Substance Abuse Trends and Practices in the New Millennium

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African American Mens Health Conference

• Henry Skip Francis, M.D.
• OSE/CDER/FDA June 21, 2008

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Substance Abuse treatment and HIV/AIDS

• Finding it
• Treatment
• Complications of Addiction treatment in co morbid
  conditions
• Prevention
• Information sources

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What is a Substance abuser?
An Individual who repeatedly uses a substance or
performs a behavior even with the knowledge of
its negative health consequences
Substances
Behaviors
Eating disorders Sex Gambling
Marijuana Cocaine Heroin Amphetamines et
al. Tranquilizers Hallucinogens Steroids and club
drugs
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Drug Use Epidemiology

• 16 million drug users
• 6 million are regular drug users
• Approximately 10 are IDUs
• 80-90 are Hepatitis C infected
• 25-35 of non IDUs are Hep C infected
• 90 are infected in the 1st 18 months of use

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Legal addictive substances and behaviors

• Alcohol and Tobacco
• Sex
• Gambling
• Internet
• Smart drugs (21)
• Ginkgo Biloba
• DHEA
• Growth hormone
• Viagra

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DRUG TYPES ABSINTHE INHALANTs
MUSHROOMS ALCOHOL NITROUS NUTMEG AMANITAS
IBOGAINE OPIATES AYAHUASCA KAVA PEYOTE CAFFEI
NE KETAMINE SALVIA COCAINE L S D Tobacco D
M T MDMA (ECSTASY) 2C-B D P
T MESCALINE 2C-T-7 D X M MAOIs
5-MeO-DiPT G H B METH 5-MeO-DMT HEROIN
MORNING GLORY











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Drug User ProfileTrouble never travels alone

• 60 male, 45 white, 43 done HS, 53 employed
• 40 HIV or AIDS
• 30 TB skin test positive
• 80-90 Hep C, 40 Hep B, 60 ETOH
• STDs 0 to 80, Females gt Males
• Data is known for IDUs (10 of DU population) only

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Finding Addiction(The CAGE questions)

• Have you ever tried to Cut down on your drug use?
• Have you ever been Annoyed about criticism of
  your drug use?
• Have you ever felt Guilty about your drug use?
• Have you ever had a morning Eye opener?

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Drugs of Preference by Ethnic Group

• African American
• Heroin
• Cocaine (crack)
• Tobacco
• Alcohol

• White American
• Alcohol
• Tobacco
• Amphetamines
• Powder cocaine

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Components of Drug Use Treatment

• Personal needs
• Family services
• Housing and transport
• Financial services
• Legal services AIDS/HIV services
• Educational service
• Medical service
• Vocational service
• Child care service

• Treatment needs
• Behavioral therapy
• Clinical and case management
• Intake and processing
• Treatment plans
• Pharmacotherapy
• Continuing care
• Substance use monitoring
• Self help/peer support groups

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Substance Abuse treatment in HIV/AIDS patients

• Pharmacology of Addiction Medications
• Treatment of Addiction
• Complications of Addiction treatment in co morbid
  conditions
• Referral options
• Information sources

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Integrated therapy

• Drug use treatment
• Medications
• Behavioral and complementary care
• Relapse
• Chronic care
• Co morbid conditions
• Medical
• Psychiatric
• Environmental

• Environmental
• Genetic predisposition
• Social support/surroundings
• Health beliefs
• Health provider capability
• Buprenorphine Training?
• Drug use identification
• Familiarity with co morbid conditions

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Relapse

• Expect it- substance abuse is a chronic condition
• Average 3-4 attempts before maintaining long term
  sobriety1
• Not a failure, but time to intensify treatment
• Primary care provider critical part of relapse
  prevention plan

1 Vaillant, The Natural History of Alcoholism,
1983
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COMORBID CONDITIONS

• Public Health Threats
• Tuberculosis
• HIV/AIDS
• STDs
• Hepatitis B, C, other

• Individual Threats
• Infections
• Violence/trauma
• Overdose
• Chronic drug use
• Drug interactions
• MENTAL HEALTH

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Prevention of drug use and HIV Transmission

• Prevention has several stages in drug users
• Prevention of co morbid conditions is essential
• Homelessness
• Mental Health
• Violence
• Adolescents and orphans
• Drug use prevention is a life long process
• Drug addiction is a chronic disease

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HIV/AIDS Transmission Prevention Targets
Sex
Injection Drug User
HIV HCV
Normal Individual
DrugUser
HCV
IDU
Mother-to-Infant
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An HIV-infected Cocaine Injection
Network(Network 40)
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Referral questions to ask of providers

• What type of accreditation or licensing does the
  program have?
• Have there been studies on effectiveness of
  programs treatment effectiveness?
• Knowledge and competence using medications.
• Is there an aftercare program?
• Drug relapse policy

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Contact informaton

• NIDA www.nida.nih.gov
• SAMHSA www.samhsa.gov
• DEA www.dea.gov
• Adolescent info www.bluelight.nu
• Drug info www.erowid.org
• Henry Francis, M.D. Henry.francis_at_fda.hhs.gov