THE 6TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS

State of the art and new perspectives in drug addiction

treatmentDr L Michel, MD, PhD

Inserm U1178

Centre Pierre Nicole/French Red Cross

Paris

The 6th National Scientific Conference on HIV/AIDS

Drug dependence

1. Addiction is a disease

2. Addiction is a brain disease, but not only

– Genetic, environmental and social factors…

– Psychological factors

3. Addiction is a chronicle disease

4. Addiction is treatable

The 6th National Scientific Conference on HIV/AIDS

Comprehensive care 1. Combination of

– Medical + psychosocial interventions

– Harm reduction interventions

2. Multidisciplinary, integrated and long-term approach (guidelines for the treatment of drug dependence: a European perspective, EMCDDA, 2011)

– Relapse belongs to the recovery process

3. Gold standard for opioid dependence

– Opioid agonist treatment + psychosocial intervention

The 6th National Scientific Conference on HIV/AIDS

Abstinence rates are higher in patients receiving psychosocial interventions

Psychosocial interventions: cognitive and behavioural approaches contingency management Techniques (WHO, 2009)

The 6th National Scientific Conference on HIV/AIDS

Reach all populations

• Enlarge treatment options

– Improve existing options

• Methadone induction in primary care in France (ANRS-Methaville)

• 6 months buprenorphine implants (Rosenthal, 2013)

• Naltrexone implants (3-6 months): – «Better designed research is needed to establish the safety and efficacy of

naltrexone implants. Until such time, their use should be limited to clinical trials » (Larney, 2014)

The 6th National Scientific Conference on HIV/AIDS

Reach all populations

• Enlarge treatment options

– Create new options

• Oral 24h morphine release: Austria, Switzerland, Slovenia, and UK soon

• Diacetylmorphine: Switzerland, Neederland, Denmark for injecting drug users

• Injectable buprenorphine (Bup IV trial, France)

The 6th National Scientific Conference on HIV/AIDS

Improve damages prevention

7Curr Opin HIV AIDS 2012, 7:362–368

The 6th National Scientific Conference on HIV/AIDS

Improve damages prevention• Medication assisted treatment

– Opioid agonist treatments efficient to prevent HIV & HCV (Tsui, 2014 ; Nolan, 2014)

– Preventive impact enhanced if strategies combined

• Substance-use treatment + support for safe injection more effective at reducing HCV seroconversion (Hagan, 2011)

– Van den Berg (2007): Full participation in harm reduction programmes including NEP + OST at adequate dosage (≥ 60mg methadone/day)

The 6th National Scientific Conference on HIV/AIDS

Improve damages prevention• Needle and syringes programs

– ANRS-AERLI program (France): educational intervention on risks associated with drug injection (Roux, 2015)

• HCV transmission related to

– Sharing paraphernalia (Pouget 2012)

– Pipe and straw sharing (Jauffret 2009, Aaron 2008)

– Supervised consumption rooms: prevent individual and social damages related to drug use practices (Potier, 2014)

• To be opened in 2016 in Paris, Strasbourg, Bordeaux ?

The 6th National Scientific Conference on HIV/AIDS

Improve damages prevention

• Decrease mortality related to overdoses

– Spread of nasal naloxone among DUs (January 2016)

• Reach High risk populations

– Prison setting: reach a principle of equivalence for harm reduction measures (ANRS-Pride program)

The 6th National Scientific Conference on HIV/AIDS

Stimulant use and dependence

• No agonist treatment

• Main treatment modality: psychosocial interventions

– cognitive-behavioural therapy

– contingency management

• Research

– Trials with methylphenidate, naltrexone, antipsychotics, dexamphetamine, butyrylcholinesterase (cocaine metabolism), anti-cocaine vaccine, varenicline

The 6th National Scientific Conference on HIV/AIDS

Prevent !

•Delaying drug use onset

– Every year use of a substance is delayed, the risk of developing a substance use disorder is reduced

•Use specific tools for teenagers prevention

– Working on emotions rather than drugs dissuasion

•Use specific therapy for young drug users

– Multidimensional family therapy

The 6th National Scientific Conference on HIV/AIDS

Perspectives

• Future:

– Interventions on the reward circuitry ?

• UNGASS 2016:

– Special Session of the United Nations General Assembly on the World Drug Problem

• Ending the drug war ?