Medications for Opioid Use Disorder Save Lives by unknow

Author:unknow
Language: eng
Format: epub
Tags: Health and Medicine: Medical Technologies and Treatments, Health and Medicine: Health Sciences, Health and Medicine: Policy, Reviews and Evaluations
Publisher: The National Academies Press
Published: 2019-03-20T00:00:00+00:00

Populations with Comorbid Infectious Diseases

It is increasingly evident that the ongoing epidemics of OUD, opioid overdose, hepatitis C virus (HCV), and HIV in the United States are linked and warrant combined evidence-based interventions for prevention and treatment. These would include broad HCV and HIV testing and substance use screening, the provision of medications to treat OUD, and increased population-level HCV treatment (Perlman and Jordan, 2018). A variety of successful models have been described for co-locating the treatment of all three conditions (Rich et al., 2018).

Epidemiological studies reveal that among people who inject drugs in the United States, HIV rates are decreasing and HCV rates are increasing (Schranz et al., 2018). However, rural counties hard hit by the opioid epidemic are experiencing catastrophic increases in HIV transmission as well as HCV (NASEM, 2018). These increases in infectious disease transmission rates are being driven in large part by increases in injection drug use in communities across the country.

Interactions between methadone and older medications for HIV, such as efavirenz, and interactions between buprenorphine and ritonavir-boosted atazanavir may have historically impacted OUD treatment in people living with HIV. However, such interactions are less of a concern with the current first-list antiretroviral therapies, which are regimens containing integrase inhibitors (Gourevitch and Friedland, 2000; McCance-Katz et al., 2007). Methadone and buprenorphine treatment significantly reduce the use of illicit opioids and HIV transmission risk behaviors, such as injection drug use and the sharing of injection equipment (Gowing et al., 2011; Woody et al., 2014). Methadone and buprenorphine also improve HIV viral suppression and adherence to antiretroviral therapy. Extended-release naltrexone has been shown to improve HIV viral suppression in persons with HIV leaving prison (Fanucchi et al., 2019). Co-location of HIV and OUD treatment in primary care or OTPs has been demonstrated to improve treatment outcomes for both conditions (Berg et al., 2011; Low et al., 2016; Lucas et al., 2010). Office-based buprenorphine treatment for OUD provided in HIV treatment settings has also been associated with decreased opioid use (Fiellin et al., 2011).

In the United States today, the majority of people with HCV have a history of injecting drugs (Norton et al., 2017). A retrospective study of clinical data reported that almost half of people receiving office-based buprenorphine had positive screening tests for HCV antibodies, but only 2 percent had initiated HCV treatment (Carey et al., 2016). Methadone and buprenorphine treatment reduce the risk of HCV infection among injection drug users (Tsui et al., 2014), and people retained in OUD treatment are significantly more likely to initiate HCV treatment (Norton et al., 2017). High rates of successful HCV treatment have been achieved among patients receiving their HCV treatment onsite at OTPs (Butner et al., 2017; Litwin et al., 2009).

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