Integration of Buprenorphine into HIV Primary Care Settings

"If I was still under the addiction of [opioids] . . . I would jump up in the morning and I would forget about the HIV medicine and I would go out and get [high]."

The intersection of opioid abuse, particularly injection drug use (IDU), and HIV is well documented; in fact, IDU is the second most frequent route of HIV transmission. Injection drug use, either directly or via sexual contact with an IDU partner, accounts for one-third of the estimated AIDS cases since the beginning of the epidemic, and 18 percent of new infections in the United States.

Opioids are natural, semisynthetic or entirely manmade drugs that bind to receptors in different parts of the body and are generally used as non medical painkillers. Heroin, morphine, fentanyl, codeine, oxycodone, buprenorphine, and methadone are opioids.

With an estimated 2.4 million opioid- dependent Americans, opioids are among the most frequently abused drugs. And nonmedical pain medication abuse has been garnering a lot of press. It’s been featured in the Chicago Tribune and The Baltimore Sun, and on MSNBC. It was a front cover story of USA Today and a feature in Time magazine.

According to a 2010 Substance Abuse and Mental Health Services Administration (SAMHSA) national study, dependence/abuse of pain relievers ranked second (after marijuana) among illicit drug use in the past year. Heroin ranked fifth.

Prescription pain medications, such as hydrocodone (Vicodin), oxycodone (OxyContin, Percocet), and hydromorphone (Dilaudid), are highly addictive. According to the SAMHSA study, 5.3 million Americans reported nonmedical use of prescription pain relievers in the last month.And the consequences are growing: “Between 2004 and 2008, emergency department visits involving oxycodone, hydrocodone, and methadone increased 152%, 123%, and 73%, respectively, and the number of fatal overdoses due to opioid analgesics now exceeds those due to heroin and cocaine combined.” In fact, mortality among illicit opioid users has been estimated at 13 times that of the general population.

This problem is exacerbated among people living with HIV/AIDS (PLWHA) who may be using such medications for pain management.