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Substance Abuse Trends and Practices in the New Millennium

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An Individual who repeatedly uses a substance or performs a ... CAFFEINE KETAMINE SALVIA. COCAINE L S D Tobacco. D M T MDMA (ECSTASY) 2C-B. D P T MESCALINE 2C-T-7 ... – PowerPoint PPT presentation

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Title: Substance Abuse Trends and Practices in the New Millennium


1
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2
African American Mens Health Conference
  • Henry Skip Francis, M.D.
  • OSE/CDER/FDA June 21, 2008

3
Substance Abuse treatment and HIV/AIDS
  • Finding it
  • Treatment
  • Complications of Addiction treatment in co morbid
    conditions
  • Prevention
  • Information sources

4
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
5
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

6
Legal addictive substances and behaviors
  • Alcohol and Tobacco
  • Sex
  • Gambling
  • Internet
  • Smart drugs (21)
  • Ginkgo Biloba
  • DHEA
  • Growth hormone
  • Viagra

7
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











8
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

9
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?

10
Drugs of Preference by Ethnic Group
  • African American
  • Heroin
  • Cocaine (crack)
  • Tobacco
  • Alcohol
  • White American
  • Alcohol
  • Tobacco
  • Amphetamines
  • Powder cocaine

11
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

12
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

13
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

14
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
15
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16
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

17
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

18
HIV/AIDS Transmission Prevention Targets
Sex
Injection Drug User
HIV HCV
Normal Individual
DrugUser
HCV
IDU
Mother-to-Infant
19
An HIV-infected Cocaine Injection
Network(Network 40)
20
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

21
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
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