HIV RISK BEHAVIOR COMPARED AMONG THOSE ASSIGNED TO VARIOUS AGONIST MEDICATIONS FOR OPIATE DEPENDENCE

The letter below was submitted to the Editor of the Journal Substance Abuse Treatment some 3-4 months ago, with a follow-up request for response - but no acknowledgement was forthcoming. It's blogged at this time for the possible interest of blog viewers.

The article by Lott and co-authors (1) presents data from a study carried out in 1996-97 in which HIV risk behaviors were compared among subjects assigned to various agonist medications for opiate dependence. One out of four subjects was given “…a fixed daily dose of 20 mg of METH [i.e., methadone] and served as a control group.” Seven years before the trial commenced the then-Director of the National Institute on Drug Abuse had stated, "...in this age of AIDS, a low dose policy is not simply inappropriate, but can be fatal to the IV drug abuser in treatment as well as his or her sexual partners and children." (2) It is difficult to comprehend the rationale for unnecessarily subjecting people to a potentially fatal outcome, even during the course of a study of limited duration and even with provision (when it’s not too late!) for “therapeutic rescue.”

References

1. Lott, D.C., Strain, E.C., Brooner, R.K., Bigelow, G.E. & Johnson, R.E. (2006). HIV risk behaviors during pharmacologic treatmenty for opioid dependence: A comparison of leomethadyl acetate hydrochloride, buprenorphine, and methadone. J Subst Ab Treatm 31, 187-194

2. Schuster, C.R. (1989). Methadone Maintenance - An adequate dose is vital in checking the spread of AIDS. NIDA Notes. Spring/Summer, p. 3