buprenorphine and Hepatitis-B

Care for opioid users changed greatly in France in 1996 when general practitioners (GP) were allowed to prescribe high-dose sublingual buprenorphine (Subutex((R))) for maintenance treatment of major opioid dependence. In order to evaluate treatment benefits, a prospective epidemiological 2-year follow-up was initiated in May 1996 with the participation of 105 French GPs.. A cohort of outpatient opioid users who started high-dose sublingual buprenorphine maintenance therapy at study onset or who had recently started were included in a prospective epidemiological study by GPs involved in management of drug abusers. Patients were followed for 2 years with collection of standardized information at 1, 3, 6, 12, and 24 months. The main evaluation criteria were follow-up by the same GP throughout the study and retention in the care system 2 years later. For patients who fulfilled these criteria, secondary end points were analyzed: information about buprenophine prescription, social status, and hepatitis B and C and HIV seroconversions.. The 101 GPs included 919 patients and 909 were analyzed 2 years later. At study onset, a majority of the patients (70.6%) were taking an ongoing maintenance treatment, 10.5% had previously received such a treatment and the treatment was initiated for 18.8%. At the end of the study, 508 patients (55.9%) were still being followed by the same GP and 101 (11.1%) were followed by another healthcare provider (another GP, hospital or specialized center). No information about the care giver was available for 82 patients (9%). Among the other patients, 123 (13.5%) were lost to follow-up, 24 (2.6%) had moved, 23 (2.6%) were incarcerated, 11 (1.2%) had successfully discontinued drug usage and 7 (0.8%) had died. Other reasons for unsuccessful follow-up by the same GP were mainly (for 6 patients each): relapse, switch to methadone, no medical information, non-compliance with scheduled controls. Among the patients followed by the same GP, declaration of heroin and drug intake significantly decreased (p<0.001), and social status (GAF scale) and TMSP evaluation significantly improved (p<0.001). The social situation (housing condition and work) also improved significantly (p<0.001). The rate of buprenorphine treatment was 84% with longer and less fractionated prescriptions. The HBV, HBC and HIV seroconversion rates were low in this high-risk population (2.7%, 4.1% and 0.8% respectively).. This two-year follow-up of 909 opioid users showed that nearly 70% of the patient remained within the healthcare system, mainly with the same GP or more rarely with another practitioner. Among the 508 patients still followed by the same GP, maintenance treatment with high-dose buprenorphine was observed in more than 80% of the patients. These patients had a significantly improved social status, a significant decrease in drug intake and a significant improvement in their social adaptation and severity of drug abuse.

Topics: Adult; Ambulatory Care; Buprenorphine; Drug Prescriptions; Employment; Family Practice; Female; Follow-Up Studies; France; Hepatitis B; Hepatitis C; HIV Infections; Housing; Humans; Male; Narcotics; Opioid-Related Disorders; Patient Compliance; Risk Factors; Severity of Illness Index; Socioeconomic Factors; Treatment Outcome

Evaluation of State Opioid Substitution Treatment OST (methadone and buprenorphine/naloxone- Addnok-N) program in Georgia and optimization of the routine measurement instrument. Patients were recruited from 4 Tbilisi and 5 regional State Programs in May-October 2013. 2 structured self-questionnaires (one - anonymous for sensitive questions) were developed for patients to assess demographics, retention in treatment, mean drug dose, HIV and Hepatitis C and B status, illicit drug and alcohol use, social activities, crime involvement, health status, HIV risk behavior, treatment compliance and satisfaction. 608 patients (7 females) were surveyed (512 - on Methadone, 96 - on buprenorphine/naloxone). 337 (1 female) patients completed an anonymous questionnaire. Mean age - 39.43±8.7 (21-65 years). 10 (1.64%) respondents were HIV positive; 448 (73.68%) - HCV+ and 24 (3.95%) - HBV+; average methadone dose - 39.27±22.2mg; buprenorphine/naloxone - 7.4±3.6 mg; 64 (40%) of employed began working while in program; 365 (60%) have been in treatment for less than 1 year, and 146 (24%) - for 1-3 years vs. 258 (51%) out of 506 patients surveyed in 2011. 494 (81.2%) reported improvement of social status and 508 (83.5%) - of health status. 305 (90.5%) out of 337 reported no- and 30 (8.9%) - reduction of criminal activity. 467 (76.81%) patients attended individual and 200 (32.9%)-group psychotherapy sessions with various frequencies. The common adverse events: sleep disturbances - 48.84%; weakness - 50.82%; mood disturbances - 42.44%, and heaviness - 36.35%. 257 (46%) reported using of alcohol; 16 - opioids; 29 - sedative/hypnotics; 8 - marijuana and 1 - ATS past 30 days; 55 - drug injection and 11 - sharing of any injection equipment past 6 months. State OST program is effective in Georgia in terms of reduction of illegal drug use, injection risk behavior and criminal activity, and on the other hand - improving of social activity and general health. Treatment retention is less as compared with 2011 survey.

