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Note: The following Graphs, Background, Area Description and Data Sources are an excerpt from the “Drug Abuse Trends Minneapolis/St. Paul, MN for January 2010, by Carol Falkowski, Alcohol and Drug Abuse Division, Minnesota Department of Human Services. To download the entire PDF, please go to: http://www.dhs.state.mn.us/main/groups/disabilities/documents/pub/dhs16_147922.pdf
Source: Drug and Alcohol Abuse Normative Evaluation System (DAANES), Minnesota Department of Human Services, 2009. Total number of admissions = 10,315. Primary substance unknown = 60.
Source: Drug and Alcohol Abuse Normative Evaluation System (DAANES), Minnesota Department of Human Services, 2009.
Source: Drug and Alcohol Abuse Normative Evaluation System (DAANES), Minnesota Department of Human Services, 2009.
Background
This report is produced twic annually for participation in the Community Epidemiology Work Group of the National Institue on Drug Abuse, an epidemiological surveillance network of research from 21 U.S. metropolitan areas, and is also available at: www.dhs.state.mn/adad
Area Description
The Minneapolis/St. Paul (”Twin Cities”) metropolitan area includes Minnesota’s largest city, Minneapolis (Hennepin County,) the capital city of St. Paul (Ramsey County,) and the surrounding counties of Anoka, Dakota, and Washington. Recent estimates of the population of each county are as follows: Anoka, 313,197; Dakotak, 375,462; Hennepin, 1,239,836; Ramsey 515,274; and Washington, 213,395, for a total of 2,557,165, or roughly one-half of the Minnesota State population. In the five-county metropolitan area, 84 percent of the population is white. African-Americans constitute the largest minority group in Hennepin County, while Asians are the largest minority group in Ramsey, Anoka, Dakota, and Washington Counties.
Data Sources
Treatment data are from addiction treatment programs (residential, outpatient) in the five-county Twin Cities metropolitan area as reported on the Drug and Alcohol Abuse Normative Evaluation System (DAANES) of the Minnesota Department of Human Services (through June 2009).
Crime laba data are from the National Forensic Laboratory Information System (NFLIS), sponsored by the U.S. Drug Enforcement Administration.
College student alcohol use data are from the 2009 College Student Health Survey, conducted by Boynton Health Service, University of Minnesota. N = 5,692 students randomly selected from nine Minnesota colleges and universities.
Being drunk and asleep at the wheel of his car while it was parked in his apartment lot with the keys on the console was sufficient evidence to convict a Crookston man of drunken driving, the Minnesota Supreme Court ruled unanimously Thursday [January 21].
In a seven-page decision, Justice Alan Page said the jury could reasonably conclude that Daryl Fleck was in “physical control” of his vehicle when arrested.
Fleck’s appellate lawyer, G. Tony Atwal, an assistant state public defender, disagreed with the ruling. “Presumably, if you’re in or about your car, the county attorney could now charge you with a physical control DWI,” Atwal said.
In 2007, Fleck was drunk and asleep in his car with the driver’s door open in the assigned parking spot at his apartment building when someone called police. He got his fourth drunken-driving conviction and was sentenced to four years in prison. The state Court of Appeals affirmed his conviction, setting up the appeal to the Supreme Court.
Atwal said he pushed the appeals because there was no indication Fleck had driven; the engine was cold, and the car wouldn’t even start when an officer tried it. If the car had been by the side of the road, it would have been very different, Atwal said.
The Supreme Court resoundingly disagreed.
Page emphasized that the law says “physical control of a motor vehicle” in an attempt to deter intoxicated people from getting into cars except as passengers and to help nab drunken drivers.
“Mere presence in or about a vehicle is insufficient to show physical control; it is the overall situation that is determinative,” he wrote.
He acknowledged that Fleck’s circumstances were not typical for a “physical control” drunken-driving offense because the jury couldn’t infer Fleck drove to the spot where he was found.
But a jury could reasonably determine that “Fleck, having been found intoxicated, alone, and sleeping behind the wheel of his own vehicle with the keys in the vehicle’s console, was in a position to exercise dominion or control over the vehicle and that he could, without too much difficulty, make the vehicle a source of danger,” the justice wrote.
