Woo hoo! We’re number… 2 in a rather dubious contest. The Lancet just published a new study reviewing injection drug use data and corresponding cases of HIV/AIDS from 148 countries around the globe. Even without input from Africa, the Middle East, or Latin America, the estimated number of injection drug users is close to 16 million people worldwide.

Three million of those – the same number of people found in the entire city of Los Angeles — are thought to be HIV positive.

Worldwide Statistics for Injection Drug Users

China leads the pack with the largest number of injection drug users. Median estimates place the figure around 2.35 million people, with the prevalence of HIV approximately 12.3 percent (or 289,050).
The United States ranks second with around 1.85 million IDUs, and an estimated case load of 15.6 percent HIV-positive individuals (or 288,600).

Prevalence rates of HIV were found to be the lowest in Australia and New Zealand (1.5 percent and 1.6 percent respectively) in spite of the high number of injection drug users. The most likely cause is thought to be successful needle-exchange programs instituted early in the 1980s when the risk of spreading HIV was first associated with sharing needles.

Prevention Efforts Aimed at Injection Drug Users

Kamyar Arasteh and Don Des Jarlais from Beth Israel Medical Center agree that when, “HIV prevention efforts are implemented on a large scale when prevalence is [still] low in injecting drug users, it is possible to avert HIV epidemics in users.”

Prevention efforts like needle-exchange and syringe-exchange programs, HIV testing, counseling, and medical treatment for the disease can promote proper sanitation and hygiene practices to keep people safe from contagious and infectious diseases of all kinds.

Recommendations to Protect Yourself from Contracting or Spreading HIV

The Centers for Disease Control and Prevention outlines very simple, very specific steps you can take to minimize your risk of infection with HIV/AIDS:

• Only use new, sterile syringes obtained from a reliable source (such as pharmacies or needle exchange programs) – do not reuse and do not share
• Use clean, fresh, sterile water to prepare drugs
• Use a new or disinfected container and filter to prepare drugs (boil in water or disinfect with bleach before each use)
• Clean the injection site with a new alcohol swab prior to injection
• Dispose of syringes immediately after using in a puncture-proof container
• Get tested for the virus every year (on your birthday, anniversary, or another day you’ll always remember)
• Most importantly — enroll in and complete substance abuse treatment and relapse prevention counseling to stop using and injecting drugs

More information on reducing HIV risk from drug use can be found in the “HIV Prevention Bulletin: Medical Advice For Persons Who Inject Illicit Drugs,” available online at the CDC’s website.

Do you have needle exchanges where you are? Are they legal? Underground? How often did you make it there when you needed supplies?

We’ve been talking the past couple posts about the misconceptions that people hold concerning opiate addiction and opiate addicts and how those misconceptions work to prevent those who need it from receiving the treatment they need. Today, it’s racism I want to talk about, racism and its early connections with prejudice against those struggling with drug addiction, and opiate addiction specifically.

Racism and Opiate Addiction: Today Versus Yesterday

Today, racism and addiction comes in many forms. It’s apparent in the fact that there are more billboards and advertisements for malt liquor and cigarettes in predominantly African American neighborhoods and that the majority of offenders serving time for drug possession and sales are African American. But the victims of early racist opinion concerning opiate addiction were not African American but Chinese.

Opium Addiction and Racist Misconceptions

Because opium had been a part of Chinese culture for many years, it was easy for those who wanted to denigrate opium addicts to use racist misconceptions associated with Chinese immigrants to America to do the job on a large scale. Although opium smoking had not had any negative impact on society, stories first published by William Randolph Hearst, a notorious publisher of falsifications, described how women were seduced with opium by Chinese immigrants and how they were stealing jobs from American citizens.
 
Not only was this propaganda racial in nature, but it turned public opinion against opiates and helped to begin the long crusade against opiates and other drugs. Due in part to Hearst’s racist articles, Congress imposed taxes on both opium and morphine. Once opium started to be controlled, withdrawal symptoms ran rampant throughout the communities that used it, which in turn brought more negative attention to the drug because people blamed the negative symptoms on the drug instead of on the fact that people were going through withdrawal from it. Congress then passed an act that made the prescription of opium illegal without first registering and paying a tax.

The Stereotype of Opiate Addicts and Racism
 
With these seemingly (on the surface, anyway) noble acts, the stage was set for the stereotype of the drug addict to be born. The targeted race has changed, but the racism inherent to the so-called War on Drugs makes it something of a witch hunt. With little distinction given to drugs used for medicinal or recreational purposes, the public’s negative opinion of drugs was set and continues today.
 
The negative stereotype of a drug addict was intermixed with racism at the start; do you think it’s still that way, or has it become multi-cultural?

The other day we started this discussion about the misconceptions that people hold about drug addiction and especially opiate addiction as well as the people who are struggling with the disease. Today, I want to talk about the concept of addiction as a medical disease: one that is legitimate. One that can be treated.  

Opiate Addiction is a Disease

Drug addicts are thought of as lawless, reckless, selfish criminals who don’t care for anyone other than themselves. This perception is sad, but even sadder is how common it is. Very few people recognize that drug addiction is really a disease, just like any other. It has a cause, it has symptoms, and it has a treatment if not a cure. But the treatment for drug addiction is very often kept from the hands of those who need it most due to public misconception and hastily constructed laws from the early 1900’s that are still on the books.

The Drug Laws that Bind
 
Back in 1973, President Nixon formed the Drug Enforcement Agency, the same year that the Methadone Control Act was introduced. Methadone, a synthetic opiate, had been used since 1963 to help those struggling with opiate addiction. Methadone had a unique property that meant it only had to be introduced into the system once every 24 hours, instead of once every four to six hours like heroin. In the minds of medical professionals, this helped patients stay off of heroin and stay away from crime, since they no longer needed to find ways to pay for an expensive heroin habit. Sadly, the Methadone Control Act completely changed how doctors could prescribe methadone, making it much more difficult for those who needed it for opiate addiction treatment as opposed to pain management to receive the drug. While it is still possible to get methadone, it is highly regulated and there are many rules and regulations that make it more difficult for some to receive the doses they need to stay clean.

What’s the Problem Here?
 
This is just one example of how drug addiction is misunderstood. With other diseases, like heart disease or diabetes, treatment options that work are not held under tight guard. Doctors are allowed to prescribe insulin to diabetes patients, but what if they weren’t? What if insulin prescriptions were as tightly controlled as methadone? Sadly, this type of scenario might have to take place in order to help the public understand the true nature of addiction, but it’s one that I dearly hope won’t have to happen. Drug addiction is just a disease, and like any other disease, treatments should be available on an as-needed basis without having to jump through hoops and stand in lines to make it happen.

There is a Solution

Thankfully, Suboxone and Subutex, both buprenorphine-based drugs FDA-approved for nothing but opiate addiction treatment, are available through a doctor’s office just like the prescriptions that most likely caused the addiction in the first place.
 
Have you ever thought about drug addiction in these terms? What do you think about the comparison of drug addiction to other diseases like diabetes?