title: Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior--outcomes of a randomized trial.
abstract: OBJECTIVE
  Determine the extent to which buprenorphine injectors continue treatment with buprenorphine-naloxone or methadone, and the impact of these treatments on substance use and HIV risk in the Republic of Georgia.
  
  
  METHODS
  Randomized controlled 12-week trial of daily-observed methadone or buprenorphine-naloxone followed by a dose taper, referral to ongoing treatment, and follow-up at week 20 at the Uranti Clinic in Tbilisi, Republic of Georgia. Eighty consenting treatment-seeking individuals (40/group) aged 25 and above who met ICD-10 criteria for opioid dependence with physiologic features and reported injecting buprenorphine 10 or more times in the past 30 days. Opioid use according to urine tests and self-reports, treatment retention, and HIV risk behavior as determined by the Risk Assessment Battery.
  
  
  RESULTS
  Mean age of participants was 33.7 (SD5.7), 4 were female, mean history of opioid injection use was 5.8 years (SD4.6), none were HIV+ at intake or at the 12-week assessment and 73.4% were HCV+. Sixty-eight participants (85%) completed the 12-week medication phase (33 from methadone and 35 from buprenorphine/naloxone group); 37 (46%) were in treatment at the 20-week follow-up (21 from methadone and 16 from the buprenorphine/naloxone group). In both study arms, treatment resulted in a marked reduction in unprescribed buprenorphine, other opioid use, and HIV injecting risk behavior with no clinically significant differences between the two treatment arms.
  
  
  CONCLUSIONS
  Daily observed methadone or buprenorphine-naloxone are effective treatments for non-medical buprenorphine and other opioid use in the Republic of Georgia and likely to be useful for preventing HIV infection.
authors.affiliation: Addiction Research Centre, Alternative Georgia, Tbilisi 0177, Georgia; Department of Psychiatry, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, 121 08 Prague, Czech Republic. Electronic address: dato@altgeorgia.ge.
authors.forename: David
authors.initials: D
authors.lastname: Otiashvili
authors.forename: Gvantsa
authors.initials: G
authors.lastname: Piralishvili
authors.forename: Zura
authors.initials: Z
authors.lastname: Sikharulidze
authors.forename: George
authors.initials: G
authors.lastname: Kamkamidze
authors.forename: Sabrina
authors.initials: S
authors.lastname: Poole
authors.forename: George E
authors.initials: GE
authors.lastname: Woody
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D015658:HIV Infections / Q000523:psychology* / Q000635:transmission; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D016485:Needle Sharing / Q000706:statistics & numerical data; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012309:Risk-Taking; D015813:Substance Abuse Detection; D015819:Substance Abuse, Intravenous / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D009294:Narcotics; D002047:Buprenorphine; D008691:Methadone
keywords: Buprenorphine abuse; Republic of Georgia; Treatment
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