HIV and substance abuse are both significant public health problems that merit the attention of public health officials and policymakers. Today, an estimated 40 million people worldwide are living with HIV. Of these, 2 to 3 million people are injection drug users. In the United States, approximately a third of HIV/ AIDS cases are related to injection drug use. Research shows that use of drugs, injected or not, can affect decisionmaking – particularly about engaging in unsafe sex – that can endanger the health of the drug user and of others. Substance abuse is a double-edged sword because it increases an individual’s risks for continuing drug use while also increasing the likelihood of exposure to HIV and other bloodborne infections. Infectious diseases that are more prevalent among injection drug users than in the general population are HIV, other STDs, including hepatitis B and C, and tuberculosis. Prevention and early treatment of drug abuse and drug-related diseases are critical public health measures to reduce the spread of new infections.
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KEY POINTS
Substance abuse and addiction involve compulsive drug-seeking behavior that interferes with an individual’s ability to function normally in many aspects of daily life. Substance abuse and mental health problems often occur together and, unless treated, can lead to chronic social and medical consequences. Accurate and reliable diagnosis of substance abuse or dependence is not a perfect science. Screening techniques, in concert with a thorough medical history and evaluation, are important in detecting and correctly diagnosing a substance abuse-related disorder.
HIV transmission is preventable in people who use drugs. For drug users and the community at large, drug addiction treatment is disease prevention. Hepatitis C is extremely common in patients with a past or current history of injection drug use. All patients with hepatitis C should be vaccinated against hepatitis A and B if serologic studies show no prior exposure.
The clinical issues to be addressed are to treat comorbid conditions as soon as possible, treat drug use and HIV aggressively, and be aware of common drug interactions seen in patients treated for drug use and HIV simultaneously.
SUGGESTED RESOURCES
Brief Interventions and Brief Therapies for Substance Abuse. Treatment Improvement Protocol (TIP) Series 34. Rockville, MD: Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment; 1999. DHHS Publication No. (SMA) 99-3353. Available at http://www.health.org/govpubs/BKD341/ Accessed 1/04.
Klein MB, Lalonde RG, Suissa S. The impact of hepatitis C virus coinfection on HIV progression before and after highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2003;33:365-372.
WEBSITES
American Society of Addiction Medicine: http://www.asam.org/ Accessed 11/03. National Institute on Drug Abuse: http://www.nida.nih.gov
Accessed 11/03.
Erowid (detailed biochemical and other information on drugs):
http://www.erowid.org Accessed 11/03.
Office on National Drug Control Policy: http://www.whitehousedrugpolicy.gov/ Accessed 11/03.
Substance Abuse and Mental Health Services Administration (drug abuse statistics, clinical treatment information): http://www.samhsa.gov
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REFERENCES
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American
Psychiatric Association Press; 1994. American Society of Addiction Medicine. Screening Instruments. In: Graham AW, Schultz TK, Mayo-Smith MF, Ries RK, Wilford BB, eds. Principles of Addiction Medicine. Chevy Chase MD: American Society of Addiction Medicine; 1998:1283-1286. Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:933-938. Gourevitch MN, Friedland GH. Interactions between methadone and medications used to treat HIV infection: a review. Mt. Sinai J Med. 2000;67:429-436.
Hyman SE, Malenka RC. Addiction and the brain: the neurobiology of compulsion and its persistence [Review]. Nat Rev Neurosci. 2001;2:695-703.
Johnson RE, Chutuape MA, Strain EC, Walsh SL, Stitzer ML, Bigelow GE. A comparison of levomethadyl acetate, buprenorphine, and methadone for opioid dependence. New Engl J Med. 2000;343:1290-1697.
Leshner, AL. Addiction is a brain disease, and it matters. Science. 1997;278:45-47.
McLellan AT. Have we evaluated addiction treatment correctly? Implications from a chronic care perspective. Addiction. 2002;97: 249-252.
O’Brien CP. A range of research-based pharmacotherapies for addiction. Science. 1997;278:66-70.
Principles of Drug Addiction Treatment: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse; 1999. NIH Publication 99-4180. Available at http:// www.drugabuse.gov/PubCat/PubsIndex.html Accessed 1/04.
Principles of HIV Prevention in Drug-Using Populations: A Research-Based Guide. Bethesda, MD: National Institute on Drug Abuse; 2002. NIH publication 02-4733. Available at http://www.drugabuse.gov/ PubCat/PubsIndex.html Accessed 1/04. Samet JH, Rollnick S, Barnes H. Beyond CAGE. A brief clinical approach after detection of substance abuse. Arch Intern Med. 1996;156:2287-93.
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