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Official websites use. Share sensitive information only on official, secure websites. Email: WShaocheng gmail. DSM-V-defined substance use disorder comprises four groups of symptoms: impaired control, social impairment, risky use, and pharmacological reactions. Behavioral patterns of impaired control, including impulsivity and risk taking, are associated with HIV risk behaviors. Substance users with stronger craving symptoms are more likely to use drugs via intravenous injection than other routes because of the faster drug effect and the higher bioavailability; thus, they are at high risk of HIV infection. Public health policies such as Needle and Syringe Exchange Programs and medication-assisted treatment are proven to reduce HIV risk behaviors such as the frequency of intravenous injection and even the incidence of HIV infection, but both of them have limitations. While intravenous injection is a frequently discussed issue in public policies and the HIV-related literature, it is a much less frequent topic in the addiction literature. Substance use disorder is a complex phenotype, and is the result of a series of causal influences such as genetic factors, diverse environmental factors, and predicted drug-induced effects 1 — 4. Several behavior patterns such as impulsivity, risk taking, and stress response resulting from specific personality and physiological traits are considered to contribute to the vulnerability or liability to addictive disease, partially accounting for the influence of genetic variation, indexed as heritability, on addiction. Substance use disorder is complicated in its symptoms and signs, which involve several domains such as cognition, behavior, and physiology. Persistent substance use changes brain reward circuits and causes specific behavior patterns such as craving. According to DSM-V, the criteria of substance use disorder can be grouped into four groups: impaired control, risky use, biological reactions, and social impairment caused by substances. Impaired control includes taking larger amounts than originally intended, multiple unsuccessful efforts to decrease or discontinue use, spending a great deal of time on substance use, and craving. The development of substance tolerance and withdrawal comprise the biological reactions 6. DSM-V defines symptoms such as tolerance, withdrawal, and uncontrolled increasing intake as the basic elements of substance use disorders, and these symptoms are associated with intravenous drug use. As a result of tolerance development, the longer these symptoms persist, the greater the amount of drug the user needs to consume to have the same effect. Among the most frequent and tolerant drug users, injection is more common, because injection causes an immediate and strong drug effect, leading to frequent reuse of contaminated needles and needle sharing. DSM-V also defines impaired control and risky use as the other two basic elements of substance use disorders, which are also associated with intravenous drug use. When severe substance abusers exhibit strong craving and impaired self-control, there is a desire to experience the drug effect immediately, ignoring the hazard of blood-borne diseases, such as HIV, hepatitis B, and hepatitis C. Impulsivity is an internal mental urge and impaired self-control is associated with poor judgment. Impulsivity and impaired self-control are the tendency to act without forethought, leading to increased external risky behaviors such as unsafe intravenous drug use. We hope this review may provide insight into all possible avenues that can be explored in current and future public health approaches to reducing the spread of HIV infection by reducing injection rates. According to DSM-IV, the criteria of substance use disorder include tolerance, withdrawal, uncontrolled increasing intake, spending more time and money on substances, and impaired social, occupational, or recreational function, and use that continues in spite of knowledge of the impact of substance on physical and psychological health 7. In , DSM-V was published and revealed the criteria change of substance-related disorders. DSM-V removed the criterion of recurrent substance use resulting in legal problems and added the criterion of craving to use substance, and kept all other criteria from DSM-IV. Furthermore, the criteria of DSM-V substance use disorder can be used to specify current severity, with mild, moderate, and severe 6. A categorical view is used by clinicians to meet the needs of reporting for health care planners; on the other hand, a dimensional approach conceptualizes a quantitative disorder that is more useful for the purpose of research 8. Several routes of drug administration are commonly used by substance abusers: oral, sniffing or intranasal using, and injection. Injection can cause several side effects, including high fever, pain over the injection site, swelling or hardness under the injection site, and anaphylaxis. Compared with the other administration routes, intravenous injection results in the fastest drug effect because the drug reaches the