Nearly half of heroin addicts in Baltimore's drug treatment programs are unaware that they suffer from chronic blood infections such as HIV and hepatitis, says a study by the Johns Hopkins School of Public Health.
Though the study offers a disturbing picture of the health problems associated with addiction, the researchers said the city has an excellent chance to reduce the toll through its methadone maintenance centers.
Officials with the Open Society Institute, the foundation that paid for the study, said the methadone centers should screen clients for blood-borne infections and refer those who need care to clinics.
"You want to break down the barriers between drug treatment and the health care system," said Dr. Robert Schwartz, an addictions specialist with the Open Society Institute.
Researchers found that nearly two out of three addicts were infected with hepatitis C, a chronic infection that can eventually trigger liver failure and cancer. One-third of those infected knew it.
Meanwhile, one in five addicts were infected with the human immunodeficiency virus, or HIV, which causes AIDS. Eighty percent were aware they were infected, presumably because HIV testing is widely available and has been encouraged by public health campaigns.
One positive finding was that only 3 percent of the addicts were infected with syphilis, a sexually transmitted disease. Researchers credited the city health department's campaign in the mid-1990s with curbing what was then a serious epidemic.
The high level of hepatitis C infection did not come as a surprise to researchers. A previous Hopkins study found that more than 80 percent of those who were intravenous drug users carried the virus, which, like HIV and hepatitis B, is spread by shared needles.
In the two-year study, Open Society paid for case managers at the clinics who referred infected addicts for medical care. About 2,000 addicts were vaccinated against hepatitis B.
"It's a wonderful place to offer free testing," said Stephanie Strathdee, a Hopkins researcher who directed the study. "They're taking care of their addiction. Now, they are ready to take care of their health."
The researchers, along with Open Society officials, recommended that the treatment centers offer free testing for HIV, syphilis, and hepatitis B and C, using state laboratory services. They also urged the treatment centers to seek federal funding for hepatitis B vaccines.
The clinics should refer patients to federally funded community health centers and the city clinics that treat sexually transmitted diseases, the study said.
An unanswered question, however, is how to pay for the services - particularly, hepatitis C treatment, which can cost as much as $35,000. Federal funding is fragmented and scarce.
Karen Reese, director of the Man Alive methadone clinic on North Charles Street, said many addicts are reluctant to begin yearlong treatment for hepatitis C once they find out it can cause unpleasant side effects, such as fatigue.
Because of this, many experts are unsure who should be encouraged to get treated.
But Dr. David Thomas, a hepatitis C researcher at Hopkins, said addicts going to methadone clinics might be good candidates because they have already shown commitment to dealing with their drug problems.