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 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Illicit drug use is spreading, especially in the developing world, but has begun to stabilise in most developed countries. The phenomenon of illicit drug use is still poorly understood, with responses in most countries influenced largely by cultural factors. A range of psychosocial and pharmacotherapeutic treatments is available; of these, methadone maintenance treatment for heroin dependence has the most evidence of benefit. A large body of literature--including some well designed studies--indicates that methadone reduces heroin use, mortality, criminal activity and risk of human immunodeficiency virus (HIV) infection. Methadone is more likely to be effective if higher doses, longer durations of treatment and more realistic goals are set. However, research findings which would improve outcomes considerably are often not implemented. Methadone maintenance programmes, which attract and retain more illicit drug users than other treatment modalities, are now being made more available in many countries in recognition of their therapeutic effectiveness and utility in reducing the spread of HIV infection among people injecting heroin. HIV infection is now recognised in many countries to be the most serious complication of illicit drug use for both individual drug injectors and their communities. Levo-alpha-acetylmethadol (LAAM) has similar properties to methadone but a longer half-life. This suggests a number of clinical benefits which would also reduce the cost of treatment. However, LAAM has not been approved by regulatory authorities for routine use despite positive findings in some studies. Buprenorphine has shown some promise in the management of heroin dependence but is still undergoing evaluation. It is, however, unlikely to ever be used widely for the management of illicit drug users. Naltrexone may have some advantages for special populations. Pharmacotherapeutic treatment for cocaine and amphetamine users is still at a developmental stage.
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PMID:Managing illicit drug use. A practical guide. 751 74

The spread of HIV infections in southeastern Asia is expected to be significant. In this area, as in other parts of the world, the habits of intravenous drug users (IDUs) who share needles and supplies and engage in high-risk sexual behavior will contribute to the spread of the disease in the general population. Because drug treatment programs that promote abstinence are only successful among the limited number of drug abusers who are motivated to stop taking drugs, a harm-reduction approach to this problem makes the best sense. Reducing HIV risk requires giving priority to HIV prevention rather than to control of drug use. Interventions to prevent HIV transmission among IDUs include counseling for in-treatment drug users, needle and syringe exchange programs, and preventive intervention programs that attempt to change high-risk behavior. In India, drug abuse has a long history, and the northeastern states have experienced a rapid increase in heroin use accompanied by the spread of HIV infection. In other areas, injection of Buprenorphine is increasing. It is important to recognize IDUs as a group at high risk of transmitting HIV infection and to design strategies, such as those that have been successful in New York City, to stabilize sera-prevalence in this rapidly increasing group.
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PMID:Injection drug use: harbinger of HIV / AIDS. 1229 Mar 46

In the United States, approximately 25% of the 40,000 new human immunodeficiency virus (HIV) infections each year are secondary to injection drug use. Worldwide, there are an estimated 12.6 million injection drug users, and 10% of HIV infections (420,000 infections in 2003) are associated with this practice. Buprenorphine is a new medication used to treat opioid dependence that shows promise for reducing the rate of HIV transmission and improving the care of opioid-dependent patients with HIV infection. Although buprenorphine faces fewer clinical and regulatory barriers than does methadone, the optimal strategy for integration of office-based treatment of opioid dependence and HIV disease is an area of ongoing research. This review addresses the introduction of buprenorphine, in terms of public health, policy, and clinical implications for HIV-infected patients and for HIV care providers.
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PMID:Buprenorphine: its role in preventing HIV transmission and improving the care of HIV-infected patients with opioid dependence. 1610 91

The occurrence of human immunodeficiency virus (HIV) disease and hepatitis C is common in injection drug users, most of whom are opioid dependent. Methadone pharmacotherapy has been the most widely used treatment for opioid addiction in this population. Methadone has significant, adverse drug-drug interactions with many antiretroviral therapeutic agents that can contribute to nonadherence and poor clinical outcomes in this high-risk population. The present article summarizes current knowledge about interactions between methadone and antiretroviral medications. Buprenorphine is the newest agent available for the treatment of opioid dependence and may have fewer adverse interactions with antiretroviral agents. Buprenorphine has a significant pharmacokinetic interaction with efavirenz but no pharmacodynamic interaction; therefore, simultaneous administration of these drugs is not associated with opioid withdrawal, as has been observed with methadone. This promising finding may simplify the treatment of opioid-dependent patients with HIV disease and should also improve clinical outcomes for persons coinfected with HIV and hepatitis C virus.
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PMID:Treatment of opioid dependence and coinfection with HIV and hepatitis C virus in opioid-dependent patients: the importance of drug interactions between opioids and antiretroviral agents. 1626 22

