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Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS
ABSTRACT Aims Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries....
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Published in: | Addiction (Abingdon, England) England), 2008-09, Vol.103 (9), p.1484-1492 |
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creator | Lawrinson, Peter Ali, Robert Buavirat, Aumphornpun Chiamwongpaet, Sithisat Dvoryak, Sergey Habrat, Boguslaw Jie, Shi Mardiati, Ratna Mokri, Azarakhsh Moskalewicz, Jacek Newcombe, David Poznyak, Vladimir Subata, Emilis Uchtenhagen, Ambrose Utami, Diah S. Vial, Robyn Zhao, Chengzheng |
description | ABSTRACT
Aims Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.
Design Longitudinal cohort study.
Setting Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
Participants Seven hundred and twenty‐six OST entrants.
Measurements Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood‐borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.
Findings Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.
Conclusions OST can achieve similar outcomes consistently in a culturally diverse range of settings in low‐ and middle‐income countries to those reported widely in high‐income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment. |
doi_str_mv | 10.1111/j.1360-0443.2008.02249.x |
format | article |
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Aims Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.
Design Longitudinal cohort study.
Setting Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
Participants Seven hundred and twenty‐six OST entrants.
Measurements Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood‐borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.
Findings Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.
Conclusions OST can achieve similar outcomes consistently in a culturally diverse range of settings in low‐ and middle‐income countries to those reported widely in high‐income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.</description><identifier>ISSN: 0965-2140</identifier><identifier>EISSN: 1360-0443</identifier><identifier>DOI: 10.1111/j.1360-0443.2008.02249.x</identifier><identifier>PMID: 18636999</identifier><identifier>CODEN: ADICE5</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>Acquired immune deficiency syndrome ; Addiction ; Adolescent ; Adult ; Aged ; AIDS ; Asia ; Australia ; Buprenorphine - administration & dosage ; Care and treatment ; Cross-national analysis ; Developing Countries ; Developing nations ; Drug addiction ; Drug addicts ; Eastern Europe ; Female ; HIV ; HIV Infections - complications ; Human immunodeficiency virus ; Humans ; Intravenous drug addicts ; Iran ; LDCs ; longitudinal ; Longitudinal studies ; Male ; Medical treatment ; Methadone ; Methadone - administration & dosage ; Middle Aged ; multi-site study ; Narcotics ; Narcotics - administration & dosage ; Offenders ; opioid substitution therapy ; Opioid-Related Disorders - complications ; Opioid-Related Disorders - rehabilitation ; Public health ; Risk behaviour ; Risk Factors ; Social problems ; Substance abuse treatment ; treatment evaluation ; Treatment Outcome ; treatment outcomes ; World Health Organization</subject><ispartof>Addiction (Abingdon, England), 2008-09, Vol.103 (9), p.1484-1492</ispartof><rights>2008 World Health Organization</rights><rights>Journal compilation © 2008 Society for the Study of Addiction</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5819-3df3efd31b25fbf7e06a0f8aae8c795b9786b3fc233e76cc12b4284dce0ead753</citedby><cites>FETCH-LOGICAL-c5819-3df3efd31b25fbf7e06a0f8aae8c795b9786b3fc233e76cc12b4284dce0ead753</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27865,27924,27925,31000,33223,33224</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18636999$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lawrinson, Peter</creatorcontrib><creatorcontrib>Ali, Robert</creatorcontrib><creatorcontrib>Buavirat, Aumphornpun</creatorcontrib><creatorcontrib>Chiamwongpaet, Sithisat</creatorcontrib><creatorcontrib>Dvoryak, Sergey</creatorcontrib><creatorcontrib>Habrat, Boguslaw</creatorcontrib><creatorcontrib>Jie, Shi</creatorcontrib><creatorcontrib>Mardiati, Ratna</creatorcontrib><creatorcontrib>Mokri, Azarakhsh</creatorcontrib><creatorcontrib>Moskalewicz, Jacek</creatorcontrib><creatorcontrib>Newcombe, David</creatorcontrib><creatorcontrib>Poznyak, Vladimir</creatorcontrib><creatorcontrib>Subata, Emilis</creatorcontrib><creatorcontrib>Uchtenhagen, Ambrose</creatorcontrib><creatorcontrib>Utami, Diah S.</creatorcontrib><creatorcontrib>Vial, Robyn</creatorcontrib><creatorcontrib>Zhao, Chengzheng</creatorcontrib><title>Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS</title><title>Addiction (Abingdon, England)</title><addtitle>Addiction</addtitle><description>ABSTRACT
Aims Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.
