Opiate substitution treatment and HIV transmission in people who inject drugs: systematic review and meta-analysis.

Filed under: Methadone Treatment

BMJ. 2012; 345: e5945
Macarthur GJ, Minozzi S, Martin N, Vickerman P, Deren S, Bruneau J, Degenhardt L, Hickman M

To quantify the effect of opiate substitution treatment in relation to HIV transmission among people who inject drugs.Systematic review and meta-analysis of prospective published and unpublished observational studies.Search of Medline, Embase, PsychINFO, and the Cochrane Library from the earliest year to 2011 without language restriction.We selected studies that directly assessed the impact of opiate substitution treatment in relation to incidence of HIV and studies that assessed incidence of HIV in people who inject drugs and that might have collected data regarding exposure to opiate substitution treatment but not have reported it. Authors of these studies were contacted. Data were extracted by two reviewers and pooled in a meta-analysis with a random effects model.Twelve published studies that examined the impact of opiate substitution treatment on HIV transmission met criteria for inclusion, and unpublished data were obtained from three additional studies. All included studies examined methadone maintenance treatment. Data from nine of these studies could be pooled, including 819 incident HIV infections over 23?608 person years of follow-up. Opiate substitution treatment was associated with a 54% reduction in risk of HIV infection among people who inject drugs (rate ratio 0.46, 95% confidence interval 0.32 to 0.67; P<0.001). There was evidence of heterogeneity between studies (I(2)=60%, ?(2)=20.12, P=0.010), which could not be explained by geographical region, site of recruitment, or the provision of incentives. There was weak evidence for greater benefit associated with longer duration of exposure to opiate substitution treatment.Opiate substitution treatment provided as maintenance therapy is associated with a reduction in the risk of HIV infection among people who inject drugs. These findings, however, could reflect comparatively high levels of motivation to change behaviour and reduce injecting risk behaviour among people who inject drugs who are receiving opiate substitution treatment. Source

The treatment of alcohol and opioid dependence in pregnant women.

Filed under: Methadone Treatment

Curr Opin Psychiatry. 2012 Nov; 25(6): 559-64
Heberlein A, Leggio L, Stichtenoth D, Hillemacher T

This article addresses the question of ‘best treatment options’, which clinicians face when treating pregnant women with alcohol and opioid dependence.Studies show that alcohol consumption is associated with fetal abnormalities and long-term cognitive problems depending on the amount consumed, drinking pattern, and time of gestation. Screening and evaluation of specific interventions are important to reduce alcohol consumption during pregnancy and associated problems in infants. Opioid detoxification is only recommended beyond the first trimester and only in those pregnant women who refuse opioid maintenance therapy. Methadone is the most established treatment of pregnant opioid-dependent women, though recent results indicate some advantages of buprenorphine, slow-release oral methadone and diamorphine compared with methadone.Benzodiazepines seem to be the most recommendable option for managing alcohol withdrawal, and psychosocial interventions succeed in reducing alcohol consumption or in maintaining abstinence in alcohol-dependent pregnant women. Regarding opioid dependence, current results suggest that factors like the health status of the mother, the need for additional medications (e.g. treatment for HIV), comorbid drug dependence, and concurrent drug use need to be considered in order to find the ‘best opioid substitute’.
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Naloxone successfully counters life-threatening toxicity of benzodiazepine in a patient in methadone-maintenance treatment.

Filed under: Methadone Treatment

J Neuropsychiatry Clin Neurosci. 2012 Jun 1; 24(3): 10015-6
Yuan W, Williams BN

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Where's the Safety Net when Methadone Treatment Centers Close?

Filed under: Methadone Treatment

In southern Nevada, recovering heroin addicts are wondering what they are supposed to do now that a major methadone treatment center has closed its doors. The Nevada Treatment Center, the oldest nonprofit methadone clinic in southern Nevada, says it …
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Duluth Methadone Clinic Files Appeal to License Revocation Order

Filed under: Methadone Treatment

DULUTH, MN (Northland's NewsCenter) – The Lake Superior Treatment Center in Duluth, which treats opiate addictions using methadone, has filed an appeal to an order revoking its license. That revocation was scheduled to take effect Monday. News Fast.
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