(1) The aim of replacement therapy for heroin addiction is to suppress craving for other opiates and to prevent opiate withdrawal symptoms. (2) In France, methadone was the first drug to be licensed for this use, in 1995, with very strict prescribing and dispensing conditions. Buprenorphine was approved in 1996, and was subject to less restrictive conditions. (3) In 2003 in France, an estimated 80 000 people were receiving replacement therapy with buprenorphine and 14 000 with methadone. (4) A meta-analysis of 13 comparative trials involving a total of 2544 patients showed that buprenorphine 6 to 12 mg initially reduced both opiate and benzodiazepine use, whereas doses of 2 to 4 mg had no marked impact on heroin use. This meta-analysis concluded that buprenorphine and methadone had similar efficacy in clinical trials in which the dose was adjusted to outcome. There were more dropouts with buprenorphine than with methadone. A daily dose of 16 mg appeared to be roughly equivalent to 60 mg/day methadone. (5) France appears to be the only country to have relied primarily on buprenorphine as replacement therapy for heroin addiction. This has been the case in France since 1996. The frequency of heroin overdose has fallen markedly in France since 1996, possibly due in part to the availability of replacement therapies. Overall mortality among drug users has also declined, but this is largely due to more effective treatment of HIV infection. (6) In France, a two-year cohort study of patients treated with buprenorphine and a survey conducted during the first year of buprenorphine replacement were funded by the manufacturer, Schering-Plough. The results showed that more than two-thirds of patients remained on treatment, and that, overall, the patients' general condition improved. (7) Opioid-like adverse effects are infrequent under normal conditions of use. There are reports of cases of hepatitis in patients taking buprenorphine, with or without a benzodiazepine. Attribution to buprenorphine is unclear, however, due to the lack of appropriate analyses. (8) Some of the key adverse effects occur during misuse: buprenorphine tablets are often injected, especially during the first few months of treatment (sometimes for more than two years). Injection carries a risk of infections; other potential long-term effects are poorly understood. Compared with methadone users, and regardless of the substances involved, buprenorphine users appear more likely to self-inject. (9) The consequences of sniffing crushed buprenorphine tablets have not been studied. (10) Deaths have been reported following buprenorphine overdose, but they appear to be less frequent than with methadone (0.2 and 0.7 deaths per 1000 users, respectively in 1998). (11) Approaches designed to help patients stop self-injecting have not been tested in comparative trials. Prescriptions of methadone syrup or an injection opiate may be worth trying when all other measures fail.
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PMID:Buprenorphine replacement therapy: a confirmed benefit. 1660 48

Injecting drug use is a common mode of transmission among persons with HIV/AIDS. Many HIV-infected patients meet diagnostic criteria for opioid dependence, a chronic and relapsing brain disorder. Most HIV providers, however, receive little training in substance use disorders. Opioid agonist therapy (OAT) has a stabilizing effect on opioid-dependent patients and is associated with greater acceptance of antiretroviral (ARV) therapy, higher ARV adherence, and greater engagement in HIV-related health care. Although methadone maintenance has been the OAT gold standard, methadone is available for the treatment of opioid dependence only in strictly regulated narcotic treatment programs. Buprenorphine, a partial opioid agonist approved for the office-based treatment of opioid dependence in 2002, may result in better health and substance use treatment outcomes for patients with HIV disease.
Curr HIV/AIDS Rep 2006 Nov
PMID:The medical management of opioid dependence in HIV primary care settings. 1708 80

