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Review
. 2008 Apr 28:1:15-61.
doi: 10.4137/sart.s580. eCollection 2008.

Hepatitis infection in the treatment of opioid dependence and abuse

Thomas F Kresina  1 , Diana Sylvestre  2 , Leonard Seeff  3 , Alain H Litwin  4 , Kenneth Hoffman  1 , Robert Lubran  1 , H Westley Clark  1
Affiliations
Review

Hepatitis infection in the treatment of opioid dependence and abuse

Thomas F Kresina et al. Subst Abuse. .

Abstract

Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.

Keywords: hepatitis; medication assisted treatment; methadone; substance abuse treatment.

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Figures

Figure 1
Figure 1
The time course of an uncomplicated HAV infection (from Larson et al. 2005).
Figure 2
Figure 2
Time course of acute HBV infection showing the expression of viral markers of infection and the immune response to infection among persons who recover from acute infection (from Larson et al. 2005).
Figure 3
Figure 3
Diagram of the natural history of infection with HBV.
Figure 4
Figure 4
Time course of acute (months) and chronic (years) HDV superinfection (HBV/HDV co-infection) (from Larson et al. 2005).
Figure 5
Figure 5
Diagram of the natural history of infection with HCV.
Figure 6
Figure 6
Diagram of the natural history of HCV infection in patients with HIV infection.
Figure 7
Figure 7
Diagram of the elements of a comprehensive substance abuse treatment plan (from NIDA 2000a).
Figure 8
Figure 8
Sustained virologic response (SVR) to interferon-ribavirin treatment in 66 HCV-positive patients receiving methadone treatment (Sylvestre et al. 2005).
Figure 9
Figure 9
Sustained virologic response (SVR) among HCV-positive injection drug users (data from Backmund et al. 2001).
Figure 10
Figure 10
Enhancement of heroin-associated nephropathy by HCV infection and diabetes.
See this image and copyright information in PMC

References

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