Page said that in evaluating whether someone has control, the courts and juries consider a number of factors: proximity to the car, the location of the keys, whether the person was a passenger, the ownership of the car and whether it was operable.
He cited a case in which the state Supreme Court reinstated the drunken-driving charge of a person found behind the wheel of a car that was stuck and couldn’t be moved without a tow truck. Page said the court determined that “intent to operate” isn’t a requirement for finding that someone was in “physical control” of the vehicle.
Fleck remains in treatment and under court supervision, Atwal said.
Steve Simon, a University of Minnesota law professor and head of the DWI Task Force, said arrests such as Fleck’s are so common the suspects have a name: “slumpers.” He said that more often police find drivers passed out at a stoplight or parked by a roadside.
He said state law broadly defines “physical control” because “you don’t want people to get into a car if they’ve been drinking.” In one case, a person got a drunken-driving charge because he was steering an inoperable car that was being towed, Simon said.
In another Minnesota case, a man was drinking at home, then went to listen to the high-end stereo in his new SUV parked outside. Simon said neighbors called police about the noise, and the man ended up with a drunken-driving charge and an impounded vehicle.
Resource:
Olson, Rochelle. “High Court: Asleep at wheel, not driving, enough to get a DWI.” Star Tribune. 22 Jan. 2010. Web 29 Jan. 2010. http://www.startribune.com
Methadone maintenance therapy (MMT) is the most widely used opioid agonist treatment for opioid dependence in the world. To determine the effectiveness of MMT compared with no treatment or treatment not including agonist therapy in patients with opioid dependence, Cochrane Collaboration researchers conducted a systematic review of clinical controlled trials done between 1969 and 2008. Eleven randomized controlled trials including, coincidentally, a quantity of 1969 patients and conducted in 5 different countries were identified.
Outcome measures included treatment retention, mortality, opiate-positive drug test results, self-reported heroin use, and criminal activity. Study control groups included patients who received a double-blind placebo, those who received methadone for detoxification only, those who received counseling only, those wait-listed for treatment, and those receiving no treatment. The mean dose of methadone among patients in the MMT group was 60 mg or higher in most studies.
- MMT significantly increased retention in treatment, decreased morphine-positive drug tests, and decreased self-reported heroin use.
- MMT reduced mortality risk and criminal activity, but theses changes were not statistically significant.
Comments by Michael Levy, PhD
This meta-analysis demonstrates that, compared with no treatment or drug-free alternatives, MMT increases treatment retention and reduces heroin use in patients with opioid dependence. Although some treatment providers continue to discourage MMT, it is an effective treatment for heroin dependence, particularly for those patients who have not been able to achieve benefit through drug-free alternatives.
Reference:
Mattick RP, Breen C, Kimber J, et al. Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Syst Rev. 2009(3):CD002209.
The first time Cesar Baltierrez was caught driving drunk, he lost his license for 30 days. The second time, it was six months. When caught a third time in March 2009, he knew he could lose his license for a year, and authorities could seize and auction his car.
Baltierrez was frantic. He needed to drive to work to support his two children. Then he discovered he qualified under a special program to volunteer to have a device installed in his car that would let him drive it only when sober.
Baltierrez must breathe into an ignition interlock switch that won’t let him start the car if his blood-alcohol concentration is above 0.02 — one fourth the normal legal limit to drive. He is one of about 500 Minnesotans currently using the devices under a pilot program that went statewide in July, following the example of many states that use the technology routinely.
“I haven’t drank for 10 months now,” Baltierrez said. “I know there are consequences if I do drink.”
Minnesota lawmakers will review the pilot program in 2011 and decide whether to make the devices mandatory for offenders. Mothers Against Drunk Driving renewed its call for the devices after Paul Garay, of St. Paul Park, was infamously charged with his 20th drunken driving offense in December.
Authorities who work with drunken drivers also advocate for the widespread use of the devices, noting that although they don’t change long-term behavior, they have been shown to be an effective component in a comprehensive approach to chemical dependency treatment.
“It’s the technology of the future,” said Jean Ryan, alcohol programs coordinator at the Department of Public Safety’s Office of Traffic Safety. “We were the last [state] to pass 0.08. We don’t want to be the last [state] to use technology that prevents drunk driving.”
There were 35,736 DWI arrests in Minnesota in 2008, and 163 alcohol-related traffic deaths. About 40 percent of the state’s DWI arrests involve repeat offenders, and a third of traffic deaths are alcohol-related.
Check and recheck
Ignition interlock devices are installed in a vehicle’s console. The device requires drivers to blow and then inhale for a certain amount of time. It requires a second breath test five minutes into the drive and randomly times tests after that.
If the driver fails, the device disables the car.
For the pilot program, vendors download information from the device once a month, and the data are monitored by the state Department of Public Safety. Failures are reported to probation officers. Just a few days ago, Baltierrez’s device malfunctioned. He immediately made his way to downtown Minneapolis and provided a urine sample to prove his sobriety.
“Sometimes, it gets annoying, but I guess that’s the price we pay,” he said.
The pilot program was started in 2006, with Hennepin and Beltrami counties. It worked well in Hennepin County, but Beltrami County participants found their rural location made it difficult and costly to obtain and service their devices through the one vendor, in the Twin Cities area.
No repeat offenses
About 100 people in Hennepin County had the devices, and none re-offended while using it, said Emil Carlson-Clark, a county probation officer. Since the pilot program’s statewide expansion last summer, the number of participants has increased by about 100 each month, and now the cost is lower because the number of vendors has grown to four, Ryan said.
“It’s gotten better,” said Sheila Fontaine, a probation officer who works with Beltrami’s DWI offenders. “On a regular basis, we have people opting for this program.”
Offenders pay about $50 for a private vendor to install the device in their car, $75 to $100 each month to have the device monitored and about $50 to have it removed. Someone with three DWI convictions in 10 years can expect to have the device for two years.
There is a potential cost-savings to counties, given that it costs about $90 a day to detain someone in the Hennepin County Jail, said Fourth District Judge John Holohan, who oversees the county’s DWI court.
The devices have grown in popularity nationwide since the early 2000s, but some states have been using them intermittently since the 1990s, including Wisconsin and Illinois. In 2008, Illinois made the devices available for first-time offenders on a voluntary basis and made them mandatory for repeat offenders.
Mostly voluntary
Minnesota’s pilot program generally offers them to repeat offenders who volunteer, although some judges can impose them as a condition of release.
Starting in July, Wisconsin will require first-time offenders with a blood-alcohol level higher than .15 and all second-time offenders to have a device. Wisconsin logged 1,748 orders for the devices in 2001. That grew to 4,177 in 2007.
About 22 states use interlock devices for first-time offenders, Ryan said.
For now, Ryan said, Minnesota is moving at a slower pace, banking on the success of such people as Baltierrez to demonstrate why use of the devices should become routine. Driving with one has been life-changing, said Baltierrez.
“I can see that my life is better than from when I was drinking,” he said. “I’m pretty sure I’m not going to go back.”
Resource:
Xiong, Chao. “Drink and drive? These Minnesota cars just say no.” StarTribune. 18 Jan. 2010. Web 19 Jan. 2010. http://www.startribune.com
Edward Yaekle was addicted to heroin for more than 16 years. At one point, the Anoka resident spent $50 a day for a bag and eventually became a dealer.
Four years ago, he woke up in the Anoka County Jail for conspiracy to distribute heroin. Realizing the drug could kill him, Yaekle, now 44, sought treatment. And he stopped for good.
Yaekle’s story could have ended tragically, as it has for other addicts.
Law enforcement officials said Tuesday that heroin use and overdose deaths have increased in the Twin Cities area at an unprecedented rate. Recent studies also have found heroin brought to Minnesota has the highest purity in the country, not to mention the lowest cost.
At a news conference, the Anoka County and Hennepin County sheriff’s offices spoke of the “alarming” rate of heroin-related deaths in the past two years.
Between 2008 and November 2009, there were 36 fatalities in Anoka, Ramsey, Dakota and Hennepin counties.
Anoka County Sheriff Bruce Andersohn said five people died from heroin use in the county in the past two years, whereas there were no deaths the previous three years, possibly even longer. “The resurgence of heroin cases is alarming,” he said.
According to a Minnesota Department of Human Services report released last summer, heroin found in Minneapolis had the highest purity level — almost 60 percent — than any other city in the United States. In addition, law enforcement officials said Tuesday that one-tenth of a gram of heroin, or about two uses, costs $50 in the metro area. They say the cost is much lower than for addictive painkillers such as oxycodone. As a result, addicts sometimes turn to opiates such as heroin.
As that happens, counties are seeing more heroin abuse and overdose cases.
Hennepin County Sheriff Rich Stanek noted 16 heroin-related deaths during the past two years and an increasing number of heroin-related arrests and seizures. “We’re seeing Hennepin County as a growing concern,” he said.
Officials say much of the heroin in Minnesota likely comes from Mexico and southern border states. The higher potency rate could be accidental or intentional to bring on addiction.
According to the Minnesota Department of Human Services, heroin cases — including emergency-room visits, those seeking treatment and overdose deaths — have increased, while methamphetamine and cocaine cases have decreased or held steady since 2006. The number of admissions for heroin treatment and other opiates has more than doubled to almost 2,500 cases since 2002.
“Heroin in particular is a threat because of its highly addictive and high overdose potential. … I don’t think we’ve seen this degree of heroin use and addiction in the Twin Cities before,” said Carol Falkowski, director of the department’s Alcohol and Drug Abuse Division. “Even experienced heroin users cannot tell the purity of heroin by its appearance, so they always run the risk of accidentally overdosing.”
Yaekle doesn’t want heroin to take over the lives of others as it did his, so he has set up a Web site sharing his story and responds to every e-mail from concerned family members and drug users seeking advice on how to quit.
He tells families a sign someone is addicted is catching him or her in lies in order to hide using, obtain money or gain a place to stay.
For users, he recommends a long-term detox program. “Long-term is important,” he said. “Once you get rid of the initial withdrawals, the cravings don’t dissipate for a couple of months.”
Yaekle regrets deceiving friends and family and that he wasn’t there for his kids. To this day, one of his daughters won’t speak to him.
“You’ll steal, you’ll cheat, you’ll rob. There are things I’ve done, relationships that I’ve ruined that I can never repair,” he said. “I want to take all of those negative experiences and do something positive with it. I want people who are addicted to get better.”
Resource:
Ngo, Nancy. “Heroin use, overdose deaths on the rise in metro area, law enforcement officials report.” Pioneer Press. 13 Jan. 2010. Web 15 Jan. 2010. http://www.twincities.com
Authorities are planning extra patrols in 13 counties that had more than half of Minnesota’s alcohol-related deaths and serious injuries over the past three years.
The Department of Public Safety said extra DWI patrols will be conducted next year in:
- Anoka County
- Dakota County
- Hennepin County
- Olmsted County
- Otter Tail County
- Ramsey County
- Rice County
- St. Louis County
- Scott County
- Sherburne County
- Stearns County
- Washington County
- Wright County
Those 13 counties had 267 deaths and 605 serious injuries from alcohol-related crashes from 2006-2008.
Olmsted, Otter Tail and Scott counties are new to the list, replacing Blue Earth, Crow Wing and Itasca.
The department said enhanced patrols in the deadliest counties have resulted in more than 13,000 DWI arrests in the last five years. That works out to about one arrest per 16 traffic stops.
Resource:
“Minnesota’s 13 deadliest counties for DWI named.” LaCrosse Tribune. 11 Dec. 2009. Web 11 Jan. 2010. http://www.lacrossetribune.com
It’s a dilemma doctors face all the time. A new patient claims to be in serious pain and asks for Vicodin or OxyContin. Is the pain real or is the patient an addict?
Now, a new, controversial statewide database is supposed to help them figure that out. Starting this week, pharmacies are required to collect patient and doctor information on every prescription they fill in an effort to address the national epidemic of painkiller abuse. According to state estimates, 117,000 Minnesota adults abuse prescription drugs every year.
When it’s fully up and running in March, the database will allow Minnesota doctors and pharmacists, for the first time, to check whether patients are getting too many prescriptions for the same narcotics from different providers. Also known as doctor-shopping, it’s a way for addicts to feed their habit without tipping off individual physicians or pharmacies.
But Minnesota doctors are divided over the new registry. Some, like emergency room doctors, are relieved that they now will have a way to be sure they are not simply feeding someone’s habit. But others say it will scare doctors into writing fewer needed prescriptions for fear of being investigated by law enforcement or professionally disciplined.
“Physicians are very squeamish about prescribing and being scrutinized,” said Dr. Miles Belgrade, a pain specialist at the University of Minnesota Medical Center who testified against the proposed plan at the Legislature in 2007.
Even drugs for pets
Minnesota is the 34th state to monitor prescriptions for controlled substances such as amphetamines, barbiturates and even some diet pills. The database, funded with a $400,000 federal grant, will track more than 1 million prescriptions per year.
Under the law, almost every Minnesota pharmacy that provides controlled substances now must submit the name and address of the patient — and even the name of the animal if it’s for a pet — the name of the prescriber and the pharmacy that fills it.
Doctors will be able to check the Minnesota Prescription Monitoring Program database when they doubt a patient’s story, said Cody Wiberg, executive director of the Minnesota Board of Pharmacy, which manages it. They can see, for instance, whether the patient has filled five prescriptions for Vicodin at five different pharmacies in the past two weeks.
That’s the kind of information that Fairview Health System discovered when it looked at patient charts from several of its hospital emergency departments.
“We would see people going from one hospital to the next on the same day and on the next day and not telling the second and third doctor about the other visits,” said Susan Van Pelt, director of quality improvement for Emergency Physicians Professional Association, a doctor group that staffs some of Fairview’s emergency rooms.
Getting help for abusers
With the database, doctors can make a more informed decision about the patient, Wiberg said. The main goal, he said, is to help patients, not catch criminals.
“We’re hoping that somewhere along the line, a health professional is going to intervene and try to get this person the help that they might need,” Wiberg said. Some might be addicts who need treatment, and some might be people with under-treated chronic pain who need the help of specialists.
The law that created the database is designed to keep out those who just want to find wrongdoers. The government is prohibited from using it to check on doctors’ prescribing habits for fear of discouraging them from prescribing painkillers to people who really need them, said Robert Leach, executive director of the Minnesota Board of Medicine.
“We didn’t want … to have a chilling effect on the treatment of pain,” he said.
But Belgrade says that the chilling effect still could be a problem. “The law may say that, but that and the psychological effect on physicians are two separate things,” he said. Other states have found that the number of prescriptions declined after they began monitoring prescriptions. But no one knows if that’s because it worked as intended or if doctors simply wrote fewer of them.
The law also states that criminal investigators must have a search warrant or a court-ordered subpoena to access the database, but that, too, is of little comfort to Belgrade.
“I don’t know how hard it is to get a subpoena,” he said.
Resource:
Marcotty, Josephine. “Minnesota Targeting Painkiller Abusers.” StarTribune. 6 Jan. 2010. Web 7 Jan. 2010. http://www.startribune.com
On TV, in school and, hopefully, at home, children hear messages over and over warning them about the dangers of abusing drugs. But just when you think maybe the repetition is reaching overkill, statistics like those revealed in a National Institute on Drug Abuse study released this week show the message isn’t getting through to everyone.
For the first time in more than a decade, reported marijuana use by teens went up instead of down. Of the roughly 47,000 eighth-, 10th- and 12th-grade students surveyed, 32.8 percent of high school seniors admitted using marijuana in the last year. The rates were 26.7 percent of sophomores and 11.8 percent of eighth-graders.
With regard to alcohol, 43.5 percent of 12th-graders reported taking a drink within the previous month. While that’s down from 52.7 percent in 1997, it’s still alarmingly high, showing many teens – and probably some adults – still consider underage drinking a rite of passage or a bit of harmless mischief.
It’s not. As pointed out in a recent story, abusing these “less dangerous” drugs can make youngsters more likely to continue abusing them, and take up other substances.
These numbers underscore the importance of continuing public programs to dissuade kids from trying and abusing drugs – whether it’s alcohol, marijuana, prescription medication or even cigarettes (6.5 percent of eighth-graders surveyed admitted smoking within the previous 30 days). But there’s only so much law enforcement, teachers and public service announcements can do.
The home remains the front line. According to the Partnership for a Drug-Free America, children whose parents teach them a lot about the risks of drugs are 50 percent less likely to use. That means parents need to take an active role and not just assume their children aren’t being exposed to drugs or tempted to experiment.
Resource:
“Kids must receive anti-drug message.” Marietta Times. 17 Dec. 2009. Web. 17 Dec. 2009. <http://www.mariettatimes.com/>.
