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Thursday, August 20, 2009

hiv and meth-dream on

Thugs and badmen
punks and lifers
locked up interns
pigs and snitches

Rest your weary heads, all is well

You won't be strip-searched, torn up tonight
you won't be cut up, bleeding tonight
you won't be strung out, cold, shaking to your bones
wishing you were anywhere else but right here
So dream on

in june, hrsa published a new document which breaks down quite a bit that is already known about hiv positive folks who use crystal meth. there has been quite a bit of press over the last five years over this particular intersection of crises and i have come to believe that this 5 page overview is thoughtful and concise. i have also come to believe that as a nation and a culture, americans are far far behind the eight ball in understanding substance abuse and in our infancy in dealing with it. just take a look at our prison system if you need some validation on this point.

here is my current favorite excerpt from the document. the thoughtful approach that can be financially supported by the ryan white program could perhaps be utilized to garner further understanding to apply to the rest of our citizens who struggle with meth addiction but without hiv. you can read the rest of the article after the jump

Provider Strategies
Treating HIV-positive meth users requires intensive collaboration among mental health specialists, dentists, pharmacists, social workers, primary care physicians, substance abuse counselors and, in some cases, correctional employees. “Treating patients requires a team. We have an electronic medical record where we share everything, and we have case conferences almost every week,” says Disney. “The case manager makes sure the patient is connected with resources and . . . following their plan; the pharmacist meets with the client and checks to make sure they’re sticking with an HIV medication regimen; the physician is tracking the lab numbers; I’m helping them deal with the deeper emotional issues, and the dentist is working to improve oral health,” Disney adds.

Part of an effective strategy includes dispelling the myth that meth is harder to treat than other drugs. According to Shoptaw, meth users’ rate of retention in treatment is virtually the same as that for other drugs (3 out of 5 people complete treatment).5 Although no specific guidelines exist to screen for meth, some providers use general substance abuse screening tools, a modified CAGE questionnaire or, in some cases, diagnostic testing with informed consent.9

Shoptaw advises providers to use the “5 A’s”: ask if the patient uses meth, assess if he or she is willing to quit meth, advise in a clear voice that it is a good idea to quit, assist the patient with finding intervention, and arrange for followup. Providers should also become familiar with co-occurring disorders and create a referral system with medical professionals in their area who treat those disorders.6

Cultural competency is vital to help providers under­stand not only the drug but also the user population and the reasons for use. Equally important is detection of underlying mental health problems. Inclusion of mental health specialists extends to emergency rooms, where it is important to identify whether patients’ mental health problems are meth induced.

Providers are seeing a specific type of memory impairment among meth-using clients. According to a longitudinal memory performance test conducted by colleagues of Shoptaw, word recall and word recognition among meth users is worse than among clients who do not use meth—even after 6 months of abstinence. No real difference for picture recall and picture recognition tests was found between meth users and other clients.32 Providers should therefore use pictures and write down instructions as well as explain information to patients.

In addition to addressing psychological changes, providers can help counter physical changes resulting from meth use by advising patients to hydrate and to avoid wearing hats so as to lower base body temperature and reduce the risk of malignant hyperthermia. Similarly, patients should be advised to consume protein to help repair muscle fibers and naturally produce and replace dopamine.2 To treat xerostomia, providers can recommend the use of artificial saliva products or sugar-free citrus candies to stimulate saliva production.33

today's sound choice is tongue-in-cheek definitely... christian falk featuring robyn "dream on"



the other cj said...

Do you think it's a myth that meth is harder to treat than other drugs? I'm on the fence.... I know for me, the physical/mental/phsyiological/whatever lasted for months when I put down (I wasn't in treatment at the time).

Maybe meth users who go to treatment centers have a better physical experience than I did--I could barely sleep from nightmares, and then wanted to sleep for days...

I dunno. A spiritual bottom is a spiritual bottom, wherever you land, but it seems to me that the lingering effects of some chemicals might impact recovery rates.

But I don't know much, I just got here.

warrior scout said...

i think that the dopamine dumps that we got using meth are hard to forget. that absolutely overwhelming rush of feelgood that comes with meth is deeply intoxicating and can easily overpower any sense of right or wrong. and then the brain changes that remain after stopping use stay in place sometimes a year or year and a half.
you're right- it is challenging. but definitely worthwhile.


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