Methadone comes of age – almost...
by HDN Key Correspondent
April 2005
(Cross-posted from the SEA-AIDS eForum)
Moderators’ note: Given a wealth of evidence demonstrating the effectiveness of substitution therapy, including its role in reducing the spread of HIV transmission rates among drug users, it is worrying that the highly anticipated announcement by the World Health Organization (WHO) to include methadone in its Essential Drug List (EDL) has not yet been made. This is despite an apparent agreement by the relevant WHO committee weeks ago.
The EDL is the advisory list that WHO gives to all governments about the basic drugs that their health workers should have available.
Why has the announcement been so delayed? There are suggestions circulating in the international media that the WHO is being pressured by the US government over the new EDL recommendations. With the ‘abortion pills’ mifepristone and misoprostol also on the new EDL list of recommended drugs, however, it is not clear if current US pressure and resulting delay even relates to methadone.
If it does, however, it is vital that the WHO Director-General (DG), Dr LEE Jong-wook, stands by not only WHO’s own process for identifying medicines to be added to the EDL, but also the evidence that methadone is a critical and life-saving treatment option for drugs users throughout the world.
Endorsement of the recommendations of the WHO Expert committee on essential medicines (March 2005) by the WHO DG will be consistent with and support the various positions taken by the WHO, the United Nations Office on Drugs and Crime and the Joint United Nations Programme on HIV/AIDS in their recent joint position paper on substitution therapy.
We had hoped to use an outline of that inter-agency position paper on substitution therapy (see below) to help highlight the methadone/EDL announcement when it was made. In light of the current delay in an EDL announcement, it may be even more important to share that summary now.
**************
Methadone comes of age – almost...
HDN Key Correspondent
April 2005
**********
“PROVIDING PHARMACOTHERAPY TO HIV POSITIVE INJECTION DRUG USERS CAN MINIMIZE THE RISK OF FURTHER TRANSMISSION OF THE VIRUS AND STABLIZR THE UNDERLYING CONDITION” [WHO]
Imagine there was a simple, effective and affordable medicine that could reduce the death rate among people who use drugs such as heroin by about two-thirds. Fat chance? Now imagine that medicine does exist, but that because of a reluctance on the part of policy-makers and government officials, it was not widely available in many countries. Hard to believe? Dream no more. The medicine exists and is hopefully about to break out of its shrouded history: methadone is coming of age.
Between 5 and 10% of the world’s HIV infections are reportedly due to injection drug use. The figure may rise to as high as 70% of HIV transmission in some countries – in Asia and Europe in particular. Injection drug use is also now the predominant mode of transmission of hepatitis C virus throughout the world.
Due to the unregulated nature of illicit substances, injection drug users often use drugs of unknown potency and quality, which can frequently lead to overdoses. It is estimated that approximately 2–3% of injection drug users die each year, resulting in a mortality rate for heroin users, for example, of between six and twenty times that seen among those in the general population of the same age and sex.
Substitution therapy is a treatment approach that helps opioid drug users (e.g. Heroin) to reduce the withdrawal symptoms and craving when drug use is stopped or reduced. Methadone is one of the oral medications used for substitution therapy. Because users taking methadone are far less likely to inject drugs, it also has a significant impact on reducing their risk of HIV injection.
In their recent position paper Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, the World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) state that opioid “drug dependence treatment is an important strategy to improve well-being and social functioning of people with opioid dependence and to reduce its health and social consequences, including HIV infection.”
Participation in substitution maintenance therapy also provides opportunities for early diagnosis of other health problems, HIV, Tuberculosis, Hepatitis and STD counselling and testing, as well as referral for additional services. It is arguably the most effective, cost effective treatment option for injection drug users, and brings them into contact with various other services within the health system.
The UN paper further enlightens that “methadone maintenance therapy is correlated with reduction in HIV risk behaviours related to drug-taking, or an increase in protective behaviours.” According to WHO, “IDUs who do not enter [methadone] treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment.”
“The death rate for people with opioid dependence in methadone maintenance treatment is one-third to one-quarter the rate for those not in treatment.”
According to several conservative estimates, every dollar invested in opioid dependence treatment programmes may yield a return of between $4 and $7 in reduced drug-related crime, criminal justice costs and theft alone. When savings related to health care are included, total savings can exceed substitution therapy costs by a ratio of twelve to one.
The UN position paper concludes that because substitution therapy (also known as pharmacotherapy) has proven effective in terms of promoting retention of users in treatment, reduction of drug use, improvements of drug users’ psychological and social functioning, as well as reduction of risk-associated injecting and sexual behaviours, it should be given serious consideration both as an HIV prevention measure, and as a treatment measure for individuals with opioid dependence who are already infected with HIV.
“Programmes that combine pharmacotherapy with HIV/AIDS treatment and care should be encouraged as directly observed pharmacotherapy also provides an opportunity for directly observed antiretroviral therapy, as well as therapy for opportunistic infections such as tuberculosis,” the paper states.
“Individuals with opioid dependence benefit from substitution maintenance therapy through increased stability and improved well-being and social functioning. People receiving substitution therapy can make significant progress in their physical and emotional life, as well as in their relationships with others and their ability to contribute meaningfully to their community and society at large.”
