3):295-299.
• [16]Fuhrer R, Rouillon F, Lellouch J: Diagnostic reliability among French psychiatrists using DSM-III criteria. Acta Psychiatr Scand 1986, 73(1):12-16.
• [17]Radloff L: The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measure 1977, 3:385-491.
• [18]Carrieri MP, Roux P, Cohen J, Ravaux I, Dellamonica P, Protopopescu C, Spire B, Rosenblum A: Self-reported side effects in buprenorphine and methadone patients receiving antiretroviral therapy: results from the MANIF 2000 cohort study. Addiction 2010, 105(12):2160-2168.
• [19]Price AM, Ilgen MA, Bohnert AS: Prevalence and correlates of nonmedical use of prescription opioids in patients seen in a residential drug and alcohol treatment program. J Subst Abuse Treat 2011, 41(2):208-214.
• [20]Young AM, Havens JR, Leukefeld CG: Route of administration for illicit prescription opioids: a comparison of rural and urban drug users. Harm Reduct J 2010, 7:24.
• [21]Winstock AR, Lea T: Diversion and injection of methadone and buprenorphine among clients in public opioid treatment clinics in New South Wales, Australia. Subst Use Misuse 2010, 45(1-2):240-252.
• [22]Roux P, Villes V, Blanche J, Bry D, Spire B, Feroni I, Carrieri MP: Buprenorphine in primary care: Risk factors for treatment injection and implications for clinical management. Drug Alcohol Depend 2008, 97(1-2):105-113.
• [23]Spire B, Lucas GM, Carrieri MP: Adherence to HIV treatment among IDUs and the role of opioid substitution treatment (OST). Int J Drug Policy 2007, 18(4):262-270.
• [24]Bouhnik AD, Carrieri MP, Rey D, Spire B, Gastaut JA, Gallais H, Obadia Y: Drug injection cessation among HIV-infected injecting drug users. Addict Behav 2004, 29(6):1189-1197.
• [25]Altice FL, Mostashari F, Friedland GH: Trust and the acceptance of and adherence to antiretroviral therapy. J Acquir Immune Defic Syndr 2001, 28(1):47-58.
• [26]Williamson A, Darke S, Ross J, Teesson M: The effect of persistence of cocaine use on 12-month outcomes for the treatment of heroin dependence. Drug Alcohol Depend 2006, 81(3):293-300.
• [27]Brands B, Blake J, Marsh DC, Sproule B, Jeyapalan R, Li S: The impact of benzodiazepine use on methadone maintenance treatment outcomes. J Addict Dis 2008, 27(3):37-48.
• [28]Parr JM, Kavanagh DJ, Cahill L, Mitchell G, Mc DYR: Effectiveness of current treatment approaches for benzodiazepine discontinuation: a meta-analysis. Addiction 2009, 104(1):13-24.
• [29]Eiroa-Orosa FJ, Haasen C, Verthein U, Dilg C, Schafer I, Reimer J: Benzodiazepine use among patients in heroin-assisted vs. methadone maintenance treatment: findings of the German randomized controlled trial. Drug Alcohol Depend 2010, 112(3):226-233.
• [30]Vidal-Trecan G, Varescon I, Nabet N, Boissonnas A: Intravenous use of prescribed sublingual buprenorphine tablets by drug users receiving maintenance therapy in France. Drug Alcohol Depend 2003, 69(2):175-181.
• [31]Peretti-Watel P, Spire B, Lert F, Obadia Y: Drug use patterns and adherence to treatment among HIV-positive patients: evidence from a large sample of French outpatients (ANRS-EN12-VESPA 2003). Drug Alcohol Depend 2006, 82(Suppl 1):S71-79.
• [32]Gossop M, Marsden J, Stewart D, Treacy S: Outcomes after methadone maintenance and methadone reduction treatments: two-year follow-up results from the National Treatment Outcome Research Study. Drug Alcohol Depend 2001, 62(3):255-264.
• [33]Bell J, Burrell T, Indig D, Gilmour S: Cycling in and out of treatment; participation in methadone treatment in NSW, 1990-2002. Drug Alcohol Depend 2006, 81(1):55-61.
