Buprenorphine use: the international experience.
The confluence of the heroin injection epidemic and the human immunodeficiency virus (HIV) infection epidemic has increased the call for expanded access to effective treatments for both conditions. Buprenorphine and methadone are now listed on the World Health Organization's Model Essential Drugs List. In France, which has the most extensive experience, buprenorphine has been associated with a dramatic decrease in deaths due to overdose, and buprenorphine diversion appears to be associated with inadequate dosage, social vulnerability, and prescriptions from multiple providers. Other treatment models (in the United States, Australia, Germany, and Italy) and buprenorphine use in specific populations are also reviewed in the present article. In countries experiencing a dual epidemic of heroin use and HIV infection, such as former states of the Soviet Union and other eastern European and Asian countries, access to buprenorphine and methadone may be one potential tool for reducing the spread of HIV infection among injection drug users and for better engaging them in medical care.
Carrieri
Maria Patrizia
MP
INSERM U379, Marseilles, France. Pmcarrieri@aol.com
Amass
Leslie
L
Lucas
Gregory M
GM
Vlahov
David
D
Wodak
Alex
A
Woody
George E
GE
D023241:Antiretroviral Therapy, Highly Active; D002047:Buprenorphine / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006556:Heroin Dependence / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007391:International Cooperation; D008297:Male; D008691:Methadone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D018579:Patient Selection; D011787:Quality of Health Care; D018570:Risk Assessment; D015819:Substance Abuse, Intravenous / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016896:Treatment Outcome; D014944:World Health Organization
D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone