WHO Bulletin review of TB and illicit drug use calls for five “urgent measures”

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Sharing drug equipment that includes water pipes, often living in close quarters, frequently imprisoned, and facing greater than average rates of other health conditions including alcoholism, hepatitis B and C, as well as HIV, people who use illicit drugs have higher than average odds of getting tuberculosis infection and disease, with outbreaks of drug-resistant strains common among their numbers, a review in the latest World Health Organization Bulletin says. The review of literature and data, Managing tuberculosis in people who use and inject illicit drugs, part of a Bulletin that includes articles on opioid substitution therapy programs in a variety of settings, including prisons, makes five recommendations of what it calls “urgent measures” to address these odds.

Noting research that has shown up to 80 percent of study subjects who used illicit drugs had been incarcerated at least once, the article highlights the risk that factor alone brings, with the odds among prisoners of getting infected with tuberculosis 26 times that of people in the general population, and of developing active tuberculosis disease 23 times higher. First among the responses that the authors, Haileyseus Getahun, Annabel Baddeley, and Mario Raviglione of WHO’s Stop TB Department, recommend: that policy makers acknowledge and address the role that punitive policies and laws surrounding drug use have played in increasing the spread of tuberculosis among an already vulnerable population.

The authors also recommend addressing failings in health care where those policies lead — prisons — where responses to  dangerous and deadly communicable diseases fall under the auspices of departments of corrections, or justice departments, rather than ministries of health, and where, while risks are greater, policies for dealing with illness fall short of national standards. They also point to proposals that prison overcrowding be addressed with alternative, non-custodial sentencing options.

Other recommendations: That services for diagnosis and treatment of tuberculosis, hepatitis and HIV should be provided together, and accessible at the same time, in the same place as harm reduction services, that the impact of tuberculosis among people who use illicit drugs be accurately counted, and that research respond to the needs the conditions they face suggest, including rapid point of care diagnostic tools, shorter and simpler treatment, and developing evidence-based models of service delivery. Finally, the authors suggest that policies that alleviate, rather than compound the risks of people who are presently marginalized by policy are essential to reaching a global goal of zero tuberculosis discrimination, death and disease.

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