Injection-drug users (IDUs) acquire human immunodeficiency virus (HIV) infection by sharing drug equipment with HIV-infected persons and by engaging in risky sexual behavior. In 2007, injection-drug use was the third most frequently reported risk factor for HIV infection in the United States, after male-to-male sexual contact and high-risk heterosexual contact. To characterize HIV-infected IDUs aged ≥13 years in the United States, CDC analyzed data from the national notifiable disease reporting system for 2004–2007 from the 34 states that had conducted confidential, name-based HIV surveillance since at least 2003. The results of that analysis indicated that, during 2004–2007, 62.2% of IDUs with a new diagnosis of HIV infection were males, 57.5% were blacks or African Americans, and 74.8% lived in urban areas at the time of their HIV diagnosis. In addition, during 2004–2006, approximately 40% of HIV-infected IDUs received late HIV diagnoses (i.e., diagnosis of acquired immunodeficiency syndrome [AIDS] <12 months after the date of HIV diagnosis). To reduce the prevalence of HIV infection and late HIV diagnosis among IDUs, HIV prevention programs serving IDUs should have comprehensive approaches that incorporate access to HIV testing as part of community-based outreach, drug abuse treatment, and syringe exchange programs.
HIV infection and AIDS are notifiable diseases in all 50 states, the District of Columbia, and five U.S. territories.Although all states have had AIDS reporting since the early 1980s, HIV surveillance with uniform reporting was not implemented in all states until 2008.* CDC regards data from states with confidential, name-based, HIV surveillance systems as sufficient to monitor trends and estimate risk behaviors for HIV infection after 4 continuous years of reporting. The HIV and AIDS diagnosis data for IDUs in this report were obtained from case report forms from the 34 states† with such reporting since December 2003.
The data in this report represent IDUs who received a new diagnosis of HIV infection, regardless of when that infection was acquired. Data were adjusted for reporting delays (i.e., the time between diagnosis and report); IDU risk factor information was imputed for persons without sufficient information. IDUs who also were categorized as men who have sex with men (MSM) were excluded from the analysis. The number and percentage of IDUs who received HIV diagnoses were estimated by sex, age, race/ethnicity, and area of residence at time of HIV diagnosis. Area of residence was categorized as urban (≥500,000 population), suburban (50,000–499,999), or rural (nonmetropolitan area).
Because no standard national population estimates exist for IDUs, calculation of new HIV diagnosis rates used 2007 general population estimates from the U.S. Census.§ In addition, to identify characteristics associated with late diagnosis of HIV infection, stratified multivariate analyses using log-binomial models were conducted to estimate prevalence ratios by sex and age group in the three racial/ethnic populations with the most HIV-infected IDUs (whites, blacks or African Americans, and Hispanics or Latinos). An HIV diagnosis was considered late if diagnosis of AIDS was received <12 months after the date of HIV diagnosis.
During 2004–2007, a total of 152,917 persons received a diagnosis of HIV infection in the 34 states, including 19,687 (12.9%) IDUs. The majority of HIV-infected IDUs (62.2%) were males. By age group, the highest percentage of HIV diagnoses among IDUs (33.2%) was observed among persons aged 35–44 years. By race/ethnicity,¶ blacks or African Americans accounted for 11,321 (57.5%) of HIV-infected IDUs, whites for 4,216 (21.4%), Hispanics or Latinos for 3,764 (19.1%), American Indians or Alaska Natives for 117 (0.6%), Asians for 79 (0.4%), and Native Hawaiians or Other Pacific Islanders for 10 (0.1%). The average annual rate of new HIV infection diagnosis per 100,000 general population during 2004–2007 was 11.0 for black or African American IDUs, 4.9 per 100,000 for Hispanics or Latinos, and 0.9 per 100,000 for whites.
By area of residence, 14,726 (74.8%) IDUs with a new HIV diagnosis lived in urban areas. By race/ethnicity and sex, male blacks or African Americans (17.3) had the highest average annual rate of new HIV diagnosis per 100,000 general population during 2004–2007, followed by female black or African Americans (9.3), male Hispanics or Latinos (7.0), and female Hispanics or Latinos (2.7).