brain through the circulatory system almost immediately. In brief, compared with other drug administration routes, substances have the strongest and fastest effect via intravenous injection. Intravenous injection and needle sharing are a consequence of severe forms of drug addiction. For example, it is common for PWID to inject heroin multiple times per day, thereby reusing or sharing needles due to limited resources. Because of the fast drug effect on the brain, the highest bioavailability, and cost, intravenous injection and sharing of needles are more among the PWID with the most severe craving symptoms. With more severe craving symptoms, substance abusers are at higher risk of risky behaviors and are more likely to use drugs impulsively, regardless of the hazard of blood-borne diseases 6. Injection behavior is very common among severe substance abusers. Drug addiction is associated with several psychiatric conditions including psychosis, mood disorders, depression, suicide, violence, and aggression; consequently, many PWID suffer from multiple morbidities and lose family support and occupational functioning. As a result, drug addiction causes serious social problems, with a substantial human and financial cost. In , worldwide, an estimate showed that million people have used at least one illicit drug, 39 million opioid, amphetamine, or cocaine users, and 21 million people who inject drugs This estimate excluded several kinds of illicit drug—3,4-methylenedioxy-N-methylamphetamine MDMA or ecstasy , hallucinogens, and inhalants—so the true numbers of illicit drug users may be higher. Opioid overdose and opioid dependence are potentially lethal; injection of opioids, cocaine, or amphetamine is a substantial risk factor for transmission of HIV, hepatitis C, and hepatitis B The prevalence of opioid use disorder, amphetamine use disorder and cocaine use disorder were 0. Based on the result of the Monitoring the Future study, the number of injecting heroin users has fluctuated in recent years, with the annual prevalence rising from 0. In Western countries, almost 3. In the next paragraph, we review the previous studies which link HIV infection and PWID, and the related approaches to reduce the frequency of injection behavior. The transmission pathway was identified as spreading through certain body fluids such as blood, semen, vaginal secretions, and breast milk. Several preventive measures were implemented such as risk reduction programs, condom distribution, and needle exchange programs. The infection trend decreased from but then steadily increased from to Currently, highly active antiretroviral therapy HAART , which combines at least three drugs from two classes of antiretroviral agents, is used to treat HIV However, this virus is highly mutable so drug resistance may develop. Prevention is a good alternative to reduce HIV transmission. Ten years after HIV was first described, three main transmission routes were identified: blood-to-blood, sexual, and perinatal. Transmission by blood included transfusion of blood and blood products, needle sharing among intravenous drug users, and injection with unsterilized needles. A host of behavioral risk patterns, now defined as HIV risk behaviors, are observed in those at highest risk of HIV infection, including injection drug use and sexual behaviors including multiple partners, sex trade, and sex without using condom 24 , Injection drug use, which is becoming increasingly associated with severe substance dependence, is also a well-known transmission pathway for HIV infection 26 — Rosenberg et al. Dutra et al. Carroll and Onken reviewed the literature and found support for behavioral and pharmacological treatment effects on drug abuse, and that combinations of behavioral and pharmacological treatments have better potency than either one alone Two randomized clinical trials found that the Holistic Harm Reduction Program with behavioral therapy reduced HIV risk behaviors and improved adherence to medical treatment among intravenous drug users 32 , A systematic review by Mathers et al. The high HIV incidence among PWID in many developing countries can be controlled by key harm reduction and treatment interventions such as needle and syringe programs, medication-assisted therapy MAT , HIV counseling and testing, and antiretroviral therapy In addition, opioid substitution is being used to reduce the prevalence of HIV infection, thereby causing modest reduction in HIV transmission rates NSEP is a public health innovation which provides clean needles and syringes to reduce the time that contaminated needles are in circulation. NSEP also offers legal, social and health counseling, sex education, and referrals to medical services as part of comprehensive approaches 37 , While the range of NSEP practices varies broadly by country, needles and syringes are available for free from vending machines and pharmacies in some countries in Europe and Australia The theory behind NSEP is that the less time the contaminated needles and syringes are in use; the less likely they are to be used by uninfected drug users. There is strong evidence that NSEP