Expanding opioid agonist therapy while learning from HIV/AIDS

Accessing opioid agonist therapy (OAT) and maintaining good adherence faces many barriers which can be geographical, financial, regulatory, situational or logistic. This post elaborates on the ideas from a recent freely-available commentary published in the journal Addiction.

In some settings, lack of services hinders access to treatment for people living with opioid use disorder (OUD). In other settings—even where health‐care and medications are provided free of charge—many people who have OUD do not seek OAT. In the United States, recent ‘estimates suggest a gap between treatment need and capacity of 1.4 and 1.3 million in 2012, respectively’ [4]. The ongoing epidemic of OUD needs to develop strategies to recruit and keep patients on OAT.

Approaches described in the HIV/AIDS literature may be useful to improve rates of access and treatment retention. For instance, a 2017 meta‐analysis showed that HIV testing uptake escalated after social media interventions and even more in the studies where social media interventions were ‘participatory’ [5]. Future research on OAT uptake could therefore assess the merit of using them to enhance OUD diagnosis in primary and specialty care settings (e.g. pain clinics).

We also often fail to identify OUD because of stigma. This is another important area where HIV/AIDS research documented a strong association with medication adherence [6]. Health‐care provider education could therefore employ strategies to reduce stigmatizing beliefs that may influence adherence.

Read the full story in the journal Addiction
Cited study: Klimas, J., Wood, E., McCracken, R. (2020) Commentary on Jin et al. Expanding the impact of opioid agonist therapy for opioid use disorder – Are there lessons from the HIV/AIDS response? Addiction. doi: 10.1111/ADD.15286

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1 Jin H.Marshall B. D. L.Degenhardt L.Strang J.Hickman M.Fiellin D. A.et alGlobal opioid agonist treatment: a review of clinical practices by countryAddiction 20201152243– 2254.

2 Wakeman S. E. Diagnosis and treatment of opioid use disorder in 2020JAMA 20203232082– 2083.

3 Sordo L.Barrio G.Bravo M. J.Iciar Indave B.Degenhardt L.Wieissing L.et alMortality risk during and after opioid substitution treatment: systematic review and meta‐analysis of cohort studiesBMJ 2017357: j1550.

4 Jones C. M.Campopiano M.Baldwin G.McCance‐Katz E. National and state treatment need and capacity for opioid agonist medication‐assisted treatmentAm J Public Health 2015105e55– e63.

5 Cao B.Gupta S.Wang J.Hightow‐Weidman L. B.Muessig K. E.Tang W.et alSocial media interventions to promote HIV testing, linkage, adherence, and retention: systematic review and meta‐analysisJ Med Internet Res 201719: e394.

6 Sweeney S. M.Vanable P. A. The association of HIV‐related stigma to HIV medication adherence: a systematic review and synthesis of the literatureAIDS Behav 20162029– 50.

7 Amankwaa I.Boateng D.Quansah D. Y.Akuoko C. P.Evans C. Effectiveness of short message services and voice call interventions for antiretroviral therapy adherence and other outcomes: a systematic review and meta‐analysisPLOS ONE 201813: e0204091.