Authors' objectives:

To examine evidence on the effectiveness of drug abuse treatment, to evaluate its potential role in reducing the spread of HIV, and to compare it to other approaches to HIV prevention among this high-risk group.

Authors' results and conclusions: Methadone maintenance is clearly efficacious in reducing opiate use and associated IV use of heroin. Its effectiveness, however, may sometimes be compromised by inadequate doses of methadone. Philosophical and political differences about the use of methadone, such as concerns about substituting one opiate for another and fears of illegal diversion, have inhibited administration of adequate does. As a result, methadone's potential to prevent HIV is probably not be realized. No clearly efficacious treatment for cocaine, whose use in IV and smokable forms is associated with HIV transmission, is yet available. Interpretation of studies to evaluation residential therapeutic communities (TCs) and outpatient drug-free (ODF) programs is more difficult because of a lack of external control groups.

Authors' recommendations: Preventing further spread of HIV increases the pressure for re-examination and scientific evaluation of public policies regarding the availability of syringes and needles. Temporarily providing methadone and counselling, without the additional ancillary services ordinarily part of methadone maintenance, to IV opiate users who are on waiting lists for treatment merits strong consideration. The impact of incremental, even partial, but sustained reductions due to methadone maintenance and perhaps other drug treatment approaches can be substantial in breaking the chain of HIV transmission.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.wws.princeton.edu:80/~ota/ns20/pubs_f.html

Year Published: 1990

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: United States

Organisation Name: U. S. Congress. Office of Technology Assessment

Copyright: Office of Technology Assessment