Topics: Adult; Aged; Alcoholism; Buprenorphine; Female; Georgia (Republic); Government Programs; Hepatitis B; Hepatitis C; HIV Infections; Humans; Male; Methadone; Middle Aged; Naloxone; Opiate Substitution Treatment; Patient Compliance; Patient Satisfaction; Surveys and Questionnaires; Young Adult

The control of blood-borne infections including HIV and hepatitis C (HCV) amongst injecting drug users (IDUs) is a challenge for health authorities in Iran. Hence, more reliable estimates of the levels of blood-borne infections and their associated factors are critically needed.. Active IDUs were recruited using peer-driven sampling in a bio-behavioural survey in 2008. Over 8 weeks, data were collected from adults living in a city in Isfahan Province who had injected drugs in the past month. Participants provided a whole blood sample and answered questions on sexual and drug-related risk characteristics. Participants were provided post-test counselling and a non-monetary incentive for their participation. Excluding two inactive cases, the initial recruits resulted in 2-8 waves of recruitment.. Overall, 118 IDUs including three females participated. The estimated population proportions of HIV, hepatitis B, and HCV infections were 0.7% (95% CI, 0.6-2.3), 0.7% (95% CI, 0.1-2.1), and 59.4% (95% CI, 47.4-68.7), respectively. Responses indicated that 31% (95% CI, 20-44.5) of the IDUs ever shared a needle/syringe for drug injection, and 77% (95% CI, 65-84) had ever injected an addictive solution marketed widely as Temgesic. Multivariate analyses revealed that the high prevalence of HCV infection amongst IDUs is associated with the lifetime duration of drug injection (AOR, 1.17; 95% CI, 1.01-1.34) and with having injected Temgesic (AOR, 4.73; 95% CI, 1.52-14.69).. Our experience in Iran indicates that IDUs can be recruited effectively in a bio-behavioural survey through peer-driven sampling and using only a single primary incentive. The high prevalence of HCV associated with injecting Temgesic is important evidence for harm-reduction policies in Iran.

Topics: Adult; Buprenorphine; Data Collection; Female; Harm Reduction; Hepatitis B; Hepatitis C; HIV Infections; Humans; Iran; Male; Multivariate Analysis; Needle Sharing; Prevalence; Risk-Taking; Sexual Behavior; Substance Abuse, Intravenous; Young Adult

Considering the importance to public health and the frequency with which drug addicts are imprisoned, we studied the prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), as well as drug addiction of patients admitted to the Elsau prison in Strasbourg (France).. The prospective study included all entering inmates from 1 September to 31 October 1997 (270 persons) to whom HIV, HBV and HCV blood tests were offered as well as a questionnaire on their drug addiction.. Thirty-six percent of the entering inmates were drug addicts, of whom 1% were HIV positive, 11.2% HBV positive and 30% HCV positive, compared to, respectively, 0.6, 9.9 and 6.4% for non-drug addicts. Ninety-five of the 98 patients used several drugs, including buprenorphine for 53 patients. At the beginning of this study, buprenorphine had been available in France for 9 months.. The results are to be taken seriously regarding the misuse of this product in this selected population (intravenous use, multiple drug use, dealing).

Topics: Adult; Buprenorphine; Female; France; Hepacivirus; Hepatitis B; Hepatitis B virus; Hepatitis C; HIV Infections; Humans; Male; Middle Aged; Narcotics; Prisoners; Prospective Studies; Seroepidemiologic Studies; Substance-Related Disorders