MMT for clients with infectious diseases
Infectious diseases, such as hepatitis and HIV/AIDS, are common among people who use injection drugs. Methadone maintenance treatment (MMT) programs should be prepared to evaluate, consider and support available treatment options for clients who have an infectious disease when they begin treatment or who acquire one during their treatment. A variety of issues should be considered for such clients during treatment planning. For this reason, MMT guidelines include screening of all clients for hepatitis and HIV before treatment begins. Stabilization on MMT can help healthy clients make lifestyle changes that will reduce their risk of acquiring these conditions.
MMT providers should adopt strategies to promote health and to help educate clients about ways to reduce harm to themselves and others, including:
- informing clients about the risks of sharing needles and other drug paraphernalia (e.g., where to get clean needles, how to clean them and how to safely dispose of them)
- immunizing at-risk clients against hepatitis B
- screening all clients for hepatitis C and tuberculosis
- screening for HIV and other sexually transmitted diseases and educating clients about safe sex
- monitoring for signs of infectious complications such as abscesses, phlebitis and infective endocarditis.
Hepatitis C is common among people who use injection drugs, and MMT providers should be prepared to assess for hepatitis and respond to the specific treatment needs of clients who have it. MMT physicians may recommend that clients be vaccinated for hepatitis A and B to help decrease the risks of secondary infection, such as liver failure and death (Vento et al., 1998). Physicians should monitor clients' liver transaminases regularly every two to three months when elevated, every six months when normal.
Clients with hepatitis C should be educated about reducing risk to partners, family and friends with whom they have close contact. For example, clients should:
- practise safe sex
- not share toothbrushes or other items that may come into contact with blood
- inform sexual partners about their hepatitis C status and encourage them to also get tested.
All clients should be screened for HIV when they begin MMT, and every six months as long as they continue risky behaviour. Clients with HIV/AIDS, like other clients, should have access to MMT if they meet the diagnostic criteria for opioid dependence. Clients should begin MMT treatment as quickly as possible to help decrease the risk of transmitting the virus to others.
Clients with HIV/AIDS benefit from MMT in a variety of ways. Clients who are stabilized on methadone report a reduction in risky behaviour, such as sharing needles. Research has also shown a reduced level of sex trade work in MMT clients. In addition, MMT clients with HIV are hospitalized less often and live longer than people with HIV who use injection drugs but are not on methadone (Weber et al., 1990). Clients who have been stabilized often find it easier to comply with their HIV treatment.
MMT providers should be aware of some specific risks for their clients who are HIV positive. Clients may:
- be more vulnerable to health problems associated with injection drug use, including endocarditis, abscesses and co-infection with other blood-borne diseases (e.g., hepatitis C)
- be at higher risk for bacterial pneumonia and tuberculosis
- be at risk for developing drug-resistant strains of HIV if they have not consistently complied with their HIV treatment regimen
- be taking medications that will interact with their methadone.