Screening for Infectious Diseases Among Substance Abusers Treatment Improvement Protocol (TIP) Series 6 Andrea G. Barthwell, M.D. Consensus Panel Chair Cynthia L. Gibert, M.D. Medical Consultant and Writer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 [Disclaimer] This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. Table 2 in the chapter on syphilis, which is cited in the text as copyrighted, is reproduced herein with permission of the copyright holder. The copyright holder's permission is required for reproduction or copying. All other material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment or the authors. Citation of the source is appreciated. This publication was written under contract number ADM270-90-0001 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Richard Bast served as the Government project officer. Stuart M. Berman, M.D.; Bernard Branson, M.D., Beth A. Dillon, M.S.W.; Samuel W. Dooley, Jr., M.D.; Dorothy C. Gunter, M.P.H.; Christopher H. Hayden; Robert Johnson, M.D., M.P.H.; T. Stephen Jones, M.D.; Bess Miller, M.D., M.Sc.; Louis B. Polish, M.D.; William O. Schalla, M.S.; George Schmid, M.D.; and Ronald O. Valdiserri, M.D., M.P.H., of the Centers for Disease Control and Prevention, served as technical experts. Text development was provided by Mollie Sayers, Patricia Kassebaum, and Dixie McGough. The opinions expressed herein are those of the Consensus Panel members and do not reflect the official position of SAMHSA or any other part of the U.S. Department of Health and Human Services (DHHS). No official support or endorsement of SAMHSA or DHHS is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions. The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this publication are used only because they are considered essential in the context of this Treatment Improvement Protocol. DHHS Publication No. (SMA) 95-3060 Printed 1993 Reprinted 1995 Care has been taken to make the information in this Treatment Improvement Protocol current. However, the user of this document should realize that regimens for treating infectious diseases do change, especially in the treatment of HIV/AIDS and multidrug-resistant tuberculosis. If there is any question about the appropriateness of nay information contained in this protocol, or question about whether the information is current with the latest advances in treatment, the reader is encouraged to consult a specialist in infectious diseases. What Is a TIP? CSAT Treatment Improvement Protocols (TIPs) are prepared by the Quality Assurance and Evaluation Branch to facilitate the transfer of state-of-the-art protocols and guidelines for the treatment of alcohol and other drug (AOD) abuse from acknowledged clinical, research, and administrative experts to the Nation's AOD abuse treatment resources. The dissemination of a TIP is the last step in a process that begins with the recommendation of an AOD abuse problem area for consideration by a panel of experts. These include clinicians, researchers, and program managers, as well as professionals in such related fields as social services or criminal justice. Once a topic has been selected, CSAT creates a Federal Resource Panel, with members from pertinent Federal agencies and national organizations, to review the state of the art in treatment and program management in the area selected. Recommendations from this Federal Panel are then transmitted to the members of a second group, which consists of non-Federal experts who are intimately familiar with the topic. This group, known as a non-Federal Consensus Panel, meets for about three days, makes recommendations, defines protocols, and arrives at agreement on protocols. Its members represent AOD abuse treatment programs, hospitals, community health centers, counseling programs, criminal justice and child welfare agencies, and private practitioners. A Chair for the Panel is charged with responsibility for ensuring that the resulting protocol reflects true group consensus. The next step is a review of the proposed guidelines and protocol by a third group whose members serve as expert field reviewers. Once their recommendations and responses have been reviewed, the Chair approves the document for publication. The result is a TIP reflecting the actual state of the art of AOD abuse treatment in public and private programs recognized for their provision of high-quality and innovative AOD abuse treatment. This TIP on guidelines to screening for infectious