AIDS has reached epidemic proportions in the United States and intravenous drug use increases risk for AIDS, both through needle-sharing, and through the direct immunosuppressive effects of heroin and cocaine. We propose to establish a Treatment Research Unit (TRU) to evaluate the effecdveness of new treatments for drug abuse and the impact of these new treatments on the prevalence of AD:)S. lbe proposed TRU program will focus on intravenous cocaine and heroin abuse, each of which is associated with a high risk for AD:)S. The safety and efficacy of new pharmacological treatments for concurrent cocaine and opiate abuse and for cocaine abuse alone will be evaluated in controued inpatient studies. After four weeks of inpatient detoxification, pharmacotherapy and muld-modality treatment, clients will participate in oulpatient treatment evaluation and follow up studies. The effects of each treatment program on ADDS prevalence will be monitored bv HIV screening. The first studies will focus upon the efficacy of two new pharrnacotherapies: (1) a bulprenorphine-naloxone sublingual preparation for treatment of clients with dual cocaine and heroin abuse problems; and (2) sertraline, a serotonin uptake inhibitor, for the treatment of cocaine abuse. Each study will be conducted under randomized double-blind conditions with appropriate placebo controls. These protocols are illustrative models of our proposed drug abuse treatment and AIDS risk reduction programs. However, the TRU will be able to evaluate the effectiveness of other new treatment modalities as these become available upon the advice of the Scientific Advisory Group and NI]DA. The TRU will provide a new treatment capacity which does not exist in the Greater Boston area. Tbis TRU would provide 5 new beds for inpatierit treatment for clients with cocaine and heroin abuse and 60 new outpatient treatment positions during each year of the project. We propose to evaluate 150 clients in each treatmeniprotocol. The evaluation and implementation of new treatrnent programs for drug abuse are an important step towards reducing cocaine and heroin abuse and risk for AIDS.
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