Journal of General Internal Medicine Produces Special Issue on Substance Abuse
The May 2002 issue of the Journal of General Internal Medicine is devoted to the subject of substance abuse. Published by the Society of General Internal Medicine, the journal promotes improved patient care, research, and education in primary care. Its articles focus on topics such as epidemiology, prevention, the health care system, curriculum development, and other nontraditional themes, in addition to clinical research in problems in internal medicine.
This special issue on substance abuse covers a wide array of subjects related to the use of drugs, alcohol, and nicotine. Needle exchange programs, physician attitudes toward treating patients with substance abuse problems, and the advantages of integrated medical and substance abuse care are among the topics covered.
The findings of several research projects supported by the National Institute on Drug Abuse (NIDA), one of the National Institutes of Health, are presented below.
Cocaine Use Linked to Poor Adherence To Antiretroviral Therapy in HIV Patients
Researchers from the Montefiore Medical Center in New York City measured adherence to antiretroviral drug regimens in 85 HIV-infected current and former cocaine users.
The study's lead investigator, Dr. Julia H. Arnsten, says that active cocaine use was the strongest predictor of poor adherence and, in turn, failure to maintain viral suppression. Overall adherence among cocaine users was 27 percent, compared with 68 percent among subjects who reported no cocaine use during the 6-month study period. Thirteen percent of active cocaine users maintained viral suppression, compared with 46 percent of nonusers.
The study was funded by NIDA.
- WHAT IT MEANS: The findings from this study indicate that interventions to improve adherence to drug regimens to treat HIV infection should include assessing and treating cocaine use by patients.
Physicians, Residents Report Experiencing Less Professional Satisfaction in Treating Substance-Abusing Patients
Based on a survey of primary care physicians, Dr. Richard Saitz, Associate Professor of Medicine and Epidemiology at Boston University School of Medicine and Public Health, reports that residents and faculty physicians find less satisfaction caring for patients with alcohol or drug problems than managing patients with hypertension.
One hundred forty-four residents and faculty physicians were asked about their level of satisfaction in treating patients with substance abuse problems and patients with hypertension.
The study was partially supported by NIDA.
- WHAT IT MEANS: Further understanding and responding to physician satisfaction in caring for drug abusing patients may improve their care
Integrated Medical/Substance Abuse Treatment Increases Likelihood of Patients' Continuing Substance Abuse Treatment
Researchers at the Johns Hopkins Medical Institutions followed the course of 120 adult patients engaged in active substance abuse and who had been hospitalized for treatment of medical conditions. To be eligible for the study, the patients had to report that they wanted to stop using drugs.
Seventy-nine of the patients were given their required medical care, integrated with intensive substance abuse treatment. Forty-one patients received only standard medical care. Upon completion of their hospitalization, more than half (50.6 percent) of the patients who had received the integrated medical/substance abuse treatment entered outpatient substance abuse programs, compared with 2.4 percent of the comparison patients.
The study was partially funded by NIDA.
- WHAT IT MEANS: Hospitals can play an important role in providing needed drug treatment services and referrals to patients with drug-related problems.
Needle-Exchange Program Found to Reduce Emergency Room Visits Among Intravenous Drug Users
A NIDA-funded study in the New Haven, Connecticut area found that a mobile needle exchange program reduced emergency department use among out-of-treatment injection drug users (IDUs).
Dr. Harold A. Pollack, University of Michigan, Dr. Frederick L. Altice, Yale University School of Medicine, and colleagues from Yale University studied 373 IDUs. Of those studied, 117 had used the needle-exchange program and 256 had not.
Emergency department visits declined among the needle-exchange program users and increased among those who did not use the program. There were significant reductions in emergency department use among Hispanics, men, HIV-negative IDUs, and those with mental illness.
- WHAT IT MEANS: Based on these findings, it appears that needle-exchange-based health care services can reduce emergency department use among high-risk IDUs.