Design Longitudinal cohort study.
Setting Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
Participants Seven hundred and twenty‐six OST entrants.
Measurements Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood‐borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.
Findings Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.
Conclusions OST can achieve similar outcomes consistently in a culturally diverse range of settings in low‐ and middle‐income countries to those reported widely in high‐income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.</description><subject>Acquired immune deficiency syndrome</subject><subject>Addiction</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>AIDS</subject><subject>Asia</subject><subject>Australia</subject><subject>Buprenorphine - administration & dosage</subject><subject>Care and treatment</subject><subject>Cross-national analysis</subject><subject>Developing Countries</subject><subject>Developing nations</subject><subject>Drug addiction</subject><subject>Drug addicts</subject><subject>Eastern Europe</subject><subject>Female</subject><subject>HIV</subject><subject>HIV Infections - complications</subject><subject>Human immunodeficiency virus</subject><subject>Humans</subject><subject>Intravenous drug addicts</subject><subject>Iran</subject><subject>LDCs</subject><subject>longitudinal</subject><subject>Longitudinal studies</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Methadone</subject><subject>Methadone - administration & dosage</subject><subject>Middle Aged</subject><subject>multi-site study</subject><subject>Narcotics</subject><subject>Narcotics - administration & dosage</subject><subject>Offenders</subject><subject>opioid substitution therapy</subject><subject>Opioid-Related Disorders - complications</subject><subject>Opioid-Related Disorders - rehabilitation</subject><subject>Public health</subject><subject>Risk behaviour</subject><subject>Risk Factors</subject><subject>Social problems</subject><subject>Substance abuse treatment</subject><subject>treatment evaluation</subject><subject>Treatment Outcome</subject><subject>treatment outcomes</subject><subject>World Health Organization</subject><issn>0965-2140</issn><issn>1360-0443</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>8BJ</sourceid><sourceid>7QJ</sourceid><sourceid>7TQ</sourceid><recordid>eNqNks1v0zAYxiMEYt3gX0AWB27p_JH448ChatlaMbEDg0lcLCd-w1zaONgJtP_9HFoNiUvxxbb8ex7Jz_NmGSJ4StK6XE8J4zjHRcGmFGM5xZQWarp7lk2eHp5nE6x4mVNS4LPsPMY1xlhIVbzMzojkjCulJtnDR9ijxrXWtd8jaoLfov4B0P3yFtV-szGVD6Z3vwDFfrB75FsUhyr2rh96ly6JDaZLDj4g3znvLLLQQWuhrQGZ1qLl6uvlbLX4_Cp70ZhNhNfH_SL7cvXhbr7Mb26vV_PZTV6Xkqic2YZBYxmpaNlUjQDMDW6kMSBrocpKCckr1tSUMRC8rgmtCioLWwMGY0XJLrJ3B98u-J8DxF5vXawhfaUFP0RdSpkCofQ0KJIvEewkmJLkhaLFSZAojjHHIoFv_wHXfghtiiUxquQF5ThB8gDVwccYoNFdcFsT9ppgPU6BXuuxbD2Wrccp0H-mQO-S9M3Rf6i2YP8Kj7Un4P0B-O02sP9vYz1bLMZT0ucHvYs97J70JvzQXDBR6vtP13r-TZGrhbjTkj0ClfDO8Q</recordid><startdate>200809</startdate><enddate>200809</enddate><creator>Lawrinson, Peter</creator><creator>Ali, Robert</creator><creator>Buavirat, Aumphornpun</creator><creator>Chiamwongpaet, Sithisat</creator><creator>Dvoryak, Sergey</creator><creator>Habrat, Boguslaw</creator><creator>Jie, Shi</creator><creator>Mardiati, Ratna</creator><creator>Mokri, Azarakhsh</creator><creator>Moskalewicz, Jacek</creator><creator>Newcombe, David</creator><creator>Poznyak, Vladimir</creator><creator>Subata, Emilis</creator><creator>Uchtenhagen, Ambrose</creator><creator>Utami, Diah S.