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International Association of Providers of AIDS Care
Revised May 12, 2017

Fact Sheet 301

Opioid Replacement Therapy


WHAT IS OPIOID REPLACEMENT THERAPY?
WHO SHOULD CONSIDER OPIOID REPLACEMENT THERAPY?
WHAT ARE THE BENEFITS OF OPIOID REPLACEMENT THERAPY
WHAT ARE THE CONCERNS ABOUT OPIOID REPLACEMENT THERAPY?
THE BOTTOM LINE

 


WHAT IS OPIOID REPLACEMENT THERAPY?

Opioid replacement therapy is the substitution of an opioid, such as heroin, with a longer-lasting prescription opioid with less potential for abuse. It’s also known as opioid substitution therapy (OST).

Methadone and buprenorphine are opioids that are typically used for this purpose and administered under the supervision of a doctor.

As an alternative to detox programs, opioid replacement therapy has been shown to be effective in reducing the risk of overdose, HIV and hepatitis C virus (HCV) transmission (see Fact Sheet 673), and illicit opioid use. See Fact Sheet 154 for more information on how drug use relates to HIV.

Opioid replacement therapy is a form of harm reduction. A harm reduction approach to drug use seeks to lessen the damaging effects of this behavior on the health and wellbeing of people who use drugs, as well as their communities. For more information on harm reduction and HIV, see Fact Sheet 155.


WHO SHOULD CONSIDER OPIOID REPLACEMENT THERAPY?

For people who use illicit opioids, opioid replacement therapy should be considered as a viable option for reducing their risk of overdose, getting HIV and HCV, and curbing addiction. It is best used by people who have an addiction and dependence upon opioids.

Using opioid replacement therapy eliminates the need for users to resort to illegal activity to prevent withdrawal. It also provides people who inject drugs the opportunity to remove themselves from the illicit opioid market and community. This has been shown to be a large step in improving their quality of life.

Additionally, public health agencies should consider providing opioid replacement therapy, or providing referrals to other organizations that do. These services can greatly improve the lives of their clients.


WHAT ARE THE BENEFITS OF OPIOID REPLACEMENT THERAPY?

The largest benefit associated with opioid replacement therapy is a reduction in the risk of fatal overdose.

Other benefits include a decrease in risk of HIV and HCV transmission, injection-related bacterial infections, and illicit opioid use.

Opioid replacement therapy also provides an opportunity for users to remove themselves from the illicit drug community without being forced to experience withdrawal, which has proven to be a significant barrier for a majority of individuals.
 


WHAT ARE THE CONCERNS ABOUT OPIOID REPLACEMENT THERAPY?

Due to the fact that opioid replacement therapy follows a protocol created by a doctor, some clients feel as though they have little control over their own treatment.

In addition, traveling to a clinical setting may be inconvenient for clients who are employed or rely heavily on public transportation.

Lastly, the effectiveness of opioid replacement therapy varies depending on the type of opioid replacement drug prescribed. For example, Suboxone, a combination of buprenorphine and naloxone, greatly restricts the possibility for abuse. However, when buprenorphine is taken by itself, the drug is more likely to be misused by a person taking it.

Despite these drawbacks, many clients find that the benefits are well worth the logistics of obtaining opioid replacement services.


THE BOTTOM LINE

Opioid replacement therapy is an effective measure for reducing many of the harms associated with illicit, injection opioid use. When used efficiently, opioid replacement therapy can greatly improve the lives of opiate drug users.
 


 


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