ATrain Education

 

Continuing Education for Health Professionals

Alcohol Use Disorders and Opioid Dependence Treated in Primary Care

Module 7

Pharmacotherapies in Opioid Dependence Related to HIV

The integration of treatment of substance-related and addictive disorders has a substantial impact on multiple HIV clinical outcomes including patient morbidity and mortality, adherence to antiretroviral treatment, quality of life, and HIV transmission [82]. Methadone maintenance treatment alone has been shown to reduce the rate of HIV infection in treatment cohorts by over 50% [83]. The introduction of medication assisted treatment in primary care has provided opportunities to integrate primary medical care for people living with HIV/AIDS with care and treatment for opioid dependence. Integrating primary medical care and medication assisted treatment using buprenorphine for opioid dependence can improve the health outcomes among people who use drugs because it provides an opportunity to address the health-related consequences of people living with HIV, particularly the health negative consequences of injection drug use [84, 85]. Multiple models have been piloted for the integration of medication assisted treatment using buprenorphine within HIV primary care [86, 87]. These include an on-site combination of addiction treatment/HIV specialist treatment; HIV primary care physicians prescribing buprenorphine; a nonphysician health care provider integrating medical care and substance abuse treatment services using buprenorphine; and community outreach model where buprenorphine is provided along with medical services in a mobile van or where buprenorphine is provided through a community-based recovery center. These service models have uncovered barriers to integrating medication assisted treatment using buprenorphine within HIV primary care that are both financial and regulatory. Regulatory challenges include licensing and training restrictions imposed by the Drug Addiction Treatment Act of 2000 and confidentiality regulations for alcohol and drug treatment records [88]. These models of care are important because buprenorphine has fewer adverse events associated with its use in patients and fewer drug-drug interactions among patients with HIV disease that require treatment with antiretroviral therapy [89, 90]. Also, buprenorphine is available by prescription. Thus, HIV treatment providers and primary care providers could offer both medication treatment for opioid dependence and concurrent treatment of HIV disease with an eye to drug-drug interactions between HIV medication and addiction pharmacotherapies. Therefore, based on these considerations, it may be preferable to utilize buprenorphine maintenance treatment rather than methadone maintenance treatment for patients with HIV disease and opioid dependence.

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