The Centers for Disease Control and Prevention's HIV Prevention Strategic Plan Through 2005 advocated for increasing the proportion of persons with human immunodeficiency virus (HIV) infection and in need of substance abuse treatment who are successfully linked to services for these 2 conditions. There is evidence that integrating care for HIV infection and substance abuse optimizes outcomes for patients with both disorders. Buprenorphine, a recently approved medication for the treatment of opioid dependence in physicians' offices, provides the opportunity to integrate the treatment of HIV infection and substance abuse in one clinical setting, yet little information exists on the models of care that will most successfully facilitate this integration. To promote the uptake of this type of integrated care, the current review provides a description of 4 recently implemented models for combining buprenorphine treatment with HIV primary care: (1) an on-site addiction/HIV specialist treatment model; (2) a HIV primary care physician model; (3) a nonphysician health professional model; and (4) a community outreach model.
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PMID:Initial strategies for integrating buprenorphine into HIV care settings in the United States. 1710 6

The confluence of the heroin injection epidemic and the human immunodeficiency virus (HIV) infection epidemic has increased the call for expanded access to effective treatments for both conditions. Buprenorphine and methadone are now listed on the World Health Organization's Model Essential Drugs List. In France, which has the most extensive experience, buprenorphine has been associated with a dramatic decrease in deaths due to overdose, and buprenorphine diversion appears to be associated with inadequate dosage, social vulnerability, and prescriptions from multiple providers. Other treatment models (in the United States, Australia, Germany, and Italy) and buprenorphine use in specific populations are also reviewed in the present article. In countries experiencing a dual epidemic of heroin use and HIV infection, such as former states of the Soviet Union and other eastern European and Asian countries, access to buprenorphine and methadone may be one potential tool for reducing the spread of HIV infection among injection drug users and for better engaging them in medical care.
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PMID:Buprenorphine use: the international experience. 1710 7

Buprenorphine is used for the treatment of opioid dependence. As the number of persons receiving buprenorphine treatment and antiretroviral therapy continues to grow, so too does the existence and clinical impact of drug interactions between buprenorphine and medications for treating human immunodeficiency virus (HIV) infection. Awareness that such interactions exist may deter some patients and physicians from initiating potentially lifesaving therapy or lead to complications among patients whose treatment is already under way. Complications include nonadherence to antiretroviral therapy and the development of viral resistance. Illicit drug use is a frequent consequence of adverse drug effects experienced by injection drug users. The occurrence of unrecognized drug interactions can lead to unsuccessful therapy for HIV infection and the treatment of substance dependence. The present review is organized to provide a working background of buprenorphine pharmacology. Review of the current state of knowledge regarding specific interactions between buprenorphine and antiretrovirals is followed by a review of the clinical applicability of these interactions.
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PMID:Pharmacokinetic interactions between buprenorphine and antiretroviral medications. 1710 8

This study examined drug interactions between buprenorphine, an opioid partial agonist medication used in the treatment of opioid dependence, and the nonnucleoside reverse-transcriptase inhibitors (NNRTIs) efavirenz (EFV) and delavirdine (DLV). Opioid-dependent, buprenorphine/naloxone-maintained, human immunodeficiency virus (HIV)-negative volunteers (n=10 per NNRTI) participated in 24-h sessions to determine pharmacokinetics of buprenorphine and of buprenorphine with either EFV or DLV after administration of standard doses of either antiretroviral for 15 or 7 days, respectively. Opiate withdrawal symptoms, cognitive effects, and adverse events were determined before and after antiretroviral administration in opioid-dependent participants. The pharmacokinetics of NNRTIs in healthy control participants were used to determine the effect of buprenorphine on NNRTIs. EFV decreased the buprenorphine area under the concentration-time curve (P<.001). DLV increased buprenorphine concentrations (P<.001). Clinically significant consequences of these interactions were not observed. Buprenorphine did not alter antiretroviral pharmacokinetics. Adjustments of doses of either buprenorphine or EFV or DLV are not likely to be necessary when these drugs are administered for the treatment of opiate dependence and HIV disease.
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PMID:Interactions between buprenorphine and antiretrovirals. I. The nonnucleoside reverse-transcriptase inhibitors efavirenz and delavirdine. 1710 9


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