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Recreational drugs and anti-HIV medications

The use of recreational or party drugs has been on the rise in the past few years. Key concerns regarding how recreational drug use may affect HIV infection and anti-HIV therapy include:

1. Some recreational drugs may weaken the immune system, thereby speeding up progression of HIV disease.
2. Recreational drugs may affect one’s ability to adhere to anti-HIV treatment, increasing the risk of HIV-drug resistance and treatment failure.
3. Recreational drugs may lower one’s inhibitions and affect one’s ability to practice safer sex.
4. Because many recreational drugs and anti-HIV medications are metabolized (processed) in the body by the same group of chemicals or enzymes, taking both together can lead to drug interactions. This may lead to the amount of either the anti-HIV medication or recreational drug being significantly increased or decreased, which could potentially cause a harmful and even fatal reaction.

Common recreational drugs and their interactions with anti-HIV medications:

Ecstasy/MDMA
Ecstasy (E or X) is a drug containing the chemical MDMA. It stimulates certain senses, lowers inhibitions, gives an energy boost and may cause hallucinations. It also causes dehydration, headaches, chills, agitation, blurred vision and stomach upset. All protease inhibitors, especially ritonavir (Norvir) and efavirenz (Sustiva), can cause a large increase of the amount of ecstasy in the blood. There has been at least one death reported from this drug interaction.

Crystal Meth (methamphetamine)
Methamphetamine (crystal meth, ice, crystal, yaba, tina) is a synthetic form of amphetamine, a stimulant drug. It causes a perceived sharpening of the senses, heightened sex drive and an increase in body temperature, heart rate and breathing. It may also cause paranoia, memory loss and mood swings and rages. Crystal meth is extremely addictive. Taking amphetamines with protease inhibitors, especially ritonavir, may cause a dangerous increase in the level of crystal meth. Inhaling poppers may further increase the level and effects of crystal meth.

Ketamine
Ketamine (Special K) is a powerful anaesthetic. It is a dissociative drug that gives a sensation of the mind “leaving” the body. It can also cause feeling of numbness, dizziness, blurry vision, hallucinations and confusion. At high doses it may cause irregular heartbeats, difficulty breathing and loss of consciousness. The protease inhibitors ritonavir (Norvir), lopinavir/ritonavir (Kaletra) and nelfinavir (Viracept) all increase the potency of Special K including its potential dangerous effects. Special K may also increase the level of efavirenz (Sustiva) in the blood.

Cocaine / Crack
Cocaine is a stimulant drug made from the leaves of the South American coca plant. Cocaine is not metabolized in the body in the same way as anti-HIV medications, so there does not appear to be any major drug interactions. However, long-term use of crack cocaine can cause severe anxiety, depression, malnutrition and weight loss, which can weaken the body’s immune system.

Marijuana
Marijuana (cannabis, week, pot) is made from a plant. It affects the central nervous system and can cause sedation, relaxation, stimulation of certain senses including appetite, and a sense of relief from pain. It may also impair coordination and cause anxiety and paranoia. There is no proven direct drug interaction between marijuana and anti-HIV medications. However, some studies have shown that long-term use of marijuana may increase the risk of respiratory illnesses, heart disease and cancers of the mouth, throat and lungs.

Alcohol
Alcohol is a central nervous system depressant that generally relaxes the body and causes sedation. There is no direct interaction between alcohol and most anti-HIV medications—except for abacavir (Ziagen), whereby the total amount of abacavir absorbed increases by 41% in men. (This has not been studied in women.) However, long-term use of alcohol damages the liver and affects the liver’s ability to metabolize (process) many of the anti-HIV medications, therefore affecting the level of medications present in the body. There is established evidence that regular alcohol use is associated with poor adherence to anti-HIV medications.

Poppers
Poppers are a nitrite-based drug. Amyl nitrite is a drug used medically to open up the blood vessels to increase blood flow to the heart. It also causes blood to rush to the brain, speeds up the heartbeat and relaxes certain muscles. As a party drug, it comes in a liquid form that can be sniffed as a vapour. There are no documented interactions between poppers and anti-HIV medications. However, sniffing poppers after taking drugs used for sexual dysfunction—such as sidenafil, (Viagra), tadalafil (Cialis) or vardenafil (Levitra) —can be very dangerous if one is also taking a protease inhibitor as part of HIV combination therapy. This can lead to heart problems including potential heart attack.

Other things to consider when taking recreational drugs:

1. Try not to mix recreational drugs with anti-HIV medications.
2. If you are trying a recreational drug for the first time, take that drug by itself and do not mix it with other drugs. This will give you better idea about how the drug works on you.
3. Because most recreational drugs are cut/mixed with other substances, it is difficult to gauge their purity or quality. Try to start with no more than half of the normal amount of the drug, then wait a half-hour to see how it affects you before taking the rest.
4. People react differently to the same drug. Just because your friend can tolerate a drug combination doesn’t mean you can.
5. Drink water regularly to prevent dehydration while doing recreational drugs.
6. Get plenty of rest before and after partying, and allow your body and immune system to recover.
7. Do not skip your anti-HIV medications because doing so may lead to drug resistance. Talk to your doctor if you are thinking of stopping or skipping medications. If you do miss a dose of your medications while you are out partying, take the dose you missed as soon as possible. However, if it is within two hours of your next dose, just continue with your regular schedule and do not double the dose.
8. Many recreational drugs are highly addictive and regular usage may create a problem of drug dependency and addiction. Many drugs can also damage the brain. Talk to your doctor, nurse or social worker if you plan to use recreational drugs so they can work with you to get all the information about the effects of the drugs, their potential interactions with anti-HIV medications and how to avoid possible harm.
   
   For more information on party drugs and ways to reduce harm-related drug use, check out the website and other links of the Canadian Harm Reduction Network at www.canadianharmreduction.com