Addiction Treatment
Download
1 / 22

Addiction Treatment as HIV Prevention - PowerPoint PPT Presentation


  • 119 Views
  • Uploaded on

Addiction Treatment as HIV Prevention . Charles P. O’Brien, MD, PhD David Metzger, PhD George E. Woody, MD University of Pennsylvania Treatment Research Center. Current AIDS epidemiology. Approximately 33,000,000 living with HIV/AIDS Over 10,000,000 infections among IDU

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Addiction Treatment as HIV Prevention ' - chin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

Addiction Treatment

as HIV Prevention

Charles P. O’Brien, MD, PhD

David Metzger, PhD

George E. Woody, MD

University of Pennsylvania

Treatment Research Center


Current AIDS epidemiology

  • Approximately 33,000,000 living with HIV/AIDS

  • Over 10,000,000 infections among IDU

  • Outside of Africa, over 33% of all new infections are estimated to be attributable to injection drug use

  • No estimates of the major role of alcohol and non-injection drug use such as crack cocaine


Predictors of seroconversion in explore drug and alcohol use
Predictors of seroconversion in Explore: drug and alcohol use

* REF = no, light or moderate use of alcohol; no speed use; no use before sex

** Heavy alcohol = 4+ drinks every day or 6+ drinks on a typical day


IDUs as Percent of Total Registered HIV Cases

Eastern Europe and Central Asian Countries, 2007

Countries with Injection Driven Epidemics, OSI, 2008


IDUs as Percent of Total Registered HIV Cases

East and South East Asian Countries, 2007

Source: UNAIDS 2008 Report on the Global AIDS Epidemic


HIV prevention strategies for drug using populations

  • Education about HIV transmission

  • HIV counseling and testing

  • Increased access to sterile injection resources and condoms

  • Drug addiction treatment

  • HIV treatment


Treatment Options for Opioid Addiction

  • Outpatient drug free counseling- not effective

  • Medication-free therapeutic community-

    • Expensive, not widely available, effective with small proportion of patients

  • Methadone-1964, national program 1971

  • Partial agonist- Buprenorphine

    • Suboxone (combination)

  • Naltrexone oral, depot and implant


  • Methadone

    • Full agonist

    • Cross tolerance with all opioids

    • Reduces craving

    • Prevents withdrawal

    • Prevents pleasure from other opioids

    • Low dose not effective



    Suboxone

    Buprenorphine Combined with antagonist

    Reduces abuse potential

    Bup 2 mg: Nal 0,5 mg

    Bup 8 mg: Nal 2 mg

    (*Bup 16 mg: Nal 4 mg)

    (*Bup 32 mg: Nal 8mg)

    *tested, not marketed


    Report good effects

    60

    Placebo

    2 mg Bup

    8 mg Bup

    2 mg Bup/Nx

    8 mg Bup/Nx

    50

    40

    Evaluation

    30

    20

    10

    0

    BL 0h 0.5h 1.5h 2.5h 3.5h 24h 48h

    Comer and Collins,The Journal of Pharmacology and Experimental Therapeutics, 303(2), 695-703, 2002


    Treatment Options for Opioid Addiction

    • Naltrexone effective in special populations

    • Physicians, pharmacists, nurses

    • Parolees, Probationers

    • Countries where agonists are not available

    • ADHERENCE

      • Oral

      • Depot

      • Pellet implant



    Percent opioid free subjects by visit
    Percent opioid-free subjects, by visit

    Weeks ≤4:

    Grace period

    Weeks 5 to 24: Assessment period

    Note: “Opioid-free” is indicated by urine drug tests (negative for opioids), naloxone challenge results, and TLFB data. Weeks with missing urine test results were imputed as positive.


    Treatment Options for Alcoholism

    • Outpatient drug free counseling- with self-help

      • Alcoholics Anonymous

    • Medication-free therapeutic community-

      • Expensive, not widely available, effective with small proportion of patients

    • Naltrexone: oral, depot

    • Acamprosate

    • Topiramate (off label)


    Treatment Options for Stimulant Addiction

    Cocaine, Methamphetamine

    Injection, nasal, smoked

    • No FDA approved medication

    • Outpatient counseling

      • Cognitive Behavioral Therapy

    • Medications in clinical trials

    • Vigabatrin

    • Topiramate

    • Modafinil

    • Baclofen


    1

    0.8

    0.6

    0.4

    0.2

    0

    Rate of needle sharing reported by

    In-Treatment IDUs compared to

    Out-of-Treatment IDUs

    Selwyn

    Martin

    Klee

    Williams

    Longshore

    Metzger

    Stark

    Capplehorn

    et al

    et al

    et al

    et al

    et al

    et al

    et al

    et al

    1987

    1990

    1991

    1992

    1993

    1993

    1994

    1995


    100

    80

    60

    40

    20

    0

    Percent of subjects reporting

    injection prior to, during, and

    following methadone treatment

    Injection

    Injection

    Injection

    Injection

    Injection

    After Tx

    in Prior

    in Prior

    in Year

    Prior to Tx

    Entry

    Entry

    Year

    Month

    After

    Tx

    (Ball and Ross, 1991)


    Percent infected after 18 months

    by treatment status

    22%

    Percentage

    3.5%

    4.5%

    Metzger et al 1993


    Conclusions

    • Data suggests effective treatments for drug users:

    • - recognize addiction as a chronic disease - use pharmacologic and counseling

    • interventions

    • - are accessible, acceptable, and affordable


    Conclusions
    Conclusions

    • Behavioral and serologic data support the hypotheses that drug users in treatment: - significantly reduce the frequency of use - practice fewer risk behaviors - have greater access to HIV treatment

      - are more adherent to HIV care


    ad