Archive for the ‘needle fixation’ Category

Opioid Addicts in Indiana Contract HIV

aaaaaaaaaaaaindianaThe New York Times ran an article 5/5/15 about a small town in rural Indiana that is facing a relative epidemic of new cases of HIV.

Austin, Indiana, a town of only 4200, has more than 140 people just diagnosed with HIV. The town is struggling to understand what to do about this epidemic, since the area has had a low HIV rate in the past.

The new cases of HIV were intravenous opioid addicts, and Opana was specifically mentioned by the opioid addicts in the article.

As in many small towns, needle exchange has been met with resistance from citizens who feel giving free needles to addicts only serves to encourage them to use more drugs.

Fortunately, the Indiana governor has authorized a needle exchange program for the area where addicts were sometimes using the same needle as many as three hundred times. Unfortunately, the needle exchange is not being run according to best practices. People must sign up for the service. Obviously, many opioid addicts who could benefit from free new needles are hesitant to register with anyone, due to the shame and stigma associated with addiction in this country.

To add to the difficulty, local police still arrest any addict found with needles, unless they are enrolled with the needle exchange. In other words, if one addict signs up for needle exchange and distributes these new needles to other drug users, those users could still get arrested if the police find their needles. Police say they are doing this to force addicts to register with the needle exchange.

We already know, from decades of studies, that actions like these by the police erode trust in the whole needle exchange program. Studies show needle exchange works best when people aren’t asked to register, and are allowed to procure free needles for other people who won’t come to a needle exchange. These type programs are very effective at halting the spread of HIV

The article only tangentially mentions treatment; it says some intravenous drug users have gone to a residential treatment center about 30 miles away, and others remain on a waiting list.

Sadly, no mention is made of medication-assisted treatment of opioid addiction with buprenorphine and methadone.

I did my own research: residents of Austin can drive to an opioid addiction treatment center less than a half hour away, in Charlestown, Indiana Also, there are at least two OTPs in Louisville,, only a few minutes farther, in Kentucky.

I hope someone is telling all the opioid addicts about this option. We know that after an opioid-addicted person enters medication-assisted treatment, the risk of contracting HIV drops at least three-fold. Thankfully HIV can now be treated, and is more like a chronic disease than the death sentence it was twenty-five years ago, but wouldn’t it be better to prevent HIV in the first place?

I fear Austin, Indiana is a harbinger of things to come in other small towns in our nation. Let’s stop with the politics, and get patients into medication-assisted treatment. Let’s do unrestricted needle exchange, and let’s hand out naloxone kits!

Needle Fixation

I’m reading an interesting book that covers different aspects of injection drug use: the history of “recreational” drug injection, pharmacological aspects of injecting, social aspects, health complications, infectious transmissions, and something called “needle fixation.” The authors define needle fixation as “the habit of injecting compulsively,” where the process of injecting becomes as important or more important than the drugs. (1)

That chapter was particularly interesting. I’ve heard patients talk about how they are addicted not only to the drugs, but also to the ritual of drawing their drug up into the needle, and the act of injecting it. This chapter says not all addicts who inject develop this sort of intense relationship with the act of injecting. The authors wrote  a list of questions meant to assess the degree of needle fixation.

For each question, the addict can answer “strongly disagree,” “disagree,” “neither agree nor disagree,” “agree,” or “strongly agree.” The more answers under the “agree” or “strongly agree,” the worse the needle fixation, except for questions 6 and 11, which are scored in the opposite direction.

Here are the questions:

  1. I inject water if I have no injectable drugs available.
  2. I enjoy the pain I experience when injecting myself or when injected by others.
  3. I think that I would find it more difficult to give up the act of injecting than to give up my preferred drug.
  4. I find the thought of injecting a partner sexually arousing.
  5. I am attracted to the needle because of the association with pain.
  6. If I could get the same rush without the hassle of using the needle I would give up injecting.
  7. I find the thought of being injected by a partner sexually arousing.
  8. Injecting water has a calming effect on me.
  9. I flush blood in and out of the syringe barrel before/after injecting the drug.
  10. I find injecting sexually arousing.
  11. If someone invented a method of taking drugs that gave me a better rush than the needle, I would give up injecting and use this.
  12. I continue to flush blood in and out of the syringe barrel even if there are blood clots.
  13. The act of injecting has become a substitution for sex for me.
  14. The preparation and process of the injection is more important to me than the drug rush.

The higher the score, the worse the needle fixation.

Apparently there’s sometimes a sexual aspect of injecting, or injecting your partner, about which I was clueless. The above questions indicate such a relationship. The authors of that section of the book talk about the symbolism of the needle (phallus), and the sadomasochistic side of the pain of the needle and the pleasure that follows with the drug intoxication. Part of me wondered about that last part.

I really wanted details about how I can help addicts on methadone or buprenorphine to lose the obsession and compulsion to use a needle. Unfortunately, the authors say no specific therapy or counseling technique has been proven to be superior to others. They do state the obvious, that the dose of maintenance medication (methadone or buprenorphine) should be high enough to prevent physical withdrawal.

Hopefully I can use this information to ask better questions, and get a better understanding about why people inject, particularly after they’re in treatment. Acknowledging the compulsion to continue using needles even when not in withdrawal will at least bring the issue into the open. Maybe it will help to know that other people have had this compulsion, and with counseling and time have been able to overcome it.

1. Pates et. al., editors, Injecting Illicit Drugs, (Mauldin, MA, Blackwell Publishing, 2005) pp 47-58.