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Updated May 2, 2006

Case 2: Heroin Use and HIV

Authors: Emily Darby, MD Chinazo O. Cunningham, MD

A 42-year-old man with CDC category A2 HIV disease and a CD4 count of 320 cells/mm3 presents for a routine follow-up visit at an HIV clinic. He has a 9-year history of intravenous heroin use. He served a 4-month prison term 3 years ago, during which time he did not use heroin, but resumed heroin use within weeks after leaving prison. He later tried methadone (Methadose) detoxification therapy, but shortly after stopping methadone, he again relapsed and currently injects approximately 0.5 grams of heroin per day. He recently spoke with a friend who obtains buprenorphine-naloxone (Suboxone) from his physician, and he is interested in knowing what options are available for treating his heroin addiction through the HIV clinic.

Which one of the following statements is TRUE related to treatment of heroin addiction in this patient?

A In the United States, any physician can administer methadone maintenance to an HIV-infected patient after completing a three-hour training course regarding appropriate use of methadone for treatment of heroin addiction.
B For a chronic heroin user, medical detoxification with methadone is more likely than methadone maintenance therapy to successfully reduce long-term heroin use.
C The use of buprenorphine in the out-patient setting is limited by its very short half-life and the required four times a day administration.
D In the United States, buprenorphine may now be provided legally through outpatient medical clinics, but physicians who intend to prescribe buprenorphine are required to undergo special training and receive a waiver from the SAMHSA Center for Substance Abuse Treatment.