HDN Key Correspondent
Email: Correspondents@hdnet.org
April 2005
(Cross-posted from the SEA-AIDS eForum)
Moderators’ note: Given a wealth of evidence demonstrating the effectiveness of substitution therapy, including its role in reducing the spread of HIV transmission rates among drug users, it is worrying that the highly anticipated announcement by the World Health Organization (WHO) to include methadone in its Essential Drug List (EDL) has not yet been made. This is despite an apparent agreement by the relevant WHO committee weeks ago.
The EDL is the advisory list that WHO gives to all governments about the basic drugs that their health workers should have available.
Why has the announcement been so delayed? There are suggestions circulating in the international media that the WHO is being pressured by the US government over the new EDL recommendations. With the ‘abortion pills’ mifepristone and misoprostol also on the new EDL list of recommended drugs, however, it is not clear if current US pressure and resulting delay even relates to methadone.
If it does, however, it is vital that the WHO Director-General (DG), Dr LEE Jong-wook, stands by not only WHO’s own process for identifying medicines to be added to the EDL, but also the evidence that methadone is a critical and life-saving treatment option for drugs users throughout the world.
Endorsement of the recommendations of the WHO Expert committee on essential medicines (March 2005) by the WHO DG will be consistent with and support the various positions taken by the WHO, the United Nations Office on Drugs and Crime and the Joint United Nations Programme on HIV/AIDS in their recent joint position paper on substitution therapy.
We had hoped to use an outline of that inter-agency position paper on substitution therapy (see below) to help highlight the methadone/EDL announcement when it was made. In light of the current delay in an EDL announcement, it may be even more important to share that summary now.
**************
Methadone comes of age – almost...
HDN Key Correspondent
April 2005
**********
“PROVIDING PHARMACOTHERAPY TO HIV POSITIVE INJECTION DRUG USERS CAN MINIMIZE THE RISK OF FURTHER TRANSMISSION OF THE VIRUS AND STABLIZR THE UNDERLYING CONDITION” [WHO]
Imagine there was a simple, effective and affordable medicine that could reduce the death rate among people who use drugs such as heroin by about two-thirds. Fat chance? Now imagine that medicine does exist, but that because of a reluctance on the part of policy-makers and government officials, it was not widely available in many countries. Hard to believe? Dream no more. The medicine exists and is hopefully about to break out of its shrouded history: methadone is coming of age.
Between 5 and 10% of the world’s HIV infections are reportedly due to injection drug use. The figure may rise to as high as 70% of HIV transmission in some countries – in Asia and Europe in particular. Injection drug use is also now the predominant mode of transmission of hepatitis C virus throughout the world.
Due to the unregulated nature of illicit substances, injection drug users often use drugs of unknown potency and quality, which can frequently lead to overdoses. It is estimated that approximately 2–3% of injection drug users die each year, resulting in a mortality rate for heroin users, for example, of between six and twenty times that seen among those in the general population of the same age and sex.
Substitution therapy is a treatment approach that helps opioid drug users (e.g. Heroin) to reduce the withdrawal symptoms and craving when drug use is stopped or reduced. Methadone is one of the oral medications used for substitution therapy. Because users taking methadone are far less likely to inject drugs, it also has a significant impact on reducing their risk of HIV injection.
In their recent position paper Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, the World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) state that opioid “drug dependence treatment is an important strategy to improve well-being and social functioning of people with opioid dependence and to reduce its health and social consequences, including HIV infection.”
Participation in substitution maintenance therapy also provides opportunities for early diagnosis of other health problems, HIV, Tuberculosis, Hepatitis and STD counselling and testing, as well as referral for additional services. It is arguably the most effective, cost effective treatment option for injection drug users, and brings them into contact with various other services within the health system.
The UN paper further enlightens that “methadone maintenance therapy is correlated with reduction in HIV risk behaviours related to drug-taking, or an increase in protective behaviours.” According to WHO, “IDUs who do not enter [methadone] treatment are up to six times more likely to become infected with HIV than injectors who enter and remain in treatment.”
“The death rate for people with opioid dependence in methadone maintenance treatment is one-third to one-quarter the rate for those not in treatment.”
According to several conservative estimates, every dollar invested in opioid dependence treatment programmes may yield a return of between $4 and $7 in reduced drug-related crime, criminal justice costs and theft alone. When savings related to health care are included, total savings can exceed substitution therapy costs by a ratio of twelve to one.
The UN position paper concludes that because substitution therapy (also known as pharmacotherapy) has proven effective in terms of promoting retention of users in treatment, reduction of drug use, improvements of drug users’ psychological and social functioning, as well as reduction of risk-associated injecting and sexual behaviours, it should be given serious consideration both as an HIV prevention measure, and as a treatment measure for individuals with opioid dependence who are already infected with HIV.
“Programmes that combine pharmacotherapy with HIV/AIDS treatment and care should be encouraged as directly observed pharmacotherapy also provides an opportunity for directly observed antiretroviral therapy, as well as therapy for opportunistic infections such as tuberculosis,” the paper states.
“Individuals with opioid dependence benefit from substitution maintenance therapy through increased stability and improved well-being and social functioning. People receiving substitution therapy can make significant progress in their physical and emotional life, as well as in their relationships with others and their ability to contribute meaningfully to their community and society at large.”
HDN Key Correspondent
Email: Correspondents@hdnet.org
posted by AIDS-Care-Watch at 12:52 pm
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