Opioid Addicted Buprenorphine Injectors: Drug Use During and After 12-Weeks of Buprenorphine–Naloxone or Methadone in the Republic of Georgia ☆ Gvantsa Piralishvili, M.D., Ph.D. a , David Otiashvili, M.D., Ph.D. b , Zura Sikharulidze, M.D., Ph.D. c , George Kamkamidze, M.D. d , Sabrina Poole, M.S. e , George E. Woody, M.D. e, ⁎ a Centre for Mental Health and Prevention of Addiction, 21a Kavtaradze str., Tbilisi, GA 0186, USA b Addiction Research Center, Alternative Georgia, 14a Nutsubidze Street, Office 2,Tbilisi, GA 0177, USA c Medical Centre Uranti, Nutsubidze 5 Plateau, Build 2a, Tbilisi, GA 0183, USA d Health research Union, Nutsubidze 8, Tbilisi, GA 0177, USA e Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania and Treatment Research Institute, 600 Public Ledger Bldg; 150 South Independence Mall (W) Philadelphia, PA 19106, USA abstract article info Article history: Received 10 May 2014 Received in revised form 3 October 2014 Accepted 6 October 2014 Available online xxxx Keywords: Opioid substitution therapy Non-opioid drug use Methadone Buprenorphine/naloxone Aims: The aim of this study is to assess the prevalence of non-opioid drug use among opioid-addicted, buprenorphine injecting individuals in Georgia, during and after a 12-week course of buprenorphine–naloxone (Suboxone®) or methadone. Methods: Randomized controlled trial with daily observed Suboxone® or methadone and weekly counseling, urine tests and timeline followback (TLFB) in weeks 0–12 and 20, and the Addiction Severity Index (ASI) at weeks 0, 4, 8, 12, 20. Results: Of the 80 patients (40/group, 4 women), 68 (85%) completed the 12-weeks of study treatment and 66 (82.5%) completed the 20-week follow-up. At baseline, injecting more than one drug in the last 30 days was re- ported by 68.4% of patients in the methadone and 72.5% in the Suboxone® groups. Drug use was markedly re- duced in both treatment conditions but there were significant differences in the prevalence of specific drugs with more opioid (1.5 vs. 0.2%; p = 0.03), less amphetamine (0.2 vs. 2.8%; p b 0.001) and less marijuana (1.7 vs. 10.2%; p b 0.001) positive urine tests in the methadone vs. Suboxone® groups. At the 20-week follow-up, TLFB results on the 34 that continued methadone or the 3 on Suboxone® showed less opioid (5.6 vs. 27.6%; p b 0.001), illicit buprenorphine (2.7 vs. 13.8%; p = 0.005), benzodiazepine (13.5 vs. 34.5%; p b 0.001), and marijuana (2.8 vs. 20.7%; p b 0.001) use than the 29 who did not continue opioid substitution therapy. Conclusions: Despite small but significant differences in opioid and other drug use, both treatments were high- ly effective in reducing opioid and non-opioid drug use. © 2014 Elsevier Inc. All rights reserved. 1. Introduction Opioid substitution therapy (OST) using buprenorphine and methadone has been introduced in some Former Soviet States including Ukraine (Bruce, Dvoryak, Sylla, & Altice, 2007; Dvoriak et al., 2013; Dvoryak & Grishayeva, 2008; Golovanevskaya, Vlasenko, & Saucier, 2012; Lawrinson et al., 2008) and Georgia (Gambashidze, Sikharulidze, Piralishvili, & Gvakharia, 2008; Otiashvili et al., 2010; Piralishvili, Gamkrelidze, Nikolaishvili, & Chavchanidze, 2012) and data are becoming available on its effectiveness in these cultural set- tings. Findings from the U.S., Western Europe, and Australia have consis- tently found that OST is associated with substantial reductions in illicit opioid use, criminal activity, and drug related mortality, and that it can play an important role in reducing the spread of HIV by reducing injec- tion risk and improving adherence to antiretroviral therapy (Cornish, Macleod, Strang, Vickerman, & Hickman, 2010; Degenhardt et al., 2010; Gowing, Farrell, Bornemann, Sullivan, & Ali, 2011; Kimber et al., 2010; MacArthur et al., 2012; Malta, Strathdee, Magnanini, & Bastos, 2008; Mattick, Breen, Kimber, & Davoli, 2003; Mattick, Breen, Kimber, & Davoli, 2007; Suntharasamai et al., 2009; Tilson et al., 2007). These findings have led to an interest in comparing outcomes of pa- tients being treated with methadone or buprenorphine since they have different pharmacologic properties, safety profiles, and conditions under which they can be prescribed. The largest and latest Cochrane Journal of Substance Abuse Treatment xxx (2014) xxx–xxx ☆ The study is registered with WHO International Clinical Trials Registry Platform (ICTRP)—ID NCT01131273. ⁎ Corresponding author at: Treatment Research Institute, 600 Public Ledger Bldg, 150 South Independence Mall (W), Philadelphia, PA 19106. Tel.: +1 215 399 0980x112, +1 215 694 9248 (mobile); fax: +1 215 399 0987. E-mail addresses: gpirali@mail.ru (G. Piralishvili), dato@altgeorgia.ge (D. Otiashvili), zuras@uranti.ge (Z. Sikharulidze), georgekamkamidze@gmail.com (G. Kamkamidze), SPoole@tresearch.org (S. Poole), woody@tresearch.org (G.E. Woody). http://dx.doi.org/10.1016/j.jsat.2014.10.003 0740-5472/© 2014 Elsevier Inc. All rights reserved. Contents lists available at ScienceDirect Journal of Substance Abuse Treatment Please cite this article as: Piralishvili, G., et al., Opioid Addicted Buprenorphine Injectors: Drug Use During and After 12-Weeks of Buprenorphine– Naloxone or Methadone in the Republic..., Journal of Substance Abuse Treatment (2014), http://dx.doi.org/10.1016/j.jsat.2014.10.003