Chilling with pills

HIV medications and recreational drugs can interact in dangerous and sometimes unpredictable ways. But knowing proper harm reduction techniques can help.

The Canadian AIDS Treatment Information Exchange (CATIE) has new educational materials ready to help people juggle their medication and their recreational drug use.

“It’s not about rules, what you can and can’t do with your life,” says David Coop, director of treatment information at CATIE. “It’s about being informed and about making informed choices about lifestyle.”

Coop, along with Montreal doctor Benoit Trottier, presents a new fact sheet on the risks of using HIV medications and using party drugs at a workshop Wed, May 7.

It can be a hard message to deliver. Recreational drug users usually don’t rely upon scientific data, learning from experience that scientific and medical researchers can be prejudiced against their lifestyle. Instead they rely upon a common knowledge built up through personal experience.

“It’s an old science,” says Walter Cavalieri, president of the Toronto Harm Reduction Task Force. “Try it and watch the results. That’s what happens with people who use drugs…. It’s an experimental method with human subjects and an inaccurate body count. There’s an informal body of evidence. Now, how do we insinuate all this knowledge that CATIE has put together, into that common pool of evidence? That’s the crucial thing.”

But that kind of old science can be dangerous. Coop points to one of the most conclusive pieces of data on mixing HIV medication and recreational drug use, an autopsy report of a UK man who died of an ecstasy overdose. Protease inhibitors in his system caused the potency of the drug to be multiplied 10 to 12 times.

“The difficulty with producing a fact sheet about recreational drugs and HIV,” Coop admits, “is the term ‘fact sheet’ gives people the impression that there are solid facts.

“The interactions between recreational drugs and anti-retroviral therapies have not been studiedscientifically, nor are they likely to be. Most are illegal substances and not available in standard doses. What we are relying upon is anecdotal case reports. We are also relying upon what we know about the metabolizing of these drugs.”

So what advice does the fact sheet offer?

Alcohol is possibly one of the most harmful drugs to mix with an HIV cocktail because of the stress it puts on your liver. It can double levels of some protease inhibitors, creating a risk of pancreatitis and causing painful kidney stones.

The same liver enzyme system used to break down protease inhibitors and other medications has to work also on the alphabet soup of party drugs: E, K, LSD, crystal and possibly GHB. That means that both HIV meds and drugs will stay in a person’s system a lot longer – as much as 10 times longer – creating greater toxicity. This may result in an overdose or nasty medication side effects.

Methadone and heroin can have an opposite reaction with medications being eliminated from your system at a much faster rate. This may induce withdrawal symptoms, leading some people on methadone maintenance programs to fall back into heroin.

Cocaine seems relatively free of interactions with meds, according to the fact sheet. But there is the risk of interruptions in a medication regime with weekend-long drug binges coke users might pull. Missed meds could cause resistant strains of the virus to develop.

And being hepatitis C-positive increases the liver risk even more.

One of the big challenges is getting the information out.

“If it sits on a shelf, or if it’s not communicated to people, then it’s dead,” says Cavalieri. “I don’t fault CATIE for producing information [but] there’s no guarantee it will be read.”

On the downside, party drug consumers often don’t access needle exchanges and other programs targeted to street drug users. Working in CATIE’s favour is the tendency of HIV-positive people to seek out health information. The fact sheet will be posted on CATIE’s website and made available at AIDS service organizations, community health clinics and centres like the 519 Community Centre.

Last year CATIE’s publication editor, RonniLyn Pustil, authored the well-received publication PreFix, with the help of a focus group of drug users. The pamphlet is being reprinted.

“Intravenous drug users were a main target group that we wanted to inform and educate,” says Pustil. “And not just IV drug users, but people who work in needle exchanges, people who work at methadone clinics, in community health centres. PreFix is really meant to be a tool for the community intermediaries, to use when they are working with drug users.”

* A free community health forum on HIV medications and recreational drug use will be hosted by the AIDS Committee Of Toronto on Wed, May 7, starting at 7pm at the Primrose Hotel (111 Carlton St). For more information, check out www.catie.ca.