Trusting Doctors and Talking about Drug Use

There are a million and one reasons why it’s important to have a doctor you trust – whether you’re living with HIV or not.  Of course, that doesn’t mean it’s easy or even always possible, especially if you live outside the big city.  At PWN, we’ve always encouraged women to be assertive with doctors and specialists about their needs, and to try if at all possible to find service providers who treat you with respect and make you feel valued.  You have a right to be treated with dignity, to ask questions and have things explained.  Ultimately, your doctor should help you to make important decisions about your health; it’s their job to convince you if they have a particular treatment in mind.  These are the “feel-good” reasons for having a good relationship with your doctor (feeling respected and valued).  I’m only just beginning to truly understand the ways in which physical health and wellbeing depend on it too.

There is so much information that is crucial to share with your doctor, and unfortunately a lot of it is stuff that’s difficult to talk about with anybody – all the taboo stuff, especially sex and drugs.  As we look into it more, we’re learning just how much drugs (prescribed medications as well as party and street drugs) affect the way our bodies respond to HIV meds.  It’s important for doctors to know what we’re using, how much and how often, so that they can prescribe appropriately.  And it’s important for doctors to ask questions about sex and drugs, not to make assumptions, to be non-judgmental, and to work to gain our trust.

We’re currently working on a new version of the Pocket Guide for Women Living with HIV.  One of the changes to this edition is the removal of the statement “There isn’t a lot of information about how street drugs and HIV medicines work together”.  Since the last edition, there has been quite a lot of research into specific drugs and how they influence and change the way that HIV antiretroviral medications work.  Of course, because street and party drugs are not regulated, we can’t really know what’s actually in the drugs people use – their strength, whether they are cut with something else, how strong they are, etc. – but we know a lot more about drug interactions now.

Basically, all drugs (party and street drugs, but also prescription drugs including HIV meds and methadone) affect the way the liver deals with other drugs.  Some street drugs (and methadone) can increase or decrease the amount of HIV drug in your body.  The change can be enough to make your HIV treatment toxic (which could harm you) or to stop it from working (meaning you’ll need to choose a new combination).  Similarly, HIV drugs can increase or decrease the amount of street drug (or methadone) in your body, leading to hallucination, psychosis, seizure, overdose, withdrawl symptoms, or death.  As one example, the antiretroviral drug Ritonavir (a protease inhibitor, also called Norvir) decreases heroin levels by 50%, which can lead to withdrawl.  Protease inhibitors (including Ritanovir) affect the uptake of amphetamines in the opposite way – they increase drug levels in the blood by two or three times and there is a serious risk of overdosing on the amphetamines.  (This information is from this power-point presentation available from CATIE.  You can call them toll-free to ask questions too.)

Different drugs seem to interact in completely different ways, so it’s really important to be clear and specific about drug use when talking with your doctor, so they can adjust dosages accordingly.  While I haven’t dealt with them specifically here, other prescription and over-the-counter drugs can interact with HIV meds too, so make sure your doctor knows about anti-depressants, sleeping aids, medicinal marijuana, etc.  We can take some responsibility ourselves to be assertive and to do whatever we can to create a relationship of trust with a doctor we like.  But doctors and healthcare service providers have a lot to learn too.  Dr. Lissa Rankin and the writers who contribute to the KevinMD blog are also actively calling on doctors to change their approach.  It really is all about Trust.

- Miriam

This was posted on Friday, March 25th, 2011 at 10:00 am and is filed under Body Health, HIV stigma, News, Spiritual and Emotional Health, Support . Feel free to respond, or trackback. Read our comments policy.

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