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Brief Summary

GUIDELINE TITLE

Substance use treatment modalities for HIV-infected persons.

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Substance use treatment modalities for HIV-infected patients. New York (NY): New York State Department of Health; 2008 Jan. 13 p. [29 references]

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Substance use treatment modalities for HIV-infected persons. New York (NY): New York State Department of Health; 2005 Jul. 11 p.

BRIEF SUMMARY CONTENT

 
RECOMMENDATIONS
 EVIDENCE SUPPORTING THE RECOMMENDATIONS
 IDENTIFYING INFORMATION AND AVAILABILITY
 DISCLAIMER

 Go to the Complete Summary

RECOMMENDATIONS

MAJOR RECOMMENDATIONS

Clinicians should be familiar with the substance use treatment programs and services available in their communities.

Selecting the Initial Substance Use Treatment Modality

Clinicians should discuss treatment options with substance-using patients and should ask which treatment options they prefer.

Clinicians should inquire about use of multiple substances and should consider the full spectrum of the patient's drug use when discussing treatment options with the patient.

Treatment for Heroin Addiction

Clinicians should offer agonist treatment to patients who are opioid-dependent and unable to discontinue use.

Clinicians should only use naltrexone as a second choice to agonist (methadone or buprenorphine) treatment to treat opioid dependence in human immunodeficiency virus (HIV)-infected patients.

Methadone Maintenance

Role of Counseling during Methadone Maintenance

Patients must receive counseling in order to receive medication in methadone maintenance programs.

Buprenorphine Treatment

Role of Counseling during Buprenorphine Maintenance

Counseling and other support resources should be made available to all patients treated with buprenorphine.

Patients who decline counseling services should be maintained on buprenorphine if otherwise medically appropriate.

Naltrexone Treatment

Clinicians should only use naltrexone as a second choice to agonist (methadone or buprenorphine) treatment to treat opioid dependence in HIV-infected patients. Strong supports should be in place to maximize adherence and treatment retention.

Clinicians should not use oral naltrexone until patients are opioid-free for 3 to 4 days.

Clinicians should not use oral naltrexone in patients with acute hepatitis or liver failure.

Key Point:

Oral naltrexone is not a highly recommended therapy for the following reasons:

  • It has a very low retention rate.
  • Concern about its safety in the setting of liver disease
  • It blocks the analgesic effects of opioid agonists and should be discontinued 72 hours prior to elective surgery.
  • There is an elevated risk of fatal overdose upon discontinuation of oral naltrexone therapy.

Medication-Assisted Opioid Withdrawal

Clinicians should not initiate medication-assisted opioid withdrawal in opioid-dependent pregnant women. Rather, opioid-dependent pregnant women should be referred for treatment in a methadone maintenance treatment program.

See the original guideline document for information about treatment for stimulant and sedative dependence; non-pharmacologic treatment modalities, including twelve-step programs and acupuncture; and substance-use treatment settings.

Communication and Confidentiality

Clinicians should inform substance-using HIV-infected patients of the laws governing confidentiality of both HIV status and substance use treatment.

Clinicians should obtain written consent from the patient before communicating with substance use treatment programs.

CLINICAL ALGORITHM(S)

None provided

EVIDENCE SUPPORTING THE RECOMMENDATIONS

TYPE OF EVIDENCE SUPPORTING THE RECOMMENDATIONS

The type of evidence supporting the recommendations is not specifically stated.

IDENTIFYING INFORMATION AND AVAILABILITY

BIBLIOGRAPHIC SOURCE(S)

  • New York State Department of Health. Substance use treatment modalities for HIV-infected patients. New York (NY): New York State Department of Health; 2008 Jan. 13 p. [29 references]

ADAPTATION

Not applicable: The guideline was not adapted from another source.

DATE RELEASED

2005 Jul (revised 2008 Jan)

GUIDELINE DEVELOPER(S)

New York State Department of Health - State/Local Government Agency [U.S.]

SOURCE(S) OF FUNDING

New York State Department of Health

GUIDELINE COMMITTEE

Substance Use Committee

COMPOSITION OF GROUP THAT AUTHORED THE GUIDELINE

Chair: Marc N Gourevitch, MD, MPH, New York University School of Medicine , New York, New York

Members: Bruce D Agins, MD, MPH, New York State Department of Health AIDS Institute, New York, New York; Julia H Arnsten, MD, MPH, Montefiore Medical Center, Bronx, New York; Lawrence S Brown, Jr, MD, MPH, FASAM, Addiction Research and Treatment Corporation, Brooklyn, New York; Brenda Chabon, PhD, Montefiore Medical Center, Bronx, New York; Barbara H Chaffee, MD, MPH, Binghamton Family Care Center, Binghamton, New York; Michael L Christie, MD, AIDS Community Health Center, Rochester, New York; Chinazo O Cunningham, MD; Montefiore Medical Center, Bronx, New York; Nereida L Ferran-Hansard, MD, Jacobi Medical Center, Bronx, New York; Steven S Kipnis, MD, FACP, FASAM, New York State Office of Alcoholism and Substance Abuse Services, Orangeburg, New York; Joseph P Merlino, MD, MPA, Mount Sinai School of Medicine, New York, New York; Nancy Murphy, NP, St. Luke's Roosevelt Hospital Center, New York, New York; Edward Nunes, MD, New York State Psychiatric Institute, New York, New York; David C Perlman, MD, Beth Israel Medical Center, New York, New York; Sharon L Stancliff, MD, Harm Reduction Coalition, New York, New York; Robert Whitney, MD, Erie County Medical Center, Buffalo, New York

Liaisons: Daliah I Heller, MPH, Liaison to the New York City Department of Health and Mental Hygiene, New York, New York

AIDS Institute Staff Liaisons: Diane M Rudnick, MEd, Liaison to the New York State Department of Health AIDS Institute, New York, New York

AIDS Institute Staff Physician: Eunmee H Chun, MD, New York State Department of Health AIDS Institute, New York, New York

Principal Contributors: Steven L Batki, MD, SUNY Upstate Medical University, Syracuse; John AR Grimaldi, Jr, MD, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York

FINANCIAL DISCLOSURES/CONFLICTS OF INTEREST

Not stated

GUIDELINE STATUS

This is the current release of the guideline.

This guideline updates a previous version: New York State Department of Health. Substance use treatment modalities for HIV-infected persons. New York (NY): New York State Department of Health; 2005 Jul. 11 p.

GUIDELINE AVAILABILITY

AVAILABILITY OF COMPANION DOCUMENTS

PATIENT RESOURCES

None available

NGC STATUS

This NGC summary was completed by ECRI Institute on September 19, 2007. This NGC summary was updated by ECRI Institute on June 12, 2008.

COPYRIGHT STATEMENT

DISCLAIMER

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