diseases among substance abusers is the sixth published by CSAT since a treatment improvement initiative began. It represents another step by CSAT toward its goal of bringing national leadership to bear in the effort to improve AOD abuse treatment. Consensus Panel Members Andrea G. Barthwell, M.D. Chair, TIP Project Medical Director Interventions Chicago, Illinois William A. Alexander, M.D. Associate Professor of Clinical Medicine Morehouse School of Medicine Atlanta, Georgia Lawrence S. Brown, Jr., M.D., M.P.H. Senior Vice President Division of Medical Services, Evaluation and Research Addiction Research and Treatment Corporation Brooklyn, New York Assistant Clinical Professor of Medicine Department of Medicine Harlem Hospital College of Physicians and Surgeons Columbia University New York, New York Milton Earl Burglass, M.D., M.P.H., M.Div., M.S.,C.A.S., F.A.A.F.P Zinberg Center for Addiction Studies Harvard Medical School Cambridge, Massachusetts Henry F. Chambers, M.D. Associate Professor of Medicine University of California at San Francisco San Francisco, California Luis E. Fundora, M.D. Medical Director Impact Drug and Alcohol Treatment Center Pasadena, California Monto Ho, M.D. Professor of Medicine, Microbiology, and Pathology Chair, Department of Infectious Diseases and Microbiology University of Pittsburgh Pittsburgh, Pennsylvania Nancy Lodl, B.S.N., C.A.C., M.S. Information Specialist National Association for Perinatal Addiction Research and Education Chicago, Illinois B. W. MacArmstrong Health Facilities Surveyor Alcoholism and Drug Abuse Division Department of Health and Social Services State of Alaska Anchorage, Alaska Lucia Meijer Administrator Assessment Center Seattle, Washington Janet L. Mitchell, M.D., M.P.H. Chief of Perinatology Harlem Hospital Center New York, New York Gloria J. Mouzon, M.D., F.A.A.F.P. Interventions/Crossroads Outpatient Services Chicago, Illinois Elizabeth Pugh Licensing Consultant Kansas Department of Social and Rehabilitative Services Alcohol and Drug Abuse Services Topeka, Kansas Norbert P. Rapoza, Ph.D. Director Immunology and Infectious Diseases American Medical Association Chicago, Illinois Peter A. Selwyn, M.D., M.P.H. Associate Director, AIDS Program Associate Professor of Medicine and Epidemiology and Public Health School of Medicine Yale University New Haven, Connecticut Larry Siegel, M.D. Medical Director ImmuneCare of Key West Key West, Florida David C. Thomasma, Ph.D. Director of Medical Humanities Program Loyola University of Chicago Strich School of Medicine Maywood, Illinois D. Heather Watts, M.D. Associate Professor Department of Obstetrics/Gynecology University of Washington Seattle, Washington Bruce M. Whyte, M.D. Medical Epidemiologist Division of Public Health Georgia Department of Human Resources Atlanta, Georgia Foreword The Treatment Improvement Protocol Series (TIPs) fulfills CSAT's mission to improve alcohol and other drug (AOD) abuse and dependency treatment by providing best practices guidance to clinicians, program administrators, and payers. This guidance, in the form of a protocol, results from a careful consideration of all relevant clinical and health services research findings, demonstration experience, and implementation requirements. A panel of non-Federal clinical researchers, clinicians, program administrators, and patient advocates employs a consensus process to produce the product. This panel's work is reviewed and critiqued by field reviewers as it evolves. The talent, dedication, and hard work that TIPs panelists and reviewers bring to this highly participatory process have bridged the gap between the promise of research and the needs of practicing clinicians and administrators. We are grateful to all who have joined with us to contribute to advance our substance abuse treatment field. Nelba Chavez, Ph.D. Administrator Substance Abuse and Mental Health Services Administration David J. Mactas Director Center for Substance Abuse Treatment Definition of the Term "Drug Use" The term "drug use" as used in this Treatment Improvement Protocol (TIP) encompasses the following categories of drugs: Cannabis (marijuana, hashish) Cocaine Hallucinogens (e.g., LSD, mescaline) Inhalants (e.g., gasoline, glue) Alcohol Opioids (e.g., heroin, pentazocine [Talwin], codeine) Phencyclidine (PCP) Sedatives, hypnotics, or anxiolytics (e.g., barbiturates, benzodiazepines) Stimulants (e.g., amphetamines) Tobacco, considered to be a drug, is excluded