title: Treatment of opioid use disorder in an innovative community-based setting after multiple treatment attempts in a woman with untreated HIV.
abstract: Opioid use disorder is associated with significant health and social harms. Various evidence-based interventions have proven successful in mitigating these harms, including harm reduction strategies and pharmacological treatment such as methadone. We present a case of a 35-year-old HIV-positive woman who was off antiretroviral therapy due to untreated opioid use disorder, and had a history of frequently self-discharging from hospital against medical advice. During the most recent hospital admission, the patient was transferred to an innovative community-based clinical support residence that supported harm reduction. Initially, she received methadone to only manage the withdrawal symptoms rather than for long-term maintenance therapy. However, with gradual dose increases to treat cravings and withdrawal, she ultimately discontinued all drug use and reinitiated antiretroviral therapy. This case highlights that patients whose goal is not abstinence can be successfully treated for acute medical illnesses and comorbid substance use disorders using harm reduction approaches, including appropriate dosing of pharmacotherapy.
authors.affiliation: Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, UBC, Vancouver, British Columbia, Canada Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Pauline
authors.identifier: http://orcid.org/0000-0003-4766-4296
authors.initials: P
authors.lastname: Voon
authors.affiliation: Department of Vancouver Community, Vancouver Coastal Health, Vancouver, British Columbia, Canada Faculty of Medicine, Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Ronald
authors.initials: R
authors.lastname: Joe
authors.affiliation: Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, UBC, Vancouver, British Columbia, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Fairgrieve
authors.affiliation: Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, UBC, Vancouver, British Columbia, Canada.
authors.forename: Keith
authors.initials: K
authors.lastname: Ahamad
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002170:Canada; D005260:Female; D015658:HIV Infections / Q000150:complications*; D040261:Harm Reduction; D006760:Hospitalization; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D058850:Opiate Substitution Treatment / Q000379:methods*; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy*
chemical_list: D000701:Analgesics, Opioid; D008691:Methadone