Heroin Addiction and HIV infection – Dirty needles and a place for harm reduction

Co-authored by: Jamie Felzer

Many people today know about the dangers and risky behaviors (sharing needles, unsafe sex, and mother-to-child transmission) that can increase the risk for HIV/AIDS infection. The question lies in whether or not they are able to take appropriate actions to prevent contracting the disease themselves.

Heroin addiction, dirty needled, and HIV infection

Many heroin addicts, especially those that are homeless or extremely poor, will use whatever heroin they can get, regardless of the risk it puts them in.  A study done in a San Francisco park frequented by almost 3000 IV drug users found that in times of heroin withdrawals, addicts would use dirty  needles, sometimes with visible traces of blood still on them. The need to overcome their withdrawal was more important to them than worrying about the risk of contracting HIV or any of the other countless diseases that can be contracted from such use.

Many of the users surveyed were poor and sometimes didn’t even have enough money to buy their own supply of heroin so they often pooled together what they had with others. They all shared the heroin, cooker and needle to get a fix for the time being.

Regardless of the consequences of HIV contraction, users needed their heroin.

In this community many of the users knew about the risks of sharing needles and were well aware of recommendations that they not share needles or bleach them.  The users actually found health outreach workers slogans patronizing because although they would have  loved not to have to worry about sharing needles, often the more imminent need is getting that fix or suffer being extremely sick from withdrawals.  Given the relatively rare harm-reduction sources available, they were able to use the clean needles given out by some health organizations but at other times had to be resourceful and use what they had regardless of the possible consequences.

There are 1.2 million people living with HIV in the US right now out of a 33.2 million total in the world. 2.5 million people recently acquired the disease and 18% of those new infections were from injection drug users (IDU).  HIV/AIDS is a preventable disease. If we allow users to have easier access to clean needles, we can help decrease the number of IDU infections. If you aren’t sure what your status is, get tested! HIV Testing

Here’s a great resource for finding needle exchanges operating in the U.S. : NASEN

Citation:

Social Misery and the Sanctions of Substance Abuse: Confronting HIV Risk among Homeless Heroin Addicts in San Francisco. Philippe Bourgois; Mark Lettiere; James Quesada. Social Problems, Vol. 44, No. 2  (May, 1997), pp. 155-173. University of California Press on behalf of the Society for the Study of Social Problems.

UNAIDS Website

Reduce HIV Transmission – Shooting up, clean needles, and addiction treatment

Co-authored by: Jamie Felzer

We’ve talked often on this  site about many of the negative things that often come along with heavy drug use. We’ve not yet talked about any of the factors that make injection drug use even worse. Users inject cocaine, crystal meth, and heroin, or any combination of these.

Shooting up and disease

In addition to all of the other, addiction-relevant, factors we’ve talked about on here, injection drug use brings about the worry of blood borne pathogens, especially HIV and Hepatitis C.  While it may not always be easy to find clean needles or worry about cleaning a needle between uses there are steps that can be taken to reduce the risk of transmission.

1. Get Tested!!  HIV/AIDS testing is available all over the world, often for free.   Having another STD or illness can easily kill someone with AIDS. Know your status!

President Obama just finalized a plan to revoke the 22 year travel ban on those living with HIV/AIDS.  This will significantly reduce the stigma of HIV/AIDS and should bring about more testing centers and education.  See this video to hear Obama.

2. While it may not always be easy, take great care to try to check the needle for visible signs of blood before injecting. If you think the needle may have been used before, clean it with bleach or another disinfectant.

3. Utilize the free clinics around your town that give out free, clean needles.  They are there to help you!!  Use these addiction support centers for clean needles and other equipment (like the bleach I mentioned earlier).

4. Talk about it! Regardless of where you may live, the group of people you hang out, studies have shown that talking about this subject matter increases awareness and can decrease chance of infections.  Being informed is your most important tool. For more info check out AIDS Global Information or AIDS Action.

5. Get help! Treatment options are widely available and they serve as a very effective method for reducing risky behaviors.  We can offer you placement help if you’re in southern California, but even if not SAMHSA has a relatively good addiction treatment locator – Check it out.

Citation:

CAPS Fact Sheet: What are IDU HIV Prevention Needs?

How does Obama’s health care reform affect substance abuse treatment for Medicare patients?

Co-Authored by: Jamie Felzer

Medicare and addiction?  Do you typically think of these things as related? After the recent passage of Obama’s health care system reform, those utilizing Medicare and other government-sponsored systems will obviously be affected.

Government sponsored substance abuse treatment

A recent study on substance abuse treatment services for people with Medicare found that those who were younger than 65, and with a disability or mental disorder, had a much higher prevalence of substance abuse. About 100,000 people that fit into this category.

When it comes to debating health care reform, the elderly are the ones that are most often discussed as being affected by the changes in Medicare.  However, there is also a large population of people who are not elderly but also rely on the government-provided health care (like those on Medicaid for instance).

