Background: Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes\r\namong HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIVinfected\r\nopioid-dependent individuals treated with buprenorphine or methadone.\r\nMethods: The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent\r\nindividuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised\r\nall patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data\r\non adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having\r\nreported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate\r\nroute of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model\r\nbased on GEE was then used to identify predictors of non-medical use of opioids.\r\nResults: Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and\r\nmethadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual\r\npatients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and\r\nbenzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation.\r\nConclusions: Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or\r\nbuprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids\r\nand may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and\r\ncontinuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to\r\nreduced harms from ongoing non-medical use of opioids.
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