During 2004–2006, approximately 40% of the estimated 14,715 IDUs with HIV received late diagnoses. In each of the three racial/ethnic populations analyzed (whites, blacks or African Americans, and Hispanics or Latinos), higher percentages of males received a late diagnosis than females. Compared with persons aged 13–24 years, higher percentages of persons in older age groups received a late diagnosis of HIV infection.
Reported by: A Grigoryan, MD, RL Shouse, MD, T Durant, PhD, TD Mastro, MD, L Espinoza, DDS, M Chen, MS, T Kajese, MSPH, X Wei, MS, HI Hall, PhD, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.
Editorial Note:
Since the peak of the HIV epidemic among IDUs in the late 1980s, HIV incidence among IDUs has decreased by nearly 80%. Despite that overall decline, IDUs continue to represent a substantial proportion of persons with new HIV diagnoses. Recent evidence suggests many IDUs continue to engage in high-risk behaviors such as sharing syringes and having unprotected sex (32% and 63% during the past 12 months, respectively [3]). The higher number of HIV infections among blacks or African Americans is consistent with reports that blacks or African Americans are more likely to inject drugs than whites and have higher rates of HIV infection overall (1,4). HIV prevention programs should be enhanced to target IDUs, especially black or African American IDUs, and to always include HIV testing as a component of the prevention program.
Although a recent analysis indicated that overall testing during the preceding 12 months among IDUs was high (72%), the results in this report indicated that, during 2004–2006, approximately 40% of IDUs received late HIV diagnoses. In another previous analysis, the percentage of late HIV diagnoses among IDUs was found to be significantly higher than among persons in the other major risk behavior categories: MSM (35%), MSM/IDUs (37%) and persons who engage in high-risk heterosexual contact (37%) (CDC, unpublished data, 2009). In addition, IDUs tend to receive HIV diagnoses at older ages than persons who are not IDUs, suggesting that IDUs might continue high-risk behaviors at older ages or might be more likely to receive late testing and diagnosis.
In this report, as in previous analyses, late diagnosis of HIV infection was interpreted as a diagnosis that occurred <12 months before a diagnosis of AIDS. An alternative interpretation of that sequence is that some persons have HIV infection that progresses more rapidly to AIDS. In addition, more rapid progression to AIDS has been observed among IDUs than among MSM. However, other models of rapid HIV progression suggest that the proportion of persons who progress to AIDS <12 months after diagnosis of HIV infection is only 45 in 10,000 patients and thus would have minimal impact on the findings in this analysis.
Persons who receive an HIV diagnosis late in the course of their infection receive HIV treatment late and also represent missed opportunities for counseling, education, and substance abuse treatment. To identify all HIV infections as early as possible, including those in IDUs, CDC recommends routine HIV screening in all health-care settings for persons aged 13–64 years and pregnant women and retesting at least annually for all persons at high risk for HIV.
The findings in this report are subject to at least four limitations. First, this report only includes data from 34 states with confidential, name-based HIV reporting since 2003. Although HIV is now a reportable condition in all 50 states, name-based HIV reporting was not implemented in all 50 states until 2008. The 34 states with data analyzed in this report are estimated to represent 66% of all AIDS cases in the United States. Certain areas with historically high AIDS morbidity that have not conducted confidential, name-based HIV surveillance since 2003 (e.g., California, Illinois, and the District of Columbia) were not included, thus the results might not be nationally representative. Second, diagnoses of HIV infection might not always represent new infections. CDC has established a new system for measuring incident HIV infection at the population level, providing a tool to assess HIV infection among IDUs apart from HIV diagnoses alone. However, diagnosis data continue to be an important indicator for monitoring HIV disparities and potentially adverse outcomes (e.g., late diagnosis). Third, misclassification of the HIV diagnosis date might have occurred in certain cases. For example, some persons might have had positive results from anonymous, unreported HIV tests before they had a confidential HIV test that was reported to a health department, making the time from initial HIV diagnosis to AIDS diagnosis appear shorter than was actually the case. Finally, this analysis did not consider the frequency of HIV testing or screening among IDUs. Variations in screening rates might lead to higher or lower rates of HIV diagnosis.
