Methadone For IV Drug Addiction Reduces HIV Infections

MedicalResearch.com Interview with:

Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.  He is Division Lead for Addiction Medicine in the department of Family and Community Medicine at Providence Health Care, and is also an addiction physician at the St. Paul’s Addiction Medicine Consult Service, the Immunodeficiency Clinic and Vancouver Detox. He is also Lead Study Clinician for CHOICES, a US National Institutes of Drug Abuse (NIDA) funded clinical trial looking at an opioid receptor blocker (Vivitrol) to treat opioid or alcohol addiction in HIV positive patients.Dr. Keith Ahamad, a clinician scientist at the BC Centre for Excellence in HIV/AIDS and a Family Doctor trained and certified in Addiction Medicine.

He is Division Lead for Addiction Medicine in the department of Family and Community Medicine at Providence Health Care, and is also an addiction physician at the St. Paul’s Addiction Medicine Consult Service, the Immunodeficiency Clinic and Vancouver Detox. He is also Lead Study Clinician for CHOICES, a US National Institutes of Drug Abuse (NIDA) funded clinical trial looking at an opioid receptor blocker (Vivitrol) to treat opioid or alcohol addiction in HIV positive patients.

MedicalResearch: What is the background for this study?

Dr. Ahamad: Previous methadone research has mostly been done in restrictive settings, such as the USA, where methadone can only be dispensed through restrictive methadone programs and cannot be prescribed through primary care physician’s offices. Since a systematic review in 2012, randomised controlled trials have compared methadone treatment provided at restrictive specialty clinics with primary care clinics, which have shown the benefits of primary care models of methadone delivery on heroin treatment outcomes, but not on HIV incidence.

MedicalResearch: What are the main findings?

Dr. Ahamad: After adjusting for factors commonly associated with HIV, methadone remained independently associated in protecting against HIV in this group of injection drug users. Those study participants who were not prescribed methadone at baseline were almost four times more likely to contract HIV during study follow up.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Ahamad: Methadone is an effective medication in treating opioid addiction. Through international randomized control trials, we already know that when prescribed though primary care offices, access to this life-saving medication is increased, effective, and increases patient satisfaction. Now, through our study, we have evidence that when delivered in this manner, it also decreases the spread of HIV.

MedicalResearch: How can this study help to inform health policy decisions?

Dr. Ahamad: Injection drug users remain a highly marginalized population at very high risk of contracting and spreading HIV. Traditionally, this group has been difficult to engage, in particular around treating those injecting opioids, as evidence-based treatment like methadone maintenance is often not readily available. Recently, we have seen an HIV outbreak in Southeastern Indiana that is caused by the injection of opioids. And in countries like Russia, methadone remains illegal. Methadone needs to be readily available as a treatment to help stop these outbreaks.

MedicalResearch: Why is methadone management therapy so controversial?

Dr. Ahamad: Often, addiction is not treated as a medical disease despite significant scientific evidence to support this. Methadone is a medication that many feel is replacing one “addiction” with another rather than a medical treatment no different than insulin to treat diabetes. Methadone has been proven to reduce and eliminate many of the consequences of opioid addiction. As such, methadone must be viewed as a treatment for opioid addiction rather than a substitution.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Ahamad:Future research needs to focus on continuing to find innovative ways to increase access to this essential medication. Access is of particular concern in rural areas where primary care resources are limited and often physicians are not trained sufficiently to diagnose and treat substance use disorders with medications like methadone.

Citation:

Effect of low-threshold methadone maintenance therapy for people who inject drugs on HIV incidence in Vancouver, BC, Canada: an observational cohort study

Keith Ahamad, MD Kanna Hayashi, PhD Paul Nguyen, PhD Sabina Dobrer Prof Thomas Kerr, PhD Christian G Schütz, MD Prof Julio S Montaner, MD Prof Evan Wood, MD

Published Online: 06 August 2015

DOI: http://dx.doi.org/10.1016/S2352-3018(15)00129-0

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Dr. Keith Ahamad (2015). Methadone For IV Drug Addiction Reduces HIV Infections

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