Most often substance abuse treatment co-occurs with mental health disorders, especially in the younger group receiving Medicare services.  76% of the younger claimants received substance abuse and mental health services while for those over age 65, only 54% received both treatments.  However, putting these percentages into the broader picture, only 1% of the elderly Medicare claimants have a primary diagnosis of substance abuse while for the younger group that same classification represents 5.7% of their age group.

How the law will affect substance abuse treatment

Part of Obama’s new health care reform increases the amount of research conducted regarding Medicare/Medicaid patients and their service utilization.  This research will focus on areas of providers, new treatment methods, as well as payment options to best suit all claimants. This could prove very beneficial, especially for those patients seeking treatment for co-morbid disorders.

With the recent passage in Congress of mental health parity laws that are set to begin in 2010, the healthcare system’s overhall should allow substance abuse treatment and mental health services to finally catch up with the rest of the health-care world. American will be far better off for it.

Citation:

Utilization of substance abuse treatment services under Medicare, 2001-2002. Journal of Substance Abuse Treatment. 36 (2009) 414-419

Holahan & Blumberg. An Analysis of the Obama Healthcare Plan. Urban Institute Health Policy Center.

Clubs, drugs, and dancing – Crystal meth, and club drug use

Anyone involved with the dance/rave/club culture knows that drugs often go hand in hand with music and dancing. Club drugs, as well as alcohol and drug abuse, are often rampant in the social groups full of excited club goers. Previous academic studies supported this notion but could not distinguish if the drug use took place inside the clubs/venues or whether people consumed before going out.

A recent study seems to support the latter explanation (drugs consumed before the club); at least for all drugs aside from crystal meth.

Club Dancing

In this study experimenters tested patrons as they entered and exited the club. Approximately ¼ of the attendees tested positive for some sort of drug when they entered as well as when they exited the club. There was not a significant difference in percentage of those that entered with drugs already in their system than those who exited with drug use. This supports the conclusion that no significant amount of drug use took place inside the club (excluding alcohol).

But this wasn’t true for all drugs. Cocaine and marijuana usage was the same at entrance and exit but positive crystal meth tests nearly doubled from entrance to exit.

Frighteningly enough 16% of the patrons exited the club with a BAC greater than .08%. Many of the people who were taking drugs also consumed alcohol which poses an even greater threat since the interactions between drugs and alcohol can cause severe reactions as well as a more severely impaired judgment.

Since most patrons entered with drugs already in their system, it seems reasonable to suggest that these clubs do attract drug users. Most people who entered without drug use did not take drugs during the course of their stay at the club. However the usage of methamphetamines while in the club definitely needs to be looked into further, as the effects of taking that inside the club in addition to drinking can cause many problems (legal and health wise) for both the patron and the owners.

Co-authored by: Jamie Felzer

Citation:

Miller, Holden, Johnson, Holder, Voas, Keagy (2009) Biological Markers of Drug Use in the Club Setting. Journal of Studies on Drugs and Alcohol. Vol 70 (9)

Emotional eating: A possible connection for food addicts

More cake please!!! The supposedly wondeful face of sugar addiction...

Co authored by: Jamie Felzer

Do you ever stuff yourself beyond capacity because you are depressed, feeling inadequate or self conscious?

Are you a perfectionist with difficulty expressing and realizing your feelings, instead turning to food to take out your frustrations?

If so, you may be linking strong emotions and eating- taking your inability to effectively portray feelings and transforming them into feasts of food. This is a problem often experienced by food addicts.

Typically, when under stress or any other strong negative emotion, people tend to lose their appetite.  Instead, those who eat emotionally have an increased appetite and an inability to gauge their eating as it relates to their physical state. Emotional eating does not necessarily involve binge eating, but instead, describes eating associated with particular feelings.

Researchers recently found that high amounts of emotional eating occurred when participants experienced anger, anxiety or depression. Emotional eating was a big factor for those with restrictive types of eating disorders (aka anorexia not bulimia or binging).  However emotional eating occurred often with those who desperately wanted to become thin but still had a tendency to eat according to their emotions.

This leads to eating without actually being hungry but to fill other voids.  Emotional eating involves many ups and downs of eating and those who engage in eating in this manner need help determining what behaviors are healthy and how to work on mind over matter as the saying goes.

Although the majority of cases involved people eating in response to negative emotions some people reported eating comfort foods in response to positive feelings as well.  As stated in Addiction Inbox “In an unconscious effort to raise brain levels of serotonin and dopamine, drug users often discover that doughnuts, cakes, ice cream, soft drinks, and other sugar foods can lessen withdrawal symptoms” which is why many people chose to eat in hopes of combating these strong emotions.

The same pattern of eating can happen for non-users as well, but being aware is the first step to recovery.

Citation:

Courbasson, Rizea, and Weiskopf , (2008). Emotional Eating among Individuals with Concurrent Eating and Substance Use Disorders. Journal of Mental Health and Addiction.