Special Considerations and Clinical Management of HIV in Patients With Substance Use Disorder

  • Author: Frederick L. Altice, MD (More Info)
  • Editors in Chief: Joseph J. Eron, Jr., MD; Daniel R. Kuritzkes, MD
  • Last Reviewed: 2/5/20 (What's New)

Summary

    Medically Supervised Opioid Withdrawal
    • Gradual taper using methadone or buprenorphine is the best-supported method for withdrawing from opioids[SAMHSA 2015; ASAM 2015]
    • Supervised opioid withdrawal without chronic opioid substitution therapy should be reserved for people with short-term opioid use (less than 2 years), young adults, and noninjectors[Mattick 2003a; Amato 2004]
    Pharmacotherapy for Opioid Dependence
    • Most effective chronic treatment for opioid addiction for patients with long-term opioid-dependence, particularly PWIDs, is opioid substitution therapy,[Amato 2008; Mattick 2009] although data also supports use of extended-release naltrexone[Krupitsky 2011; Baser 2011]
    • Methadone
        Buprenorphine
          Naltrexone
            Clonidine

          Action required