The overall declines in new HIV infections among IDUs since the 1980s likely are related to decreases in injection-drug use or the sharing of injection equipment and changes in social networks of IDUs (e.g., associating with persons who do not have HIV infection or who are less likely to share injecting equipment). However, many IDUs with newly diagnosed infection have suboptimal access to and utilization of highly active antiretroviral therapy (HAART), and initiate HAART at more advanced stages of infection. Programs to prevent HIV among IDUs should address both risk from injecting and risk from unsafe sexual behavior. HIV testing should be a key component of any comprehensive strategy, and new opportunities to test IDUs (e.g., in correctional facilities or mental health clinics) should be considered. In addition, newer testing technologies such as rapid HIV testing might enable programs to reach IDUs who would otherwise not be tested.
Reference:
“HIV Infection Among Injection-Drug Users — 34 States, 2004–2007.” Center For Disease Control & Prevention. US Government, 27 Nov. 2009. Web. 1 Dec. 2009. <http://www.cdc.gov/>.
 ANN ARBOR—Women suffering from alcoholism show greater effects on their daily lives than do alcoholic men, according to a study University of Michigan Prof. Kyle L. Grazier plans to present later this month.
Women coping with alcoholism report greater problems with both physical and social functioning, more bodily pain, and poorer physical and mental health than men, according to data Grazier and co-author Kathleen Bucholz at Washington University analyzed in a three-year, $2 million study funded by the National Institute of Alcohol Abuse and Alcoholism. Grazier teaches in the U-M School of Public Health’s Department of Health Management and Policy.
Grazier and Bucholz tracked more than 700 people initially interviewed as part of a larger National Institutes of Health study conducted in five American cities 20 years ago.
In their study, Grazier and Bucholz located three groups of respondents from the St. Louis sample: those diagnosed as stably alcoholic, borderline alcoholic and those unaffected by alcohol in the original study. They conducted three interviews and reviewed all medical records for care received over a two-year period. Grazier noted that their approach is unique because most research examines alcoholics in treatment centers where they’re easiest to find, but they looked at individuals in the community, including a broad spectrum of alcoholics who have and have not received treatment.
“We don’t know very much about people in the general community,” Grazier said. There have been no other community-based longitudinal studies that have followed individuals for almost 20 years to examine the long-term health services effects of alcohol use and abuse.
Women considered stable alcoholics showed greater effects on their daily life, including simple activities like walking and shopping, than men in that group.
Grazier and Bucholz are exploring reasons for the disparity, whether biological or social.
Those causes carry implications for the way physicians treat female patients and ways community-based programs educate people about the long-term health risks of alcohol.
Grazier plans to present the study at the First World Congress on Women and Mental Health in Berlin, Germany, March 27-31 (http://www.akm.ch/wmh2001/). This is the first meeting of its kind in which investigators from around the world will focus on the relationship between psychiatry, psychosomatics, neurosciences, obstetrics and gynecology.
In addition, Grazier will present a second study at the Congress—a $300,000, three-year National Institute for Mental Health-funded study on the effects of managed mental health care on women. She looked in particular at what are known as “carve out” programs, in which a separate administrative structure manages mental health and substance abuse service apart from other medical care.
Grazier gained access to records for 45,000 employees at a large West Coast company, one of the first to implement a carve out program, and looked for changes in costs and health care use over the six years since the inception of the program.
In looking at the records, which were stripped of employees’ personal identifiers, Grazier saw that carve outs had more effect on women than men—for example, they made fewer visits to care givers, and when they did receive care, they more frequently used alternative providers such as social workers, which are less expensive to insurers.
She noted that carve out programs appear to increase access and utilization among both men and women in need of entry-level services. “However, the managed care arrangement significantly reduced access to higher-intensity service use to a greater extent for women than for men. Women with mental health needs were almost twice as likely as men to have health services curtailed beyond the minimal level,” Grazier wrote in her study overview.
Grazier said she can’t draw conclusions about the quality of care received by women, but said the study does raise the question.
She is now looking at the impact of insurance coverage level on women’s treatment, as she believes women in dual-income households where both spouses are insured get different care than those who are single. In those dual-insurance situations, often the coverage from one plan can pick up what’s not paid for by the other, making care more affordable.
Reference:
Newvine, Colleen. “Women At Greater Risk Of Harm By Alcoholism.” Sober Recovery. University of Michigan. Web. 24 Nov. 2009. <http://www.umich.edu/~newsinfo>.
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