Drug Addiction and AIDS

441 Pages·1991·21.13 MB·English

by  D. C. Des Jarlais (auth.)

N. Loimer, R. Schmid, A. Springer (eds.)
Drug Addiction
and AIDS
Springer-Verlag Wien New York
DDr. Norbert ~imer
Univ.-Doz. Dr: Rainer Schmid
Univ.-Prof. Dr. Alfred Springer
Department of Psychiatry, University Hospital of Vienna
Austria
The printing of this publication has been supported by a grant of the
Austrian Ministary of Science and Research.
This work is subject to copyright.
All rights are reserved, whether the whole or part
of the material is concerned, specifically those of translation,
reprinting, re-use of illustrations, broadcasting,
reproduction by photocopying machines or similar means,
and storage in data banks.
@) 1991 by Springer-VedaglWien
Printed on acid-free paper
With 52 Figures
ISBN-13:978-3-211-82298-2 e-ISBN-13:978-3-7091-9173-6
DOl: 10.1007/978-3-7091-9173-6
Foreword
Drug abuse and AIDS present a new and unparalleled challenge to our
society. The fatal combination of the two calls for an urgent incentive for new
ideas and strategies to be developed in the fight against this until ,recently
seemingly indomitable enemy.
mY-prevalence among drug abusers has increased markedly during the late
eighties. Whereas the proportion of AIDS cases among that population had
been 1% in 1984, it had jumped up to 29% in 1989. This percentage, as we
know from epidemiological studies, varies greatly for different countries. The
highest percentage of cumulative AIDS cases among drug abusers in Europe
has been found in the southern region, while in Scandinavian countries, with
the exception of Denmark, this percentage is very low. Austria belongs to
those countries with a relatively high prevalence.
This development has had a strong impact on the social response towards drug
abuse and has caused a marked change among health authorities: WHO
experts, for instance have proposed that, controlling drug abuse and pro
moting a healthy life style should remain the long term objectives with highest
priority but that otherwise, in the short term, the priority should be prevention
of AIDS transmission. Most European countries have adopted new goals in
the direction of harm reduction in line with this new approach. Strategies most
prominently used in harm reduction include:
low treshhold counseling and treatment facilities to attract as many drug
users as possible at an early stage in their career;
- the availability of clean needles and syringes;
- AIDS counseling, counseling in safe sex and safe use practices;
- the availability of condoms;
and
- substitution treatment to limit risk-taking behavior.
Not all European countries have adopted all of these objectives but most of
them have implemented at least one or the other, according to their needs and
possibilities. In contrary in the United States the goal of drug policy is to keep
people away from drugs and to fight a war on drugs rather than to shift towards
harm reduction strategies.
Clearly enough these new objectives are accelerating a change of paradigms.
To implement them one has to shift from the sociological/criminological
VI Foreword
paradigm of deviancy to a medical paradigm, identifying the former "drug
fiend" as a ~medical case and accepting him as a patient. A certain "re
medicalization" in the treatment of drug abusers proves that these major
changes have taken place.
In most countries health professionals are not well equipped for these new
tasks which they are confronted with. There is a desperate need for further
information and postgraduate training. Meetings such as the Vienna Sympo
sium on Drug Abuse and AIDS therefore may act as important mediators to
bring together outstanding experts to present their results and to discuss their
experience in front of a large audience of scientists and practitionars in a very
open way.
Information about even radical treatment schemes and discussion of different
strategies in the fight against drug abuse and AIDS is of vital importance at a
time when much more research is needed to understand the epidemiology of
drug use and of HN-infection among drug users and the relationship between
mV-prevalence and certain behavioral patterns of drug users. Moreover,
discussion is, particularly important in a situation where no common philoso
phy about priorities exists and, last but not least, no effective cure for AIDS is
in sight. Discussions such as we have attended in Vienna are stimulating our
intellectual capacities, support unconventional thinking and, on the whole, are
highly motivating. They will definitely help us to develop ideas, which in the
long run may prove helpful to the individuals we are caring for and to the
society we are part of.
Prof. Alfred Springer, M. D.
