Methadone urged for AIDS fight in ex-Soviet states

By Andrei Khalip, Reuters, 26 Jul 2005

RIO DE JANEIRO, Brazil,- Russia and its neighbors should lift their ban on using opiates such as methadone to treat addicts who inject drugs, scientists at an international AIDS conference said on Monday.

"Methadone is essentially an AIDS prevention tool," said professor Chris Beyrer, founding director of the Center for Public Health and Human Rights at Johns Hopkins University in Baltimore.

Beyrer praised Russia for scrapping, starting this year, a measure barring drug users from participating in free AIDS treatment programs.

"This thrills us a lot. But they are still opposed to methadone use, which remains illegal there. They need to get as many people as possible off the needles," said Beyrer, calling the ban a legacy of the Soviet system.

Methadone is taken orally, avoiding the use of needles that can spread AIDS. This substitution therapy can help satisfy addicts' cravings while allowing them to function normally.

The World Health Organization recently recommended that the treatment be integrated into national HIV/AIDS programs. Another scientist at the Rio de Janeiro conference said Russia agreed to treat drug users with AIDS only because it was a condition attached to millions of dollars in foreign aid.

Others said AIDS screening figures from the region, with the exception of those from Ukraine, were not very reliable. Ukraine, which tops ex-Soviet states in the HIV incidence rate with 1.4 percent of the adult population infected, has a fledgling substitution therapy program.

But it recently upset anti-AIDS groups with a proposal to ban methadone. Researchers say actual rates in other former Soviet countries could be higher. In Russia, the rate is more than 1 percent.

"It's a relatively recent epidemic but it's fast-growing. It is just getting going," Beyrer said. Such fast-growing epidemics have never been seen in countries with declining populations, he added. Belarus, Ukraine, Russia and Kazakhstan are all losing people. "So the implications may be more severe as the disease infects mainly young people and there is already a shortage of them."

"All this is due to a rising tide of heroin, with injection infecting people almost exclusively. But next we'll have a lot to do with sexual patterns of drug users," Beyrer said. On a positive note, there was evidence that condom use was becoming the norm in Russia, at least among prostitutes, he said.

Source: ITPC eForum

Methadone comes of age, at last

by: HDN Key Correspondent Team
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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 about to break out of its shrouded history: Methadone is coming of age.

Significantly, and on the eve of the 7th ICAAP, the World Health Organization (WHO) announced that it had added methadone (and buprenorphine, a medicine with a similar clinical profile) to the WHO Model (Complementary) List of Essential Medicines - a roster of drugs endorsed by WHO, and recommended for basic use by health services throughout the world.
"This is important," said Dr Peter Piot, Executive Director of the United Nations Joint Programme on HIV/AIDS (UNAIDS). "Nations who want to provide methadone in their programmes will now have easier access."

Between 5 and 10% of the world's HIV infections are reportedly due to injection drug use and represent a much higher proportion 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 using drugs such as methadone, 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 infection.

In their position paper Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention, the WHO, the United Nations Office on Drugs and Crime (UNODC) and UNAIDS stated 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 therapy also provides opportunities for early diagnosis of other health problems, HIV, tuberculosis, hepatitis and counselling and testing, as well as referral for additional services. It is arguably the most effective, and cost-effective, treatment option for injection drug users, and brings them into contact with various other services within the health system.

According to several 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.

IDUs who do not enter methadone treatment are thought to be up to six times more likely to become infected with HIV than injectors who enter and remain in treatment.

Substitution therapy is not a stand-alone solution, however. Another new UNAIDS policy position paper 'Intensifying HIV Prevention', also endorsed by the agency's governing body just days before the ICAAP congress, lists various essential programmatic approaches to reduce HIV acquisition and transmission among drug users. They include voluntary, confidential HIV testing and counselling, prevention of sexual transmission of HIV among drug users, access to primary healthcare, and access to antiretroviral therapy.

HDN Key Correspondent Team
Email: correspondents@hdnet.org
(July 2005)