Using drugs is a 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.
Requirements for AODA outpatient treatment service providers
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.
Under DHS 75, AODA outpatient treatment services are required to conduct a risk assessment for sexually transmitted diseases, 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:
- Stop using and/or injecting drugs.
- Complete substance abuse treatment.
- The surest way to prevent the spread of human immunodeficiency virus infection and other sexually transmitted diseases is to have sex with only one uninfected partner or not to have sex at all.
- Use latex condoms correctly and every time to protect themselves and their partners from diseases spread through sexual activity.
- Get vaccinated against hepatitis B, and if appropriate, hepatitis A
Persons who should be tested routinely (referred to local public health agency or private physician) for hepatitis C virus (HCV) infection are:
- Persons who ever injected illegal drugs, including those who injected once or a few times many years ago and do not consider themselves as drug users.
- Persons who received a transfusion of blood or blood components before July 1992.
- Children born to HCV-positive women.
- HIV+ persons.
The objectives of conducting surveillance for hepatitis C are to:
- Identify new cases and determine disease incidence and trends.
- Determine risk factors for infection and disease transmission patterns.
- Estimate disease burden.
- Identify infected persons who can be counseled and referred for medical follow-up.
Persons who should be tested routinely (referred to local public health agency or private physician) for hepatitis B (HBV) infection are:
- Persons who have injected illegal drugs.
- Persons entering methadone treatment programs. If there is no serologic evidence of prior HBV infection, hepatitis B vaccine should be administered.
Persons who should be tested routinely (referred to public STD clinic or private physician) for syphilis infection are:
- Persons entering drug treatment programs. Screening should be repeated every year if at-risk behavior continues, or earlier if signs and symptoms suggestive of syphilis infection occur.
Persons who should be tested routinely (referred to public STD clinic or private physician) for gonorrhea infection are:
- Persons with indications of infection or for those who have had sexual contact with infected individuals.
Persons who should be tested routinely (referred to public STD clinic or private physician) for herpes infection are:
- Persons with genital, rectal, or oral ulcers.
Persons who should be tested routinely (referred to public STD clinic or private physician) for HIV infection are:
- Persons entering drug treatment programs. Persons who are HIV-negative, should receive follow-up screening and risk-reduction counseling.
Persons who should be tested routinely (referred to public STD clinic or private physician) for TB infection are:
- Persons entering drug treatment programs.
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.
Where to obtain further information
The Department of Health Services, Division of Public Health, has more information on communicable diseases.
The Center for Substance Abuse Treatment (CSAT) has developed Treatment Improvement Protocols (TIPs)
- TIP #6 Screening for Infectious Diseases Among Substance Abusers
- TIP #11 Simple Screening Instruments for Outreach for Alcohol and Other Drug Abuse and Infectious Diseases