MISUNDERTANDING AND MISREPRESENTING INSTITUTE OF MEDICINE REPORT ON IVDU TREATMENT

The very distinguished and respected journal Lancet editorialized on Sept. 30 (vol 368): “Intravenous drug use and HIV: evidence for action now.” First, Lancet incorrectly described methadone and buprenorphine as “opioid antagonists,” which they obviously are not. Of more substantive importance, however, is that the body of the editorial seems to water down the message embodied in its own title: “Evidence for action now”. Thus, it states that “…there is some evidence that continuous drug-dependence treatment protects against seroconversion … ”, while the IOM clearly and unequivocally concluded: ”Strong and consistent evidence from a number of well-designed, randomized controlled trials shows that opioid agonist maintenance treatment – including methadone and buprenorphine – is effective in reducing illicit opioid use … There is also strong evidence that this treatment reduces drug-related risk behavior.”

Furthermore, the unambiguous recommendations that flow from the IOM’s review are not consistent with Lancet’s call for “more robust studies” while nations “devise and implement multicomponent programmes that reflect their specific economic, cultural, and social circumstances.” The IOM conclusion reads very differently indeed; without mincing words, it states, “We do not end [the report] with ‘More research is needed.’ … We say instead, ‘Action is needed.’” Yes, indeed! How could Lancet have missed this clarion call?