CHILLING WITH PILLS

Info Sheet Aimed At Poz People Who Party

HIV medications and recreational drugs can interact in dangerous and
sometimes unpredictable ways. But knowing proper harm reduction techniques
can help.

The Canadian AIDS Treatment Information Exchange (CATIE) has new
educational materials ready to help people juggle their medication and
their recreational drug use.

"It's not about rules, what you can and can't do with your life," says
David Coop, director of treatment information at CATIE. "It's about being
informed and about making informed choices about lifestyle."

Coop, along with Montreal doctor Benoit Trottier, presents a new fact sheet
on the risks of using HIV medications and using party drugs at a workshop
Wed, May 7.

It can be a hard message to deliver. Recreational drug users usually don't
rely upon scientific data, learning from experience that scientific and
medical researchers can be prejudiced against their lifestyle. Instead they
rely upon a common knowledge built up through personal experience.

"It's an old science," says Walter Cavalieri, president of the Toronto Harm
Reduction Task Force. "Try it and watch the results. That's what happens
with people who use drugs.... It's an experimental method with human
subjects and an inaccurate body count. There's an informal body of
evidence. Now, how do we insinuate all this knowledge that CATIE has put
together, into that common pool of evidence? That's the crucial thing."

But that kind of old science can be dangerous. Coop points to one of the
most conclusive pieces of data on mixing HIV medication and recreational
drug use, an autopsy report of a UK man who died of an ecstasy overdose.
Protease inhibitors in his system caused the potency of the drug to be
multiplied 10 to 12 times.

"The difficulty with producing a fact sheet about recreational drugs and
HIV," Coop admits, "is the term 'fact sheet' gives people the impression
that there are solid facts.

"The interactions between recreational drugs and anti-retroviral therapies
have not been studiedscientifically, nor are they likely to be. Most are
illegal substances and not available in standard doses. What we are relying
upon is anecdotal case reports. We are also relying upon what we know about
the metabolizing of these drugs."

So what advice does the fact sheet offer?

Alcohol is possibly one of the most harmful drugs to mix with an HIV
cocktail because of the stress it puts on your liver. It can double levels
of some protease inhibitors, creating a risk of pancreatitis and causing
painful kidney stones.

The same liver enzyme system used to break down protease inhibitors and
other medications has to work also on the alphabet soup of party drugs: E,
K, LSD, crystal and possibly GHB. That means that both HIV meds and drugs
will stay in a person's system a lot longer -- as much as 10 times longer
- -- creating greater toxicity. This may result in an overdose or nasty
medication side effects.

Methadone and heroin can have an opposite reaction with medications being
eliminated from your system at a much faster rate. This may induce
withdrawal symptoms, leading some people on methadone maintenance programs
to fall back into heroin.

Cocaine seems relatively free of interactions with meds, according to the
fact sheet. But there is the risk of interruptions in a medication regime
with weekend-long drug binges coke users might pull. Missed meds could
cause resistant strains of the virus to develop.

And being hepatitis C-positive increases the liver risk even more.

One of the big challenges is getting the information out.

"If it sits on a shelf, or if it's not communicated to people, then it's
dead," says Cavalieri. "I don't fault CATIE for producing information [but]
there's no guarantee it will be read."

On the downside, party drug consumers often don't access needle exchanges
and other programs targeted to street drug users. Working in CATIE's favour
is the tendency of HIV-positive people to seek out health information. The
fact sheet will be posted on CATIE's website and made available at AIDS
service organizations, community health clinics and centres like the 519
Community Centre.

Last year CATIE's publication editor, RonniLyn Pustil, authored the
well-received publication PreFix, with the help of a focus group of drug
users. The pamphlet is being reprinted.

"Intravenous drug users were a main target group that we wanted to inform
and educate," says Pustil. "And not just IV drug users, but people who work
in needle exchanges, people who work at methadone clinics, in community
health centres. PreFix is really meant to be a tool for the community
intermediaries, to use when they are working with drug users."

* A free community health forum on HIV medications and recreational drug
use will be hosted by the AIDS Committee Of Toronto on Wed, May 7, starting
at 7pm at the Primrose Hotel (111 Carlton St). For more information, check
out www.catie.ca.