The committee believes that primary prevention of drug use is an important national goal, but questions remain as to whether even substantial improvement in primary prevention would reduce injection behavior. Because many people report smoking marijuana and relatively few go on to inject heroin or other injectable drugs, the efficiency of attempts to stop marijuana use as a way to prevent IV drug use is questionable. Nevertheless, primary prevention of IV drug use is critical in the light of HIV infection; such prevention requires a better understanding of the complex behaviors and conditions that surround the injection of illicit drugs.

Why does heroin use create special risk for contracting HIV/AIDS and hepatitis B and C?

The graphic below is taken from the Elimination barometer on viral hepatitis among people who inject drugs in Europe (prevention component). To view an interactive versions of the infographic below, as well as to access its signs of drug use source data, click on an the infographic. Additionally, steroid abuse can lead to endocarditis, a dangerous inflammation of the inner lining of the heart, and a number of different viral infections at injection sites.

Supplementary Data

Although testing and treatment for HIV, HCV and HBV are available in many prisons across Europe, little is known about the levels of coverage and the numbers of people in treatment. Needle and syringe programmes, while widely implemented in the community, are available in prison in only three EU Member States. The ECDC and the EMCDDA provide guidance for preventing the spread of blood-borne viruses in prison settings. A number of additional interventions have been explored with regard to their effectiveness in the prevention of infectious diseases in people who inject drugs, but the evidence here is less clear.

Non-Injection Drug Users

Prostitutes have shown a willingness to use condoms with clients, although they report safer sexual practices less often in the context of personal relationships. Popular lore about heroin users holds that, once they are “hooked,” their appetite for the drug is so great that they will run any risk to obtain it. In contrast, research has shown that users adjust their consumption to such external factors as price and availability (Waldorf, 1970; Hanson et al., 1985). This ability to adapt to various social and market forces also sustains the belief among many users that they are not addicts but merely visitors to the heroin scene who are still in control of their lives (Fields and Walters, 1985).

• A series of compounded environmental factors, including a long period of drought followed by extreme precipitation, is hypothesized to have driven an upsurge in rodent populations causing the emergence of pulmonary hantavirus in 1993 (ref.18).
• Nevertheless, women are often omitted or seen as peripheral in ethnographic accounts of the heroin world, and studies of female IV drug users are rare (Rosenbaum, 1979a).
• As discussed in Chapter 2, prostitutes are at risk of acquiring HIV infection through both sexual and drug-use behaviors.
• Sharing injection equipment among friends and injecting each other appear to have strong sexual connotations.

Still Reaching: The Syndemics that Complicate and Characterize How Drugs and HIV Intersect in People’s Lives

When using multiple data sources to estimate the total number of IV drug users, it is important to keep the drug user definition constant across all sources. The level of precision of this definition for any given study will depend on the study’s purpose. To study the transmission of HIV infection, for example, researchers will need to estimate seroprevalence for IV drug users classified by frequency of injection, how long they have been injecting, whether they share needles and with whom, as well as other relevant dimensions of drug use. As discussed in Chapter 2, prostitutes are at risk of acquiring HIV infection through both sexual and drug-use behaviors. A 1987 survey of street prostitutes in the New York City area indicated that approximately one half had injected drugs at least once and one third had injected drugs at some time during the previous two years (Des Jarlais et al., 1987). The prevalence of unprotected intercourse among prostitutes varies with the context of the sexual encounter; safer sex is practiced by female prostitutes in professional relationships more often than in personal ones (Cohen, 1987; Darrow et al., 1988).

They isolated and compared the drug-sensitive and drug-resistant malaria parasites, some of which were treated with ART and others left untreated as controls. The analysis revealed changes in the tRNA modifications of drug-resistant parasites, and these modifications were linked to the increased or decreased translation of specific genes in the parasites. The researchers investigated the role of epitranscriptomics—the study of RNA modifications within a cell—in influencing drug resistance in malaria by leveraging the advanced technology and techniques for epitranscriptomic analysis developed at SMART.

• Yet these same identification practices can improve the quality and richness of data and facilitate the evaluation of programs.
• Trade drives this pattern by facilitating the translocation of hosts and pathogens across the geographical and ecological boundaries that constrain their spread.
• Both drugs of abuse and infections such as HIV and HCV affect almost every physiological/biochemical system in the body.
• In part this may be explained by the high costs of the new medications, although barriers to detection and treatment for hepatitis C are also likely to play a role.

How did the COVID-19 pandemic impact substance use treatment and recovery services?

The COVID-19 pandemic has highlighted the large racial and other health equity disparities in the United States that play a role in addiction. However, other factors beyond the pandemic itself, such as proliferation of illicit, potent fentanyl in the drug supply, also occurred during the pandemic years, making it difficult to determine the exact cause of the increase. In U.S. outpatient doctors’ offices specifically, 1 out of every 3 antibiotic drugs prescribed is unnecessary.

• As the HIV population ages, it is expected that patients will develop age-related chronic conditions of cardiac and renal disease, malignancy, etc. whether they develop them prematurely or with greater morbidity.
• It is not due to any one bacterium, and any bacterium capable of releasing acid after ingesting sugars can contribute to this.
• Current estimates of drug frequency in DUID cases are likely to be inaccurate and actual usage is likely to be higher than previously believed due to stop limit testing.
• When the latent period equals the incubation period (dashed line in the figure), symptoms occur at a similar time to infectiousness (for example, influenza).
• An analysis of electronic health records from more than 73 million patients at 360 U.S. hospitals in June 2020 found that while people with substance use disorders made up only 10.3% of the study sample, they accounted for 15.6% of patients diagnosed with COVID-19.
• Methadone maintenance programs reduced injection drug use from 81 percent to 29 percent after five years of treatment, according to UC Davis researchers.

Side Effects of HIV Medicines

More than 110,000 people died from drug overdose in the U.S. in 2022 according to the Centers for Disease Control and Prevention, the most in any year to that point. This increase follows a steady rise in overdose deaths in the United States that has been occurring since at least the 1980s. Fentanyl and other synthetic opioids have been the main drivers of overdose deaths since 2016. Drug misuse and addiction can affect the body in ways that can increase the likelihood of worse health outcomes from COVID-19.