Clinical Pain Medicine ISSUE: MARCH 2015 | VOLUME: 13(3)printer friendly | email this articleOpioid Agonists May Lower HCV Incidence in Drug AbusersIn a group of young users of injection drugs, recent maintenance opioid agonist therapy with methadone or buprenorphine for opioid use disorders, such as heroin addiction, was associated with a lower incidence of hepatitis C virus (HCV) infection, according to a recent study (JAMA Intern Med 2014;174:1974-1981).
The use of injection drugs is a primary route of HCV transmission and young injection drug users (IDUs) are at the core of the HCV epidemic, so they may be an important target to reduce HCV transmission, according to researcher Judith I. Tsui, MD, MPH, of Boston University School of Medicine. In this cohort of IDUs, maintenance treatment with methadone or buprenorphine might be an important strategy to prevent the spread of HCV, the researchers wrote.
In an observational cohort study, Dr. Tsui and her colleagues examined the effects of opioid agonist therapy in a group of 552 young IDUs in San Francisco, from January 2000 to August 2013. Every three months, they interviewed some of the subjects and took blood samples (≥2 follow-up visits).
Most of the IDUs were men, white and homeless; the median age was 23 years; and all tested HCV-negative. The median duration of drug use was 3.6 years, and 33.3% of participants used drugs daily. Nearly 60% reported that heroin was the drug they used most often in the past month. Only 4.2% reported receiving maintenance opioid agonist treatment in the previous year.
During the study period, 171 new cases of HCV infection occurred, for an incidence of 25.1 per 100 person-years. Participants who reported receiving methadone or buprenorphine maintenance therapy in the past three months had a significantly lower incidence of HCV infection than those who reported receiving no therapy (P=0.02).
The rate ratio was significantly lower for participants who reported recent maintenance opioid agonist therapy (P=0.001), but not for those who reported recent non-opioid forms of treatment (P=0.02).
“Young injection drug users are a major driving force in the epidemic of HCV infection in the United States and Canada, and therefore are an important target for prevention. Our results suggest that treatment for opioid use disorders with maintenance opioid agonist therapy can reduce transmission of HCV in young adult IDUs, and should be offered as an important component of comprehensive strategies for prevention of primary HCV infection,” the researchers concluded.