Transcript those over 18 may purchase up to 10 syringes at registered

Managing Hard-to-Manage
Patients
Sharon Stancliff, MD
Medical Consultant
New York State Department of Health
AIDS Institute
New York, NY
Drug Users

IDU directly accounts for 44% of
AIDS case reported by June 2000

Ongoing drug users often perceived
of as hard to engage, poorly adherent,
and difficult

Education can help to bridge the gap
Syringe Access

Pharmacy access: those over 18
may purchase up to 10 syringes at
registered pharmacies

Clinic access: article 28 facilities
may register to sell or furnish
up to 10 syringes

Syringe exchange programs: 13 in NYS
Goals

Public health: primary and
secondary prevention

Health promotion: open the door for
honesty and education

Sanitation: promote proper disposal
Drug Treatment

“Do you want to stop or reduce use?”

Treatment alternatives and limitations
— Few treatments have solid track records
— We know little about how people stop
abusing drugs
— Users know this on some level
Weekly Cocaine Use Before Treatment
and at Month 12 Follow-Up
Pre
Post
Patients (%)
80
60
40
20
0
LTR
STR
ODF
MMTP
LTR: long-term resident.
ODF: outpatient, drug-free.
MMTP: methadone maintenance treatment program.
STI: short-term inpatient.
Adapted from Hubbard: Overview of 1-year follow-up outcomes in the (DATOS).g
Methadone Maintenance
1Ball

Given a high enough dose, the
majority will stop heroin use1

At lower doses, risky behavior
is reduced with significantly
lower risk of seroconversion to
HIV positive2
1991, Leavitt 2000.
2 Drucker
1998.
MMTPs

Require frequent attendance

Concerns about diversion create
an atmosphere of mistrust

Education about true risks and
benefits is often lacking
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