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A 23-year-old woman is seen for her intake physical in a residential treatment program for women recovering from substance abuse. She has not injected heroin for two days now, but her tracks are still visible (Figure 240-1). Her parents were both addicted to heroin, and she admits to having been born addicted to heroin herself. She began using heroin on her own in her early teens and has been on and off heroin since that time. She acknowledges a history of physical and sexual abuse as a child. She has had many suicide attempts and has cut herself with a knife across her arm many times. She has traded sex for money to buy heroin. Her 2 children are in foster care after having been removed by Child Protective Services. She is an attractive young woman looking for help and is thankful to have been admitted to this program. She does not know whether she has acquired hepatitis B, hepatitis C, or HIV, but wants to be tested.

Figure 240-1

A 23-year-old woman with visible tracks on her arms from intravenous heroin use. She also has visible scars from self-­mutilation with a knife. (Courtesy of Richard P. Usatine, MD.)

Injection-drug use affects millions of people across the world. Combinations of genetic, environmental, and behavioral factors influence risk of drug use and addiction. People who inject drugs often have other medical and psychiatric diagnoses, as well as social, legal, and vocational problems. Comprehensive management includes acute treatment and continuing care. Relapse is common, but involvement in a treatment program improves outcomes.

  • An estimated 16 million people inject drugs worldwide, based on data from 148 countries. The largest numbers of injectors are in China, the United States, and Russia.1
  • In the United States, injection-drug use among persons ages 15 to 29 years increased from 96 (1996) to 116 (2002) per 10,000 persons.2
  • From 2000 to 2002, 1.5% of the U.S. population older than the age of 12 years reported injection-drug use at any time; 0.19% reported injection-drug use within the last year—440,000 persons.3
  • Prevalence was highest in persons ages 35 to 49 years (3.5%); higher in men than women (2.0% vs. 1.0%); and higher in whites (1.7%) than African Americans (0.8%) or Hispanics (0.8%).3
  • In 2002, the mean age of injection-drug users (IDUs) was 36 years compared to 21 years in 1979.3
  • Needle sharing is common. In the previous 3 months, 46% of IDUs lent a person a used syringe4 and 54% injected with a used syringe.5
  • There were 27,8371-278,371 meant? substance-abuse treatment admissions for injection-drug use (14.2% of all admissions reported to Substance Abuse and Mental Health Services Administration's [SAMHSA] Treatment Episode Data Set for 2009).6
  • The most commonly injected drug is heroin. Amphetamines, buprenorphine, benzodiazepines, cocaine, and barbiturates also are injected.7
  • HIV prevalence among IDUs ...

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