Treatment of Opioid Addiction and HIV
November 9, 2015
Table of Contents
An opioid is a type of drug that relieves pain by blocking pain signals to the brain. Opioids come in many forms, including pills, patches, powders, and liquids. Also called opiates or narcotics, opioids come in various strengths -- from very strong (e.g., morphine, Dilaudid, Duragesic, Oxycontin), to moderately strong (e.g., oxycodone, as in Lortab, Percocet), to strong (e.g., hydrocodone, as in Vicodin) to mild (e.g., codeine, as found in some cough/cold medicines). Heroin is made from morphine and can be injected, snorted, or smoked.
Opioids block the body's perception of pain. For some people, opioids also cause an intensely rewarding 'rush' or sense of extreme happiness. Although opioids can be effective and safe when taken as prescribed, they can also be highly addictive. This means that those who take or use opioids can lose control, become dependent on them, and use more and more of them. For more information, see The Well Project's article on Substance Abuse and Addiction.
People who inject drugs, whether they inject heroin or another illegal substance, are more likely to get HIV, hepatitis C and/or B, and other infectious diseases through sharing or reusing needles and other injection drug equipment. It has been estimated that close to one in ten new HIV infections worldwide are the result of injection drug use. In some parts of Central Asia and Eastern Europe, unsafe injection practices are the cause of more than eight out of ten HIV infections. Of the three to four million people newly infected with hepatitis C each year, around two million of these are due to injection drug use. For more information on safer injection practices, see The Well Project's article on Cleaning Works.
Opioid substitution therapy, also called opioid replacement therapy or maintenance therapy, provides opioid addicts with a prescription medicine that replaces their drug of choice (e.g., heroin) and helps them manage their addiction. This medicine is usually supplied in a clinically supervised setting. The two medicines most often used as OST are methadone and buprenorphine; they are described below.
According to the World Health Organization (WHO), studies have shown that OST programs are effective in reducing illegal drug use, death from overdose, and behaviors that lead people to get and spread HIV. They also help those living with HIV (HIV+) to adhere to their HIV drugs and stay healthier longer. Unfortunately, less than eight percent of people who inject drugs worldwide receive OST. However, this number varies greatly depending on the country. While as many as nine out of ten injection drug users get OST in the United Kingdom, OST is unavailable in the Russian Federation. In the US, it is estimated that around one in four opiate addicts receive OST.
If you are addicted to heroin or another opiate, your health care provider may recommend treatment with methadone or buprenorphine. They are both prescription drugs that can help you manage your addiction. It is important to know that both methadone and buprenorphine are addictive. That is, your body becomes dependent on your taking them and could have withdrawal symptoms if you stopped (e.g., anxiety, sweating, chills, rapid heart rate, nausea, vomiting, diarrhea). However, they take away your craving for heroin and do not make you feel high or tired. Methadone does not interfere with day-to-day activities such as driving a car or going to work, but buprenorphine may cause drowsiness.
Each dose of methadone lasts for about 24 hours so you will only need to take it once a day. Used at the appropriate dose, methadone is a safe drug that may not have difficult side effects even if you take it for ten years or more. Like any drug, it is possible to take too much methadone or buprenorphine and overdose. Symptoms of overdose for methadone and buprenorphine include slow breathing and heart rates, severe drowsiness, muscle weakness, pinpoint pupils, and cold, clammy skin.
Buprenorphine can be used once a day or once every other day, and is available as a sublingual tablet (dissolves under the tongue). Buprenorphine is less likely than methadone to cause overdose and withdrawal symptoms.
There are several brand-name products containing buprenorphine that the US Food and Drug (FDA) has approved for treatment of opioid dependence: Subutex (buprenorphine), and Suboxone and Zubsolv (buprenorphine + naloxone). Health Canada has approved Subutex and Suboxone, while the government in the UK has approved Subutex, Suboxone, and Prefibin (buprenorphine). The World Health Organization's (WHO) guidelines recommend that health care providers offer substitution therapy for opioid dependence. However, not each country follows these guidelines, and even among those who do, each country’s preferred method for meeting the WHO guidelines differs.
Combined with behavioral therapies, counseling, and other supportive services, methadone or buprenorphine treatment can help you stop using heroin and other opiates, including prescription narcotics like Lortab, Vicodin, OxyContin, and Percocet. Taking care of a substance abuse problem can greatly increase the success of your HIV treatment.
Although the WHO's guidelines for managing opioid dependence suggest that methadone replacement treatment is very effective, access to OST remains challenging in many areas. Methadone and buprenorphine treatment are recognized and available in some countries, yet remain unavailable and illegal in others.
In the US, because methadone and buprenorphine are federally controlled drugs, you must meet the requirements of the FDA. Federal requirements along with state laws can influence whether or not methadone and buprenorphine treatment are available in your area.
You cannot get methadone or buprenorphine in every pharmacy and you may have to go to the clinic to get your medicine. Currently advocates are pushing for methadone and buprenorphine to be treated like any other prescription medications.
This article was provided by The Well Project. Visit The Well Project's Web site to learn more about their resources and initiatives for women living with HIV. The Well Project shares its content with TheBody.com to ensure all people have access to the highest quality treatment information available. The Well Project receives no advertising revenue from TheBody.com or the advertisers on this site. No advertiser on this site has any editorial input into The Well Project's content.
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