Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

416 IV. SPECIAL POPULATIONSCo-abuse of cocaine and alcohol has been associated with the highest risk(Wang, Collins, Kohler, DiClemente, & Wingood, 2000). The widespread useof alcohol and other drugs among adolescents presents a significant threatto adolescent health, associated with motor vehicle accidents, homicides,and suicides, as well as medical, psychological, and social morbidity (Singh,Kochaneck, & MacDorman, 1996). The use of alcohol and other drugs significantlyincreases adolescent risk behaviors for HIV transmission (Boyer & Ellen,1994; Rotheram-Borus, Rosario, Reid, & Koopman, 1995). Cases of AIDS andrates of HIV infection are rapidly rising among adolescents, particularly inthose from risk groups not easily accessed (Kennedy & Eckholdt, 1997;Mofenson, & Flynn, 2000).OpioidsIn addition to the exceptionally high risk of HIV transmission in opiate abuserswho inject and share needles, compromised immune function as a resultof exposure to opiates may add to risk of infection and disease progression.Brown, Stimmel, Taub, Kochwa, and Rosenfield (1974) and others(Govitaprong, Suttitum, Kotchabhakdi, & Uneklabh, 1998) found reducedlymphocyte stimulation in response to various mitogens in heroin addicts,suggesting a possible impairment in cell-mediated immunity. Addicts alsohave a significant reduction in numbers of T-cells when compared withnonaddicts (McDonough et al., 1980). A review of the literature defining theconnection between AIDS and opiate use concluded that numerous aspectsof the drug culture may have differential, even offsetting effects in terms ofthe potential to regulate either HIV-1 expression or host-regulation responses(Donahue & Vlahov, 1998).Opioids may incur considerable risk to some users; opiate addicts whoenter methadone treatment are significantly less likely to become HIV infectedin the first place (Metzger et al., 1993). In experimental studies of immunity,opiates have been found to have a variety of effects that are primarilyimmunosuppressive (McCarthy, Wetzela, Slikera, Eisenstein, & Rogers, 2001).There is evidence that chronic exposure to morphine may reduce HIV replication,while withdrawal, mediated by the stress effects, may lead to acuteimmunosuppression and disease exacerbation (Donahoe & Vlahov, 1998). Forthose already HIV-infected, consistent participation in methadone maintenancetreatment was associated with high probability and consistency of use ofART (Sambamoorthi, Warner, Crystal, & Walkup, 2000). More recent availabilityof oral outpatient opiate detoxification agents, buprenorphine and thebuprenorphine–naloxone combination, opens up new modalities to assist physiciansand patients in achieving drug-free or less harmful drug-using states (Linget al., 1998; O’Connor et al., 1998).