Director, Ludwig Boltzmann Institute for Addiction Research, Vienna
Contents
Epidemiology
Des Jariais, D. C.: Observations on the Stabilization of mv Sero-
prevalence Among Injecting Drug Users ..................' . . 1
Welle-Strand, G.: mY-Antibody Testing and Risk-Prone Behaviour
Amongst i. v .-DU's in Oslo, Norway . . . . . . . . . . . . . . . . . . . . . 8
Annell, A., Fugelstad, A., Agren, G.: HIV- Prevalence and Mortality in
Relation to Type of Drug Abuse Among Drug Addicts in Stockholm
1981-1988 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Fugelstad, A., Rajs, J.: HIV-Related Drug Addict Deaths Outside
Medical Institutions in Stockholm . . . . . . . . . . . . . . . . . . . . . . . 23
Tirelli, U., Spina, M., Rezza, G., Vaccher, E., Caprilli, F.,
Giuliani, M., Saracco, A., Lazzarin, A., Serraino, D., Gentili, G.,
Accurso, V., Mancuso, S., De Marcato, R.: mv Infection in
403 Female Prostitutes in Italy . . . . . . . . . . . . . . . . . . . . . . . . . 35
Roussaux, J.-P., Jacques, J.-P.: How to Explain the Low Figures of
AIDS Cases Among Intravenous Drug Addicts in Belgium? . . . . . . 40
Sakoman, S., HeCimovic, A.: Drug Addiction and AIDS in Republic of
Croatia and Yugoslavia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Alvarez, F. J., Carmen Del Rio, M.: Drug Abuse in Spain: Epidemiol-
ogy, Policy and Health Structure. . . . . . . . . . . . . . . . . . . . . . . . 70
Staniaszek, M.: Drug Abuse and HIV-Infection in Poland . . . . . . . . . 80
Piischel, K., Mohsenian, F.: HIV-1-Prevalence Among Drug Deaths in
Germany. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Triibner, K., Polywka, S., Piischel, K., Laufs, R.: Hepatitis B,
Hepatitis C and AIDS in Drug Deaths . . . . . . . . . . . . . . . . . . . . 97
Bschor, F., Bornemann, R., Borowski, Ch., Schneider, V.: Monitoring
of mY-Spread in Regional Populations of Injecting Drug Users -
The Berlin Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 102
Uhl, A., Springer, A., Maritsch, F., Pfersmann, V.: 5 Years Follow-up
on Viennese Heroin Addicts ......... . . . . . . . . . . . . . . . .. 110
Pont, J., Neuwald, C., Salzner, G.: Antibody Prevalence of Parenter-
ally Transmitted Viruses (HIV-1, HTLV-I, HBV, HCV) in Austrian
Intravenous Drug Users . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 117
Risser, D., Vycudilik, W., Bauer, G., Reiter, Ch.: Statistical Investiga-
tion on the Relation of Intravenous Drug Addiction and HIV-
VIII Contents
Infection. A Survey of the Years 1985 to 1989 by the Institute of
Forensic Medicine in Vienna . . . . . . . . . . . . . . . . . . . . . . . . .. 126
Loimer, N., Presslich, 0., Werner, E., Pakesch, G., Hollerer, E.,
Pfersmann, V., Vedovelli, H.: HIV-1 Infection Among Intravenous
Drug Users in Vienna 1986-1991. . . . . . . . . . . . . . . . . . . . . . .. 132
Methadone Treatment
Schmidhammer, H.: Opioid Receptors. . . . . . . . . . . . . . . . . . . . .. 143
Beubler, E.: Addiction Potential of Opiates in Medical Use . . . . . . .. 149
Kreek, M. J.: Methadone Maintenance Treatment for Harm Reduction
Approach to Heroin Addiction. . . . . . . . . . . . . . . . . . . . . .. . .. 153
Tagliamonte, A., Maremmani, I., Meloni, D.: Methadone Mainten-
ance: A Medical Approach to Heroin Addiction. . . . . . . . . . . . .. 178
Brewer, C.: Intravenous Methadone Maintenance: A British Response
to Persistent Opiate Injectors. . . . . . . . . . . . . . . . . . . . . . . . .. 187
Blix, 0., Gronbladh, L.: The Impact of Methadone Maintenance
Treatment on the Spread of HIV Among i. v. Heroin Addicts in
Sweden. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 200
Blennow, G.: Methadone Maintenance Treatment (MMT) in Stock-
holm, Sweden. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 206
Niederecker, M., Naber, D., Garwers, C., Volkl, G., Soyka, M.,
Hippius, H.: Methadone Treatment for Opiate-Addicted Patients.
