Fw: [drugwar] Lower HIV rates among black tar heroin users

Preston Peet ptpeet at nyc.rr.com
Thu Jan 29 18:01:19 EST 2004


I think this is facinating. The fact that prohibitionists lump all drug use
of any kind into one sole category, abuse, news like this will not ever
reach a mainstream audience. I think it should obviously be noted more
widely, in that perhaps some of the mechanical reasons for the lower HIV
rates among IDUs out West could be copied here, even if the dope is
different.
Peace,
Preston


----- Original Message ----- 
From: Vigilius Haufniensis
To: drugwar at mindvox.com
Cc: Mr_Tracys_Corner at yahoogroups.com
Sent: Tuesday, January 27, 2004 8:58 PM
Subject: [drugwar] Lower HIV rates among black tar heroin users


http://www.scienceblog.com/community/modules.php?name=News&file=article&sid=2202

Lower HIV rates among black tar heroin users
Posted on Monday, 26 January 2004 @ 21:59:43 EST by BJS

 Researchers have found that use of black tar heroin by injection drug users
in West Coast cities accounts for a dramatically lower percentage of
intravenous drug users in these locations who are infected with HIV. The
finding is based on comparison to East Coast cities, where powder heroin is
commonly used. Possible reasons: First, before injecting black tar heroin,
it must be heated to about 165 degrees F, according to research done
elsewhere. This temperature is sufficient for killing the HIV virus, which
limits the likelihood of HIV transmission through sharing of drug
preparation paraphernalia, according to the UCSF researchers. In addition,
black tar heroin clogs syringes, they note. Frequent rinsing and flushing is
required, reducing the amount of residual blood and HIV virus present.



>From UC San Francisco:

Black tar heroin use explains lower HIV levels among injection drug users in
the Western US

UCSF researchers have found that use of black tar heroin by injection drug
users in West Coast cities accounts for a dramatically lower percentage of
IDUs in these locations who are infected with HIV. The finding is based on
comparison to East Coast cities, where powder heroin is commonly used.

"In the early 1990s, about 40 percent of IDUs in New York City were
HIV-infected, while only about four percent of IDUs in Los Angeles were
infected with HIV. Yet in both cities, about 25 percent of gay men were
HIV-infected. The solution to this discrepancy is found in the distribution
and use of black tar heroin and is due to its unique chemical properties,"
said the study's lead author, Daniel H. Ciccarone, MD, MPH, assistant
professor in the UCSF departments of family and community medicine and of
anthropology, history and social medicine.

The study, published in the December 2003 issue of Substance Use & Misuse,
examined data from the Drug Enforcement Agency (DEA) on the predominant
types of heroin used in 20 US cities from 1990 to 1993. This data was
compared with estimates published in the American Journal of Public Health
in 1996 of the percentages of both IDUs and gay men infected with HIV in the
same cities during the same time frame.

In cities west of the Mississippi, black tar heroin - a dark, gummy,
resinous substance from Mexico - is the type of heroin predominately
available. On the East Coast, white and light brown powder heroin from South
Asia and South America is the type predominately available. Study findings
showed the percentage of IDUs infected with HIV was sharply lower in cities
where black tar heroin use predominated compared to cities where powder
heroin use predominated, a pattern that was not mirrored in the percentages
of HIV-infected gay men.

Using ethnographic, clinical, epidemiological, and laboratory data,
researchers determined that black tar use by IDUs could lead to less HIV
transmission. First, before injecting black tar heroin, it must be heated to
about 165 degrees F, according to research done elsewhere. This temperature
is sufficient for killing the HIV virus, which limits the likelihood of HIV
transmission through sharing of drug preparation paraphernalia, according to
the UCSF researchers.

In addition, black tar heroin clogs syringes, they note. Frequent rinsing
and flushing is required, reducing the amount of residual blood and HIV
virus present.

"In California, injectors are constantly complaining that their needles
clog. They almost always rinse their syringes immediately after shooting up
in order to keep them from jamming. The grounds of shooting encampments and
the walls of shooting galleries are wet from the water that they squirt
through their used needles. This is not the case in New York, where white
powder heroin does not 'gum up' needles. Laboratory studies have shown that
rinsing syringes copiously with water works well to clean out HIV," said the
study's co-author, Philippe Bourgois, PhD, professor and chair of the UCSF
Department of Anthropology, History, and Social Medicine.

Moreover, using gummy black tar heroin ruins syringes, leading to increased
turnover of syringes. "Black tar injectors rarely report using a single
syringe more than five times, while powder heroin users claim many more uses
out of their syringes," said Ciccarone.

The study also noted that injecting black tar heroin leads rapidly to venous
sclerosis - a condition that results in the loss of veins for injection
sites. Thus, black tar heroin users are much quicker to move to subcutaneous
and intramuscular injecting. Studies have shown that these are not as
efficient as venous injection for transmitting HIV.

"We believe that we have solved this longstanding epidemiological puzzle
thanks to multidisciplinary science and data from the DEA on the types and
distribution patterns of heroin. This data is valuable to public health
authorities. Consider that if powder heroin were to become more widely
available on the West Coast, public health agencies would need to prepare
for the possibility that currently successful interventions to prevent HIV
transmission among IDUs may lose much of their effectiveness," said
Ciccarone.

"Likewise, while black tar heroin use becoming predominate on the East Coast
may positively affect HIV transmission rates among IDUs, public health offic
ials will need to be aware in order to prepare for the different risks
associated with its use. The increased intramuscular injecting associated
with black tar heroin use leads to higher rates of abscesses, wound
botulism, tetanus, gas gangrene, and necrotizing fasciitis. In fact, soft
tissue infections are the number one medical/surgical admission at San
Francisco General Hospital," said Ciccarone.




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