</creator><creator>Vial, Robyn</creator><creator>Zhao, Chengzheng</creator><general>Blackwell Publishing Ltd</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QG</scope><scope>7TK</scope><scope>8BJ</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7U9</scope><scope>H94</scope><scope>7QJ</scope><scope>7TQ</scope><scope>DHY</scope><scope>DON</scope></search><sort><creationdate>200809</creationdate><title>Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS</title><author>Lawrinson, Peter ; Ali, Robert ; Buavirat, Aumphornpun ; Chiamwongpaet, Sithisat ; Dvoryak, Sergey ; Habrat, Boguslaw ; Jie, Shi ; Mardiati, Ratna ; Mokri, Azarakhsh ; Moskalewicz, Jacek ; Newcombe, David ; Poznyak, Vladimir ; Subata, Emilis ; Uchtenhagen, Ambrose ; Utami, Diah S. ; Vial, Robyn ; Zhao, Chengzheng</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5819-3df3efd31b25fbf7e06a0f8aae8c795b9786b3fc233e76cc12b4284dce0ead753</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Acquired immune deficiency syndrome</topic><topic>Addiction</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>AIDS</topic><topic>Asia</topic><topic>Australia</topic><topic>Buprenorphine - administration & dosage</topic><topic>Care and treatment</topic><topic>Cross-national analysis</topic><topic>Developing Countries</topic><topic>Developing nations</topic><topic>Drug addiction</topic><topic>Drug addicts</topic><topic>Eastern Europe</topic><topic>Female</topic><topic>HIV</topic><topic>HIV Infections - complications</topic><topic>Human immunodeficiency virus</topic><topic>Humans</topic><topic>Intravenous drug addicts</topic><topic>Iran</topic><topic>LDCs</topic><topic>longitudinal</topic><topic>Longitudinal studies</topic><topic>Male</topic><topic>Medical treatment</topic><topic>Methadone</topic><topic>Methadone - administration & dosage</topic><topic>Middle Aged</topic><topic>multi-site study</topic><topic>Narcotics</topic><topic>Narcotics - administration & dosage</topic><topic>Offenders</topic><topic>opioid substitution therapy</topic><topic>Opioid-Related Disorders - complications</topic><topic>Opioid-Related Disorders - rehabilitation</topic><topic>Public health</topic><topic>Risk behaviour</topic><topic>Risk Factors</topic><topic>Social problems</topic><topic>Substance abuse treatment</topic><topic>treatment evaluation</topic><topic>Treatment Outcome</topic><topic>treatment outcomes</topic><topic>World Health Organization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lawrinson, Peter</creatorcontrib><creatorcontrib>Ali, Robert</creatorcontrib><creatorcontrib>Buavirat, Aumphornpun</creatorcontrib><creatorcontrib>Chiamwongpaet, Sithisat</creatorcontrib><creatorcontrib>Dvoryak, Sergey</creatorcontrib><creatorcontrib>Habrat, Boguslaw</creatorcontrib><creatorcontrib>Jie, Shi</creatorcontrib><creatorcontrib>Mardiati, Ratna</creatorcontrib><creatorcontrib>Mokri, Azarakhsh</creatorcontrib><creatorcontrib>Moskalewicz, Jacek</creatorcontrib><creatorcontrib>Newcombe, David</creatorcontrib><creatorcontrib>Poznyak, Vladimir</creatorcontrib><creatorcontrib>Subata, Emilis</creatorcontrib><creatorcontrib>Uchtenhagen, Ambrose</creatorcontrib><creatorcontrib>Utami, Diah S.</creatorcontrib><creatorcontrib>Vial, Robyn</creatorcontrib><creatorcontrib>Zhao, Chengzheng</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Animal Behavior Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Applied Social Sciences Index & Abstracts (ASSIA)</collection><collection>PAIS Index</collection><collection>PAIS International</collection><collection>PAIS International (Ovid)</collection><jtitle>Addiction (Abingdon, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lawrinson, Peter</au><au>Ali, Robert</au><au>Buavirat, Aumphornpun</au><au>Chiamwongpaet, Sithisat</au><au>Dvoryak, Sergey</au><au>Habrat, Boguslaw</au><au>Jie, Shi</au><au>Mardiati, Ratna</au><au>Mokri, Azarakhsh</au><au>Moskalewicz, Jacek</au><au>Newcombe, David</au><au>Poznyak, Vladimir</au><au>Subata, Emilis</au><au>Uchtenhagen, Ambrose</au><au>Utami, Diah S.</au><au>Vial, Robyn</au><au>Zhao, Chengzheng</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS</atitle><jtitle>Addiction (Abingdon, England)</jtitle><addtitle>Addiction</addtitle><date>2008-09</date><risdate>2008</risdate><volume>103</volume><issue>9</issue><spage>1484</spage><epage>1492</epage><pages>1484-1492</pages><issn>0965-2140</issn><eissn>1360-0443</eissn><coden>ADICE5</coden><abstract>ABSTRACT
