STAGE 5. Defining the action plan
What steps should be completed?
Step 1: Specify intervention actions
This type of programs are both a form of reduction of the harm associated with the use of opiates (mainly heroin), and a type of treatment of this form of drug dependence. See
There is clear evidence that opioid (methadone or buprenorphine) substitution therapy reduces risk behaviors and infection in relation to HIV, the sharing of injection material and unsafe sexual practices, among others1,2.
On the other hand, there is strong evidence to support that methadone substitution therapy reduces mortality among opiate drug users1,3, including those of the prison population4. In this population, in addition, methadone maintenance programmes can reduce drug use and injection behavior in penal institutions, as well as readmission rates in prison5.
In addition, opioid substitution treatments improve antiretroviral therapy in HIV-positive opiate users6, helps to reduce hepatitis C transmission7 and when combined with the syringe exchange programmes they also help to reduce the incidence of infections by the HIV8.
References:
1 Mattick RP, Breen C, Kimber J & Davoli M. (2009). Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence (Review). The Cochrane Collaboration, Issue 3.
2 Gowing L et al. (2011). Oral substitution treatment of injecting opioid users for prevention of HIV infection (Review). The Cochrane Collaboration, Issue 8. 2011.
3 Bargagli A et al. (2007). A Systematic Review of Observational Studies on Treatment of Opioid Dependence. WHO Guidelines for psychosocially assisted pharmacotherapy of opioid dependence. Geneva: WHO.
4 Dolan K et al (2006). Four-year follow-up of imprisoned male heroin users and methadone treatment: mortality, re-incarceration and hepatitis C infection. Addiction. 100: 820–828.
5 Stallwitz A & Stover H. (2007). The impact of substitution treatment in Prisons. A literature review. International Journal of Drug Policy. 18: 464–474.
6 Craine N et al (2009). Incidence of hepatitis C in drug injectors: the role of homelessness, opiate substitution treatment, equipment sharing, and community size. Epidemiology and Infection. 137: 1255-1265.
7 Wright N & Tompkins CH. (2006). A review of the evidence for the effectiveness of primary prevention interventions for hepatitis C among injecting drug users. Harm Reduction Journal. 3:27.
8 Turner KM et al. (2011). The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 106: 1978-1988.
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