Controlling Disease Transmission in Injection Drug Users

Blood-borne viruses, such as HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV), are readily transmitted by sharing drug injection equipment. HIV remains viable and infectious for as long as 3 to 5 weeks in used syringes and other injection equipment containing HIV-positive blood (J Acquir Immune Defic Syndr Hum Retrovirol. 1999; 20:73-80). The hepatitis viruses are assumed to be at least as durable as HIV in used injection equipment, although experiments to establish this point have not been done. The potential for becoming infected from a single exposure to an HIV-contaminated needle or syringe is estimated to be 0.67% (J Acquir Immune Defic Syndr Hum Retrovirol. 1992; 5:1116-8), and the risk for infection among health care workers from an HIV-contaminated needlestick, including intramuscular and subcutaneous injections, is 0.3% (Ann Intern Med. 1990; 113:740-6). Parallel data for HBV and HCV, derived from needlestick injury studies in the health care setting conducted by the U.S. Centers for Disease Control and Prevention (CDC), estimate the risk to be 30% and 3%, respectively.

In addition to these chronic and often-fatal viral infections, injection drug users (IDUs) are significantly more likely than the general population to be exposed to sexually transmitted diseases and airborne infectious diseases, like tuberculosis.

The health consequences of the substantially higher incidence of various infectious diseases among IDUs extend beyond the individual IDUs and IDU communities: sexual partners of IDUs, many of whom are unaware of drug use, are at risk for acquiring HIV, HBV, and to a lesser extent HCV through sexual transmission. HIV, HBV, and occasionally HCV are also transmitted perinatally, which means that newborns of mothers who inject drugs are also at risk. Given the potential for the spread of numerous infectious agents into the general population, it is not surprising that intensive public health efforts …