Archive for April, 2014

Methadone or Buprenorphine Treatment for Opioid Dependence Reduces HIV Risk Behaviors

April 28, 2014

riskResearch over the past 20 years has shown that methadone maintenance (MET) reduces opioid use and is an effective HIV risk reduction intervention as well. Like methadone, treatment with buprenorphine-naloxone (BUP) also appears to reduce HIV risk.

To date, only one study has compared HIV risk in patients receiving MET vs. BUP. This article, currently in-press in JAIDS, reports on a similar comparison of a much larger sample in a secondary analysis of data from the National Drug Abuse Treatment Clinical Trials Network (CTN) protocol, “Starting Treatment with Agonist Replacement Therapies (START).”

The Pacific Northwest Node was one of the original nodes involved in the START study, and Dr. Andrew Saxon from the VA Puget Sound Health Care was one of the authors of this ancillary investigation.

START was a randomized, open-label phase 4 study in participants entering opioid agonist treatment programs throughout the country that aimed to compare the effect of BUP and MET on liver function. The Risk Behavior Survey (RBS) was administered to participants, measuring past 30-day HIV risk, at baseline and weeks 12 and 24. Among the 529 patients randomized to MET, 391 (74%) were completers; for BUP, 740 were randomized and 340 completed (46%).

Analysis of the survey results found significant reductions in injecting risk with no differences between groups in mean number of times reporting injecting heroin, speedball, other opiates, and number of injections. There were also no differences between groups in terms of percent who shared needles, did not clean shared needles with bleach, shared cookers, or engaged in front/back loading of syringes.

The percent having multiple sex partners decreased equally in both groups. However, for males on BUP, the sex risk composite increased, while for males on MET, the sex risk decreased, resulting in significant group differences over time. For females, there was a significant reduction in sex risk with no group differences.

Conclusions: Among MET and BUP patients who remained in treatment, HIV injecting risk was equally and markedly reduced, however MET retained more patients. Sex risk was equally and significantly reduced among females in both treatment conditions, but increased for males on BUP and decreased for males on MET. Overall, these findings further support the importance of expanding availability of evidence-based medical treatments for opioid addiction.

Citation: Woody GE, Bruce RD, Korthuis PT, et al. HIV Risk Reduction with Buprenorphine-Naloxone or Methadone: Findings from A Randomized Trial. Journal of Acquired Immune Deficiency Syndromes 2014 (in press).


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CTN-0044 Outcomes: Internet-Based Substance Abuse Treatment Improves Access and Outcomes

April 8, 2014

computerguyThis article, currently in-press at American Journal of Psychiatry and written by Aimee Campbell, Edward Nunes, Abigail Matthews, and colleagues, reports on the primary outcomes of National Drug Abuse Treatment Clinical Trials Network protocol CTN-0044, “Web Delivery of Evidence-Based, Psychosocial Treatment for Substance Use Disorders.”

Evergreen Manor of the Pacific Northwest Node was one of the CTPs involved in this study.

Computer-delivered intervention have the potential to improve access to quality addiction treatment care. This study evaluated the effectiveness of the Therapeutic Education System (TES), an Internet-based behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders.

Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to receive 12 weeks of either treatment as usual (TAU) (N=252) or TAU plus TES, with the intervention substituting for about 2 hours of standard care per week (N=255).

TES consists of 62 computerized interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment as usual consisted of individual and group counseling at participating programs.

Compared with patients in the TAU group, those in the TES group had a lower dropout rate and a greater abstinence rate (as measured by twice-weekly urine drug screens and self-report). This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry.

Conclusions: Internet-delivered interventions such as TES have the potential to help bridge the gap between the enormous need for high-quality evidence-based treatment for addiction and the capacity of the treatment system to deliver. Additional research is needed to assess the long-term effectiveness of TES, as well as its effectiveness in non-specialty clinical settings, including primary care.

Citation: Campbell ANC, Nunes EV, Matthews AG, et al. Internet-Delivered Treatment for Substance Abuse: A Multisite Randomized Controlled Trial. American Journal of Psychiatry 2014 (in press).


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