Medical Illness and Comorbidities in Drug Users: Implications for Addiction Pharmacotherapy Treatment

Abstract

Providing effective medical care to those with substance use disorders can be a challenge to clinicians. In this article, we briefly summarize issues that occur frequently in the medical treatment of substance users. The focus of this article is twofold. The first is to briefly summarize common co-occurring medical illnesses in those manifesting substance use disorders with an emphasis on issues related to providing effective treatment for these diseases in this population. Using specific examples of frequently occurring comorbid medical illness in substance users, including infectious diseases (hepatitis C and HIV disease), sexually transmitted diseases, and pregnancy as examples, the complexities of medical care for this population is demonstrated. Second, this article addresses some of the difficulties encountered in pharmacotherapy aimed specifically at treatment of substance use disorders. For example, difficulties in managing concomitant opiate therapy in those requiring medications for medical illness that may have strong and adverse interactions with opiates are addressed. Adverse events reported for some substance use disorder pharmacotherapies are also highlighted. We conclude with a brief review of models of care that have been effective in addressing the needs of this challenging population that can provide additional means for enhancing the clinical care of substance users.

Keywords:

• co-occurring disorders
• drug interactions
• HIV disease
• hepatitis C
• sexually transmitted diseases
• pregnancy
• addiction
• addiction pharmacotherapy

Notes

¹The definitions in this glossary have been adapted from Taber's Cyclopedic Medical Dictionary, edition 18, 1997.

Additional information

Notes on contributors

Joy C. Draper

Dr. Draper is Assistant Professor of Obstetrics and Gynecology at Virginia Commonwealth University. She specializes in the treatment of pregnant women who also have complications related to substance use.

Elinore F. McCance-Katz

Dr. McCance-Katz is Professor of Psychiatry at Virginia Commonwealth University. She specializes in the treatment of substance use disorders in those who with infectious diseases, particularly HIV disease.