• [34]Elkader AK, Brands B, Callaghan R, Sproule BA: Exploring the relationship between perceived inter-dose opioid withdrawal and patient characteristics in methadone maintenance treatment. Drug Alcohol Depend 2009, 105(3):209-214.
• [35]Donny EC, Brasser SM, Bigelow GE, Stitzer ML, Walsh SL: Methadone doses of 100 mg or greater are more effective than lower doses at suppressing heroin self-administration in opioid-dependent volunteers. Addiction 2005, 100(10):1496-1509.
• [36]Lopatko OV, White JM, Huber A, Ling W: Opioid effects and opioid withdrawal during a 24 h dosing interval in patients maintained on buprenorphine. Drug Alcohol Depend 2003, 69(3):317-322.
• [37]de Wet C, Reed L, Glasper A, Moran P, Bearn J, Gossop M: Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome. Drug Alcohol Depend 2004, 76(1):31-35.
• [38]Backmund M, Schutz CG, Meyer K, Eichenlaub D, Soyka M: Alcohol consumption in heroin users, methadone-substituted and codeine-substituted patients--frequency and correlates of use. Eur Addict Res 2003, 9(1):45-50.
• [39]Mateu-Gelabert P, Sandoval M, Meylakhs P, Wendel T, Friedman SR: Strategies to avoid opiate withdrawal: implications for HCV and HIV risks. Int J Drug Policy 2010, 21(3):179-185.
• [40]WHO: [http://whqlibdoc.who.int/publications/2009/9789241547543_eng.pdf;] webciteGuidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence. 2009.
• [41]McCance-Katz EF, Rainey PM, Friedland G, Jatlow P: The protease inhibitor lopinavir-ritonavir may produce opiate withdrawal in methadone-maintained patients. Clin Infect Dis 2003, 37(4):476-482.
• [42]Michel L, Giorgi R, Villes V, Poizot-Martin I, Dellamonica P, Spire B, Protopopescu C, Carrieri MP: Withdrawal symptoms as a predictor of mortality in patients HIV-infected through drug use and receiving highly active antiretroviral therapy (HAART). Drug Alcohol Depend 2009, 99(1-3):96-104.
• [43]Mattick RP, Kimber J, Breen C, Davoli M: Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev 2008, (2):CD002207.
• [44]Gerra G, Borella F, Zaimovic A, Moi G, Bussandri M, Bubici C, Bertacca S: Buprenorphine versus methadone for opioid dependence: predictor variables for treatment outcome. Drug Alcohol Depend 2004, 75(1):37-45.
• [45]Guichard A, Lert F, Brodeur JM, Richard L: Buprenorphine substitution treatment in France: drug users' views of the doctor-user relationship. Soc Sci Med 2007, 64(12):2578-2593.
• [46]Magura S, Nwakeze PC, Demsky SY: Pre- and in-treatment predictors of retention in methadone treatment using survival analysis. Addiction 1998, 93(1):51-60.
• [47]Darke S: Self-report among injecting drug users: a review. Drug Alcohol Depend 1998, 51(3):253-263. discussion 267-258
• [48]Weiss RD, Najavits LM, Greenfield SF, Soto JA, Shaw SR, Wyner D: Validity of substance use self-reports in dually diagnosed outpatients. Am J Psychiatry 1998, 155(1):127-128.
• [49]Messiah A, Loundou AD, Maslin V, Lacarelle B, Moatti JP: Physician recognition of active drug use in HIV-infected patients is lower than validity of patient's self-reported drug use. J Pain Symptom Manage 2001, 21(2):103-112.
• [50]Quaglio G, Lugoboni F, Pattaro C, Montanari L, Lechi A, Mezzelani P, Des Jarlais DC: Patients in long-term maintenance therapy for drug use in Italy: analysis of some parameters of social integration and serological status for infectious diseases in a cohort of 1091 patients. BMC Public Health 2006, 6:216.
• [51]Newman RG: Adherence to methadone treatment: Not just a patient problem. J Subst Abuse Treat 2009, 36(4):463.