A Crash is Inevitable: The HIV epidemic and Drug Addiction

In the previous article, I tried to shed some light on this current “Opioid Epidemic”, the social and political complexities and it’s intersection with the HIV/ Hepatitis epidemics.

Most recent estimates are that about 9% of new HIV infections in the US are due to injection drug use, primarily opioids. In Eastern Europe, the situation is very different. In Ukraine, it is estimated that about a quarter of all new infections result from sharing needles during heroin use with an infected person, whereas in Russia, that percentage goes up to a staggering 50%! These countries along with other Eastern European countries have very serious opioid epidemics fueling their high HIV infection rates and unlike African and Asian countries, they have failed to implement policies and interventions that have been proven to slow the HIV epidemic.

If there is a silver lining, at least here in the US, we can treat opioid addiction effectively and we have ways to prevent transmission of HIV to uninfected drug users. So let me start by presenting some very basic principles about addiction. Everyone who uses a particularly addictive drug doesn’t become addicted, in fact, most don’t. Recreational drugs have different addiction potentials.

For example, with alcohol, only about 1 in 20 persons who use it will develop an addiction, whereas, for cocaine, it could be as high as 1 in 3 users becoming addicted. There are many factors that determine whether you will be that unfortunate person who becomes addicted. Psychosocial factors are very important determinants but there can be genetic factors as well.

How can we tell if someone is addicted to a drug? There are certain common features for all addictions.

1. Inability to control use. A person finds themselves unable to stop using the drug even when there are problems related to their drug use (e.g. driving while intoxicated, financial chaos, damaged relationships, loss of employment). There are people who can