First Experiences of a Prospective Trial . . . . . . . . . . . . . . . . . .. 210
Bocker, F. M.: HIV and Methadone Treatment: The German Experi-
ence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 216
Maremmani, I., Zolesi, 0., Cirillo, M., Nardini, R., Castrogiovanni,
P., Tagliamonte, A.: Drug Addiction Treatment in Italy in the 80s:
Fear of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 223
Maremmani, I., Zolesi, 0., Castrogiovanni, P.: Psycho-Social and
Psychopathological Features as Predictors of Response to Long
Term and High Dosages Methadone Treatment . . . . . . . . . . . . .. 230
Pfersmann, D., Prosche, W., Werdenich, W., Pakesch, G., Pfers
mann, V., Presslich, 0., Loimer, N., Neider, M.: Methadone
Maintenance and Delinquency Rates of Opioid Drug Users. . . . . .. 238
Rittmannsberger, H., Bayer, Ch., Ruschak, M., Silberbauer, Ch.,
Geit, M., Simma, R., Binder, L., Mittermayer, H.: Course and
Outcome of HIV-Positive Drug Addicts in a Methadone Treatment
Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 249
Management and Treatment
Guzei, K., Kenis, P.: Managing AIDS: The European CentreIWHO
Collaborative Study and Database Project. . . . . . . . . . . . . . . . .. 257
Contents IX
Karamustafali~glu, K. 0., Agargiin, M. Y., Karamustasfalloglu, N.,
Alpkan, L.; Eradamlar, N., Beyazyiirek, M.: AIDS Fear and Risk
Behavior in Intravenous Drug Users . . . . . . . . . . . . . . . . . . . .. 267
Dobler-Michola, A., Zimmer Hofler, D., Korbel, R., Uchten
hagen, A.: mY-Risk and Social Integration in Groups of Drug-
Addicts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 272
Nilsen, B., Welle-Strand, G.: Assessment of the Work with Pregnant
i. v. Drug Users in Oslo . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 286
Serraino, D.: Treatment of Heroin Abuse and AIDS in Italy. . . . . . .. 291
Nasierowski, T., Matsumoto, H, Kaminska-Kopicz, E., Babiuch, L.:
Neuropsychiatric Problems and Psychotropic Medication in Patients
with AIDS. Data from Warsaw. . . . . . . . . . . . . . . . . . . . . . . .. 298
Zangede, R., Fuchs, D., Reibnegger, G., Fritsch, P., Wachter, H.:
Neopterin to Predict Disease Progression in Intravenous Drug Users
Infected with HIV- 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 305
Pohl, P., Banged, J., Milly, E., Kemmler, G., Rossler, H., Deisenham
mer, F., Schmutzhard, E.: Spect and Transcranial Doppler Sono
graphy for the Assessment of Cerebral Perfusion in Intravenous
Drug Users with AIDS Encephalopathy . . . . . . . . . . . . . . . . . .. 313
Koyuncuoglu, H.: The Treatment with Dextromethorphan of Heroin
Addicts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 320
Bansinath, M., Shukla, V. K., Goldfrank, L. R., Turndorf, H.: Bu
prenorphine: An Opioid Mixed Agonist-Antagonist as Possible
Antidote for Acute Cocaine Toxicity . . . . . . . . . . . . . . . . . . . .. 330
Bottke, W.: Criminal Law and AIDS. . . . . . . . . . . . . . . . . . . . . .. 340
Strang, J.: The Crisis and Opportunity of AIDS and Drug Misuse. . . .. 355
Prevention
Scully, M., Pomeroy, L., Johnson, Z., Johnson, H., Barry, A.: Ob
served Patterns of mv Related Risk Behaviour Amongst Intravenous
Drug Users Attending a Dublin Needle Exchange in Its First Year .. 368
Heckmann, W., Krauss, G., Gusy, B., Schott-Ben Redjeb, G.,
Seyrer, Y.: Outreach Work as a Strategy for Risk Reduction in
Hard-to-Reach Populations. For Example: Injecting Drug Users. .. 372
Bondolfi, G., Bovet, P.: AIDS Risk Behavior Among Intravenous
Drug Users Hospitalized in a Public Psychiatric Hospital . . . . . . .. 384
Sherr, L.: Campaigns of Fear and Behaviour Change in UK Drug
Users. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 388
Wille, R., Siegismund, H., Pels Leusden, R.: Resocialization and
AIDS-Prevention by Remedacen Substitution . . . . . . . . . . . . . .. 398
x
Contents
Avico, U., Castrogiovanni, P., Dell'Utri, A., Maremmani, 1., Meloni,
D., Mancbni, P. E., Zolesi, 0., Tagliamonte, A.: A Treatment
Modelto Heroin Addicts in Italy. . . . . . . . . . . . . . . . . . . . . . .. 412
Da Silveira, D. X., Da Silva Jr., N.: The Importance ofi.v. Drug Users
Personality Traits in AIDS Prevention . . . . . . . . . . . . . . . . . . .. 426
Observations on tbe Stabilization of HIV Seroprevalence Among
Injecting Drug Users
D. C. DES JARLAIS
Beth Israel Medical Center, 11, Beach Street, New York 10013, NY USA
Introduction
HIV seroprevalence among injecting drug users (IDUs) has
stabilized in a large number of cities, including New York,1
Stockholm,2 Vienna,3 Amsterdam,4 San Francisco,S and Innsbruck.6
This stabilization has occurred at very different levels of HIV
seroprevalence, from the 50% in New York to the 12% in San
Francisco. The precise reasons why the stabilization has occurred
at such differing levels have yet to be determined, but probably
include: the extent to which HIV had already spread among the local
group of IDUs (prior to large-scale AIDS risk reduction); and the
extent to which the local legal, geographic, and social organization
of the "community" of IDUs facilitates the multi-person use of
injection equipment. Stabilization of HIV seroprevalence among
IDUs in various cities has now occurred often enough that it can be
considered a "normal" outcome of an HIV epidemic among IDUs.
The question then arises as to how long such stabilization is
likely to endure. Should it be considered a cresting of the epidemic
to be followed by substantial declines in seroprevalence-as was the
case with traditional epidemics of infectious diseases? Or should it