reduces the frequency of injection behavior with contaminated devices. Separate reviews by Drucker et al. MacArthur et al. A review by Sawangjit et al. Noroozi et al. Fernandes et al. Heroin, cocaine, and amphetamine are the three most commonly injected drugs, but only heroin agonist pharmacotherapy is available for treating heroin addiction. Hence, this review only focuses on heroin agonist pharmacotherapy, also called substitution or maintenance pharmacotherapy. The best-known heroin substitution treatment, methadone maintenance therapy, is the standard protocol for treating heroin addiction Methadone is a long-acting synthetic opiate agonist. It is initially administered in low doses to prevent respiratory depression and the dose is gradually raised to a maximum and maintain at that level in order to minimize withdrawal symptoms. Methadone doses at a high level can block the superimposed effects of heroin, so the PWID does not experience euphoria when they inject heroin under this treatment 48 , In addition, methadone can be taken orally, thus reducing cues associated with injection behaviors in PWID Methadone maintenance treatment has proven effective in reducing heroin use after 24 months of treatment, and the longer patients remain in the treatment program the better the results Remaining in a treatment program longer can bring about a range of positive outcomes, for example, improved family relationships, more stable employment, and fewer legal problems Dutta et al. HIV seroconversion is associated with the length of time in methadone maintenance treatment In addition to methadone, buprenorphine and naltrexone are currently two other medications for opioid addiction Long-acting injectable naltrexone can block opioid receptors and decrease the feeling of craving, as well as the risk of overdose Naltrexone implants also had a lower mortality rate than buprenorphine 57 , and a randomized clinical trial supported that long-acting injectable naltrexone was as safe and effective as buprenorphine with naloxone Intravenous injection is strongly associated with HIV infection. This global spread of HIV infection ultimately results in dramatic loss of health and financial productivity. Intravenous injection is very common among PWID with severe craving symptoms as it has the fastest drug effect on brain and the highest bioavailability. Thus, PWID with more severe craving symptoms are more likely to use intravenous injection, regardless of the legal problems and the hazard of blood-borne diseases; in other words, they are more likely to take risks and are more impulsive, which are also associated with other HIV risk behaviors. As mentioned above, intravenous injection can cause local pain, swelling, or hardness over injection sites, and possible anaphylaxis. Intravenous injection, with the fastest drug effect on brain and the highest bioavailability, can relieve craving symptoms. While intravenous injection is a frequently discussed risk factor in the HIV-related literature, it is a much less frequent topic in the addiction literature. However, as there is no proven cure for HIV, the best way to reduce infection rates is to prevent its spread. More effectively identifying those at a high risk of HIV infection is the key. NSEP is a widely used public health innovation which is significantly reducing contaminated needle distribution, but the relationship between NSEP and the incidence of HIV is controversial. Only heroin agonist pharmacotherapy is available for treating heroin addiction in MAT, despite other substance such as cocaine and amphetamine being injectable. While intravenous injection is a frequently discussed target in the public policies, it is a much less frequent topic in the addiction literature. Several key findings are suggested. First, PWID use drugs intravenously because their effects kick in immediately; however, intravenous drug users and those who share needles are at risk of blood-borne diseases. This suggests that PWID will more likely take risks when they become severe substance abusers with stronger craving, needing more drugs to reach the same effect and having impaired self-control. In two small randomized controlled trials, psychosocial interventions also had an effect on reducing the frequency of HIV risk behaviors such as intravenous injection. In this review, we suggest that interventions to reduce the severity of substance use disorder and the frequency of intravenous injection could be beneficial to reducing HIV infection. However, more research is needed to illuminate the biological mechanisms behind intravenous injection and the casual relationship between drug addiction and intravenous injection, so that we can provide more effective strategies for prevention. As a library, NLM provides access to scientific literature. Cell Transplant. Find articles by Shao-Cheng Wang. Find articles by Brion Maher. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

Substance Use Disorder, Intravenous Injection, and HIV Infection: A Review

Tainan where can I buy cocaine

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Tainan where can I buy cocaine