Tuberculosis and Illicit Drug Use: Review and Update

Abstract

Illicit drug users continue to be a group at high risk for tuberculosis (TB) infection and disease. In this article, we present an updated review on the relationship between TB and drug use, summarizing more than a decade of new research. Drug users, and injection drug users in particular, have driven TB epidemics in a number of countries. The successful identification and treatment of TB among drug users remains an important component of a comprehensive TB strategy, but drug users present a unique set of challenges for TB diagnosis and control. New diagnostic modalities, including interferon-γ release assays (IGRAs), offer potential for improved diagnosis and surveillance among this group, alongside proven treatment strategies which incorporate the use of directly-observed therapy (DOT) with treatment for drug abuse. Special considerations, including co-infection with viral hepatitis and the Rifampin/methadone drug interaction, warrant clinical attention and are also updated here.

Limited Utility of Name-Based Tuberculosis Contact Investigations among Persons Using Illicit Drugs: Results of an Outbreak Investigation

“…9 First, TB patients who use crack cocaine are more likely to be sputum-smear positive at diagnosis, 10 suggesting increased contagiousness. Second, persons involved in the sale and use of illegal drugs are unlikely to volunteer names of contacts and may also be less likely to know or remember contacts' names.…”

Managing tuberculosis in people who use and inject illicit drugs

“…Studies conducted before and after the emergence of HIV infection show that, when compared with the general population, people who use illicit drugs have a higher risk not just of getting tuberculosis infection, but also of developing active disease. 1,2 Similarly, outbreaks of drug-susceptible and multidrug resistant (MDR) tuberculosis are common in this group. 1 Although the higher risk of tuberculosis observed in people who inject illicit drugs is usually the result of associated HIV infection, in people who use illicit drugs without injecting this higher risk is primarily attributable to the sharing of drug equipment, such as marijuana water pipes, and to living in cramped conditions or in dwellings with poor ventilation.…”

“…1,2 Similarly, outbreaks of drug-susceptible and multidrug resistant (MDR) tuberculosis are common in this group. 1 Although the higher risk of tuberculosis observed in people who inject illicit drugs is usually the result of associated HIV infection, in people who use illicit drugs without injecting this higher risk is primarily attributable to the sharing of drug equipment, such as marijuana water pipes, and to living in cramped conditions or in dwellings with poor ventilation. 1 Co-infection with the hepatitis B and hepatitis C viruses is also common among patients who inject illicit drugs, particularly among those who are also co-infected with the tuberculosis bacillus and HIV.…”

“…1 Although the higher risk of tuberculosis observed in people who inject illicit drugs is usually the result of associated HIV infection, in people who use illicit drugs without injecting this higher risk is primarily attributable to the sharing of drug equipment, such as marijuana water pipes, and to living in cramped conditions or in dwellings with poor ventilation. 1 Co-infection with the hepatitis B and hepatitis C viruses is also common among patients who inject illicit drugs, particularly among those who are also co-infected with the tuberculosis bacillus and HIV. 2 Although most reports on hepatitis among people who use illicit drugs have come from high-income settings, some alarming reports have also been produced about middle-and low-income settings.…”

The Effect of Alcohol Use on the Clinical Presentation of Tuberculosis

“…The most commonly cited factors, however, are presenting with cavitation on a chest radiograph and showing a positive sputum-smear result, which have been shown to be associated with delayed treatment, increased transmission, and increased risk of treatment failure [4].…”