Psychiatry - November 2008 - (Page 16)

[letters to the editor] IMPACT OF SUBSTANCE ABUSE ON TREATMENT ADHERENCE DEAR EDITOR: The article by Sansone and Sansone in the September issue of Psychiatry 2008 (“Alcohol/Substance Misuse and Treatment Adherence: Fatal Attraction”)1 was quite interesting and topical. It was informative in regard to the impact that substance abuse has on nonadherence with medical treatment. In addition to alcohol and substance misuse being an important factor in nonadherence with medical treatment, several studies have highlighted the direct impact of several illicit drugs on medical conditions themselves. The direct impact of these illicit substances on conditions like hepatitis and human immunodeficiency virus (HIV) have been shown in several studies, even when the patient is adherent with medical treatment. Methamphetamine has been shown to inhibit the innate immunity in host cells leading to increased replication of hepatitis C virus (HCV) in human hepatocytes. Methamphetamine has also been shown to compromise the anti-HCV effect of recombinant interferon alpha.2 Other studies have also indicated that in addition to leading to increased risk of HCV, chronic opiate abuse also enhances HCV replication, increases liver injury, and increases hepatic fibrosis.3 Opioid exposure in vitro has been associated with increased replication of HIV-I and impaired lymphocyte function. Studies have shown that irrespective of nonadherence to HAART medications, a study found that HCV co-infection with HIV was associated with an impaired CD4 cell response to HAART compared to those with HIV without hepatitis co-infection.4 A study by Hezode et al5 indicated that long-term daily cannabis smoking appeared to accelerate and worsen fibrosis progression in individuals with chronic hepatitis C. The ideal treatment model to address the nonadherence with medical treatment raised by the authors would be a system that integrates both the medical model , i.e., continuing care system, with that of substance abuse treatment. There obviously would be some difficulty bridging both systems as both systems have differences in priority, philosophy, funding, and training. A strong case management model making social services a core of the plan would be required. This would be essential as basic needs like housing, food, funds, and work would need to be addressed in this model to foster adherence with medical treatment.6 Workers from each side, that is the medical and substance abuse sides, should be willing to cross agency lines to collaborate on behalf of their clients. Comprehensive programs like methadone maintenance treatment programs have led to better adherence to medical treatments, and better still the fact that buprenorphine in combination with naloxone can be dispensed within primary health clinics would further help with the integrated model where both the medical illness and the substance abuse, in this case opioids, could be addressed. With regards, Adegboyega Oyemade, MD Addiction Psychiatrist Heritage Behavioral Health Center, Inc., Decatur, Illinois REFERENCES 1. Sansone R, Sansone L. Alcohol/substance misuse and treatment adherence: fatal attraction. Psychiatry (Edgemont) 2008;5(9):43–46. 2. Ye L, Peng JS, Wang YJ, et al. Methamphetamine enhances Hepatitis C virus replication in human hepatocytes. J Viral Hepat. 2008;15(4):261–270. 3. Moore K, Dusheiko G. Opiate abuse and viral replication in hepatitis C. Am J Pathol. 2005;167(5):1189–1191. 4. Lucas G, Griswold M, Gebo K, et al. Illicit drug use and HIV-1 disease progression: a longitudinal study in the era of highly active antiretroviral therapy. Am J Epidemiol. 2006;163:412–420. 5. Hezode C, Roudot-Thoraval F, Nguyen S, et al. Daily cannabis smoking as a risk factor for progression of fibrosis in chronic hepatitis C. Hepatology. 2005;42(1):63–71. 6. Substance abuse treatment for persons with HIV/AIDS. Treatment Improvement Protocol (TIP)Series 37. http://ncadi.samhsa.gov/govpubs/BKD359/37h.as px. Accessed 10/09/2008. LETTERS TO THE EDITOR SUBMISSIONS Psychiatry 2008 welcomes submissions for possible publication in the Letters section. Letters should be no more than 500 words and five references. Type with double spacing. Letters that comment on a Psychiatry 2008 article will be considered if they are received within two months of the time the article was published. All letters are reviewed by the editors and are selected based upon interest, timeliness, and pertinence, as determined by the editors. There are no guarantees a letter will be published. Letters that are not intended for publication by the authors should state this in the body of the letter. Published letters are edited and may be shortened; tables and figures are included only selectively. Send letters to: Elizabeth Klumpp, Executive Editor, Psychiatry 2008, editorial@matrixmedcom.com. Hard copy submissions are no longer accepted. Include the following statement with the letter: “The undersigned author transfers all copyright ownership of the enclosed/attached letter to Matrix Medical Communications in the event the work is published. The undersigned author warrants that the letter is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors.” 16 Psychiatry 2008 [ N O V E M B E R ] 16 http://ncadi.samhsa.gov/govpubs/BKD359/37h.aspx http://ncadi.samhsa.gov/govpubs/BKD359/37h.aspx

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Psychiatry - November 2008 Editor's Message Editorial Advisory Board Contents PsychRx Letters to the Editor Measuring Adverse Events in Psychiatry Nonsuicidal Self Injury in Adolescents Relative Tolerability of Alzheimer's Disease Treatments Biracial Identity Development and Recommendations in Therapy Depression and Cardiovascular Disease: Just an Urban Legend? Three Risk Management Basics Journal Watch Classified Advertising Information for Authors

Psychiatry - November 2008

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