Effectiveness and feasibility study of routine HIV rapid testing in an urban methadone maintenance treatment program.

Am J Drug Alcohol Abuse. 2013 Jul; 39(4): 247-251
Seewald R, Bruce RD, Elam R, Tio R, Lorenz S, Friedmann P, Rabin D, Garger YB, Bonilla V, Perlman DC

Abstract Background: Universal Human Immunodeficiency Virus (HIV) testing and treatment are strategies to decrease AIDS-related morbidity and mortality and to reduce HIV transmission. Objective: This study examined the feasibility and effectiveness of routine HIV rapid testing implemented in the largest New York City (NYC) Methadone Maintenance Treatment Program (MMTP). Methods: A routine HIV rapid testing program performed by medical providers without pretest counseling or the provision of incentives was compared to HIV rapid testing done by referral to HIV counselors with pretest counseling and incentives over the prior 12 months. Results: Routine HIV rapid testing proved feasible and effective when performed by the medical staff in the setting of a large urban MMTP. The program increased HIV testing in all genders, race/ethnicities, and ages. HIV-positive individuals were diagnosed and successfully linked to care. The elimination of HIV prevention counseling may have facilitated expanded testing. Conclusion: This study confirms that routine HIV rapid testing without HIV-prevention counseling or the provision of incentives for patients is feasible on a large scale in a busy, urban methadone clinic.
HubMed – Methadone

Factors associated with high-frequency illicit methadone use among rural Appalachian drug users.

Am J Drug Alcohol Abuse. 2013 Jul; 39(4): 241-246
Hall MT, Leukefeld CG, Havens JR

Abstract Background: In recent years there has been a sharp increase in the use of illicit methadone as well as methadone-related overdose deaths. Objective: The purpose of this study was to describe factors associated with low- and high-frequency methadone use in a cohort of rural Appalachian drug users. Methods: Interviews assessing sociodemographics, illicit drug use and drug treatment, psychiatric disorders, health and sociometric drug network characteristics were conducted with 503 rural drug users between 2008 and 2010. A two-level mixed effects regression model was utilized to differentiate low- (one use per month or less in the past six months) versus high-frequency (daily or weekly use in the past six months) illicit methadone users. Results: The lifetime prevalence of illicit methadone use in this population was 94.7% (n?=?476) and slightly less than half (46.3%) were high-frequency users. In the mixed effects regression model, initiating illicit methadone use at a younger age was associated with high-frequency illicit methadone use. Taking a prescribed medication for a physical problem, undergoing additional weeks of outpatient drug free treatment, daily OxyContin® use in the past month, and having fewer ties and second-order connections in the drug network reduced the odds of high-frequency illicit methadone use. Conclusions: Rates of illicit methadone use and high-frequency illicit methadone use among this sample of rural drug users were considerably higher than those previously reported in the literature. Health practitioners in rural areas should routinely screen for illicit opioid use, including methadone.
HubMed – Methadone

Methadone-Related Overdose Deaths in Rural Virginia: 1997 to 2003.

J Addict Med. 2013 Jul 8;
Wunsch MJ, Nuzzo PA, Behonick G, Massello W, Walsh SL

AIM:: Nonmedical use of prescription drugs and poisoning overdose deaths related to prescription drugs are increasing. This article presents an in-depth description of decedents from rural southwestern Virginia, where methadone was identified on toxicology.Cases for this study were derived from a population-based review of 893 drug-related deaths occurring from 1997 to 2003 in the Office of the Medical Examiner, Western District of Virginia.Deaths in which methadone was identified on toxicology in rural southwestern Virginia increased rapidly over the 7-year study period. In the majority of cases, the cause of death was polydrug toxicity, and the manner of death was classified as accident. A majority of decedents did not have prescriptions for drugs identified on toxicology. The mean concentration of methadone for all cases was 495 mg/L, and there was no significant difference between concentrations where methadone was found alone or in combination with other drugs. There was a significant difference in methadone concentrations for those with prescriptions (645 mg/L vs 449 mg/L) when compared with those without.Cases where methadone was identified on toxicology increased significantly over the time studied. Efforts to prevent these deaths include the use of State Prescription Monitoring Programs, Universal Precautions, and Guidelines from the Federation of State Medical Boards.
HubMed – Methadone

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