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On August 1, 2000, the Department of Health Services, Division of Supportive Living, DHS 75, Community Substance Abuse Service Standards, was promulgated.
Using drugs is an important risk factor for disease. Drug use is associated with such risk behaviors as the sharing of contaminated needles and other drug paraphernalia, and unsafe sexual practices that contribute to the transmission of certain infectious or communicable diseases.
There has been a steady increase in the incidence of hepatitis B, despite the availability of a vaccine. The prevalence of hepatitis C in drug users, and in injection drug users specifically, is also high. The association between syphilis and drug use has been substantiated by retrospective studies and is particularly strong among cocaine users.
Many drug users are reluctant to become involved with traditional medical providers because of previous poor treatment and insensitive care. As a result, they may not seek testing for and treatment of infectious/communicable diseases. Further, lack of access to health care, either due to financial or other socioeconomic reasons, may mean that drug users may have had minimal or no medical care before entering a treatment service.
Substance abuse services are the ideal beginning to provide infectious/communicable disease screening. Service staff have a good understanding of the lifestyles of individuals who use drugs and are sensitive to and knowledgeable about their concerns and needs.
Screening for infectious/communicable diseases in patients may be especially important to their recovery effort, may result in improved health and improved treatment compliance, and may prevent the spread of debilitating and life-threatening infectious/communicable diseases. Integration of drug treatment and infectious/communicable disease screening offers an important therapeutic intervention for patients, their families, and the broader community.
This is a new administrative rule for alcohol and other drug abuse (AODA) outpatient treatment services that receive certification under DHS 75. AODA outpatient treatment services are required to conduct a risk assessment for sexually transmitted diseases (STDs), human immunodeficiency virus (HIV), hepatitis B and C, and tuberculosis (TB). The evaluation/ assessment must be conducted by the AODA outpatient treatment service and may include on-site testing, performed by trained medical personnel. Those patients testing positive must be referred to the local public health agency for appropriate follow-up.
Basic prevention messages for persons with high-risk drug or sexual practices include:
Persons who use illegal drugs or have high-risk sexual practices should be provided with information regarding how to reduce their risk for acquiring bloodborne and sexually transmitted infections or of potentially transmitting infectious agents to others.
The objectives of conducting surveillance for hepatitis C are to:
What if someone refuses testing?
Patients have the right to refuse to be tested for infectious/communicable diseases and should not be denied treatment services based solely on that refusal, except where there is a potential public health threat to other patients or service staff. Treatment providers must evaluate the potential exposure risk for other patients and treatment staff, particularly for potential exposure to infectious tuberculosis (TB). In all instances, patients should be educated about the benefits to themselves and others from proper and early diagnosis and treatment for infectious/ communicable diseases.
The Center for Substance Abuse Treatment (CSAT) has developed Treatment Improvement Protocols (TIPs)
# 6 (BKD131 & BKD131C) on Screening for Infectious Diseases Among Substance Abusers, and
TIP # 11(BKD143 & BKD143C) Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases.
Both of these publications are available by calling 800-729-6686; TDD (hearing impaired) 800-487-4889.
The web-site for the Centers for Disease Prevention and Control has a vast amount of information available on all communicable diseases. The address is www.cdc.gov.
Last Revised: July 05, 2012