Aims Opioid substitution treatment has been studied extensively in industrialized countries, but there are relatively few studies in developing/transitional countries. The aim of this study was to examine the effectiveness of opioid substitution treatment (OST) in less resourced countries.
Design Longitudinal cohort study.
Setting Purposively selected OST sites in Asia (China, Indonesia, Thailand), Eastern Europe (Lithuania, Poland, Ukraine), the Middle East (Iran) and Australia.
Participants Seven hundred and twenty‐six OST entrants.
Measurements Participants were interviewed at treatment entry, 3 and 6 months. Standardized instruments assessed drug use, treatment history, physical and psychological health, quality of life, criminal involvement, blood‐borne virus (BBV) risk behaviours and prevalence of human immunodeficiency virus (HIV) and hepatitis C.
Findings Participants were predominantly male, aged in their early 30s and had attained similar levels of education. Seroprevalence rates for HIV were highest in Thailand (52%), followed by Indonesia (28%) and Iran (26%), and lowest in Australia (2.6%). Treatment retention at 6 months was uniformly high, averaging approximately 70%. All countries demonstrated significant and marked reductions in reported heroin and other illicit opioid use; HIV (and other BBV) exposure risk behaviours associated with injection drug users (IDU) and criminal activity, and demonstrated substantial improvement in their physical and mental health and general wellbeing over the course of the study.
Conclusions OST can achieve similar outcomes consistently in a culturally diverse range of settings in low‐ and middle‐income countries to those reported widely in high‐income countries. It is associated with a substantial reduction in HIV exposure risk associated with IDU across nearly all the countries. Results support the expansion of opioid substitution treatment.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>18636999</pmid><doi>10.1111/j.1360-0443.2008.02249.x</doi><tpages>9</tpages></addata></record> |
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source | Applied Social Sciences Index & Abstracts (ASSIA); International Bibliography of the Social Sciences (IBSS); Wiley:Jisc Collections:Wiley Read and Publish Open Access 2024-2025 (reading list); EBSCOhost SPORTDiscus with Full Text; PAIS Index |
subjects | Acquired immune deficiency syndrome Addiction Adolescent Adult Aged AIDS Asia Australia Buprenorphine - administration & dosage Care and treatment Cross-national analysis Developing Countries Developing nations Drug addiction Drug addicts Eastern Europe Female HIV HIV Infections - complications Human immunodeficiency virus Humans Intravenous drug addicts Iran LDCs longitudinal Longitudinal studies Male Medical treatment Methadone Methadone - administration & dosage Middle Aged multi-site study Narcotics Narcotics - administration & dosage Offenders opioid substitution therapy Opioid-Related Disorders - complications Opioid-Related Disorders - rehabilitation Public health Risk behaviour Risk Factors Social problems Substance abuse treatment treatment evaluation Treatment Outcome treatment outcomes World Health Organization |
title | Key findings from the WHO collaborative study on substitution therapy for opioid dependence and HIV/AIDS |
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