Buprenorphine Reduces HIV-related Deaths by 80 Percent. So What is It?

A new Canadian study demonstrates that opioid substitution treatment can reduce HIV and drug-related deaths in people with HIV who are also injection drug users. The findings, presented at the 2015 International AIDS Society Conference indicate individuals with HIV who also inject drugs had fewer HIV- and drug-related deaths after receiving opioid substitution treatment.

In opioid substitution treatment patients receive the drug buprenorphine as part of their addiction treatment for abusing opioids like the pain medications hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), or morphine. The drug is typically administered in a doctor's office or other medical facility.

According to the National Alliance of Advocates for Buprenorphine Treatment, buprenorphine is an partial opioid agonstic, which means it produces similar effects as opiods but its effects are less than those of full agonists like heroin and methadone. At low doses, the buprenorphine enables addicts to break their addiction to opioids without experiencing withdrawal symptoms.

“Our study adds to a growing body of evidence showing access to opioid agonist therapy has positive downstream effects on HIV-health related outcomes,” said Bohdan Nosyk, PhD, of the British Columbia Centre for Excellence in HIV/AIDS in a written statement. “These findings strongly suggest opioid agonist therapy is an essential component to improving HIV outcomes among people who inject drugs [and] indicate integration of HIV care and addictions is a promising way to improve health care access among the vulnerable and hard-to-reach population of people who inject drugs."

Nosyk and his colleagues analyzed data from 1996 to 2010 in British Columbia, looking at the effect of the opioid substitution treatment (alone and combined with antiretroviral therapy) on mortality among those with HIV who also inject drugs.

Following the 1,727 patients for an average of just over 5 years, the results showed that 28.5 percent of the study cohort died in that time. Over half (55%) of the deaths were due to HIV-related causes while drug-related causes were blamed for 18.7 percent.

The analysis found that opioid substitution therapy alone reduced the risk of HIV-related death by 80 percent. Antiretroviral therapy independently reduced the risk of both HIV-related death and death due to drug use. Using both antiretroviral therapy and opioid substitution therapy together had the greatest impact on mortality, reducing the risk of death by between 86 percent and 94 percent.  

Researchers reported that opioid substitution treatment and ART independently protected against HIV-related deaths, drug-related deaths and deaths due to other causes.

Nosyk concluded, "Further research is needed to determine how this can be implemented in a cost-effective way.”

In a press conference, Dr Nora Volkow, director of the United States National Institute on Drug Abuse called opioid substitution therapy “a win-win for prevention and a win-win for treatment."

Unfortunately, Volkow added, "there are too many places where it’s not happening… I don’t know of any other area of medicine where despite the evidence that the intervention works, someone says 'we’re not going to do that because I think that that is not right.”

In their position paper, titled "Substitution maintenance therapy in the management of opioid dependence and HIV/AIDS prevention," the World Health Organization recommends opioid substitution therapy for people who inject drugs and have been diagnosis with HIV.

According to AIDSMap.com opioid substitution is resisted in many countries because of the belief that heroin addiction can only be treated by abstinence.  A 21-country survey, published in 2013, found just three percent of people living with HIV who inject drugs had access to opioid substitution therapy.