Can Opioid Maintenance Therapy Help Prevent Hepatitis C?
Opioid maintenance therapy is the term used to describe the ongoing use of an opioid-based medication as a treatment for people recovering from uncontrolled opioid addiction. While doctors often use a medication called methadone in this form of therapy, they can also use a generally safer medication called buprenorphine.
In a study published in October 2014 in the American Medical Association journal JAMA Internal Medicine, a team of American researchers assessed the potential role of opioid maintenance therapy in preventing the spread of hepatitis C infections among people who use injection drugs.
Opioid Maintenance Therapy
Opioid-based medications are commonly used to help people who enter treatment for an addiction to heroin, prescription opioids or other opioid substances. These medications are useful in two treatment contexts: opioid detoxification and opioid maintenance. During opioid detoxification, doctors temporarily use opioid-based medications to help people in treatment avoid the potentially severe, relapse-promoting effects of opioid withdrawal.
During opioid maintenance, doctors use controlled doses of an opioid-based medication as a longer-term, safer alternative to the uncontrolled substance intake that characterizes opioid addiction. Some people receive opioid maintenance therapy for a few months, while others receive the therapy on an ongoing basis.
The medication most associated with opioid maintenance therapy is methadone, a fairly powerful opioid substance only available in the U.S. in certain facilities licensed and monitored by the federal government. However, many programs now use buprenorphine, a weaker opioid substance legal for use in a much wider range of treatment settings.
Generally speaking, buprenorphine does not come with the same potential for abuse as methadone. In addition, while people who abuse methadone can easily experience an opioid overdose, buprenorphine overdoses are relatively rare. Also, people who abuse buprenorphine have much lower chances of developing medication dependence.
Hepatitis C is the name for a viral infection that produces significant and potentially dangerous inflammation inside the liver. The same name also applies to the virus (also known as HCV) responsible for causing this form of infection. Like all viral infections, hepatitis C is contagious. In America, people who use injection drugs are the most likely population group to experience exposure to HCV. Typically, such exposure occurs during the unsanitary use of needles and syringes or other types of paraphernalia associated with injecting drugs or medications into a vein, into a muscle or under the skin. Some people develop a limited form of hepatitis C known as acute hepatitis C.
However, others develop a much more serious, ongoing form of the infection known as chronic hepatitis C. People with the chronic form of the disease can experience severe or potentially fatal health issues that include permanent liver tissue scarring (i.e., liver cirrhosis) and certain types of malignant liver cancer. Unfortunately, most initially acute cases of hepatitis C turn chronic over time.
Can Opioid Maintenance Help Prevent Hepatitis C?
In the study published in JAMA Internal Medicine, researchers from Boston University, Boston Medical Center, the University of New Mexico and UC San Francisco used data gathered from a 13-year project to help determine if injection drug users who receive opioid maintenance therapy have a lowered chance of getting infected with the hepatitis C virus.
This project included 552 young adult users who were under the age of 30 and free from hepatitis C when their participation began. Some of these participants received opioid maintenance therapy as their primary form of treatment. Others received opioid detoxification or forms of drug treatment that did not involve opioid medications. In addition, some participants did not receive any drug treatment.
Over the course of the study period, 171 of the participants were infected with HCV. After analyzing the breakdown of affected individuals, the researchers concluded that the participants who received opioid maintenance therapy had a significantly smaller chance of getting hepatitis C than the participants who went through opioid detoxification or received a form of treatment not based on the use of an opioid medication.
The study’s authors concluded that members of the opioid maintenance therapy group had a lower rate of HCV infection because they had a lower rate of exposure to the risk factors that make such an infection more likely to occur. They believe that the use of opioid maintenance therapy may substantially limit the transmission of hepatitis C among young people who consume injection drugs.
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