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The demographics, drug habits, and medical complications of a cohort of 1,129 addicts treated at Lexington in the period 1971-1972 were studied. These patients, admitted from 41 different states, had a mean period of addiction of 5.4 years. Over one-third of the sample had engaged in pimping or prostitution, and there were no differences by gender in terms of involvement. Eight-eight percent had shared injection equipment, and surprisingly, 78% admitted to some effort at sterilizing their "works." Hepatitis was the most common associated medical condition: 87% had serologic markers of hepatitis B virus (HBV) infection, 60% had evidence of hepatitis A virus (HAV) exposure, and 47% had abnormal liver function parameters. Gynecomastia was evident in 2% of male subjects. Thirteen percent of the sample had a reactive VDRL assay, but 64% of these were biologically false positive. Subtle abnormalities of immune function were also observed; 18% of the patients had recent unexplained weight loss, 6% had lymphadenopathy, 8% had leukopenia, and 2% had lymphocytopenia. We conclude that both HBV and HAV were important infectious disease risks in these addicts, and that many evidenced deficiencies in immune function well before AIDS became a major public health concern.

The authors assessed the relationship between source of pretreatment income and response to treatment at 6-month follow-up in 165 male veterans admitted to a methadone maintenance treatment program. Subjects were grouped according to whether the majority of their pretreatment income was based on job earnings, public assistance, or criminal activity. Significant improvements in drug use, legal status, and psychological functioning were found in the employed group. The group supported by criminal activity showed the most significant and pervasive improvements, especially in the areas of drug use and family, legal, and employment problems. The group receiving public assistance showed no significant improvements on any of the 16 criterion measures, including drug use.

In a three-year field study of methadone maintenance programs in New York City, Philadelphia, and Baltimore, treatment was found to be effective in reducing IV drug use and needle sharing among most heroin addicts. Of 388 patients who remained in treatment for one year or more, 71 percent had ceased IV use. Conversely, 82 percent of patients who left treatment relapsed rapidly to IV drug use. Marked differences in the effectiveness of various programs were observed: current IV use varied from less than 10 percent to over 57 percent of patients in particular treatment programs. This differential effectiveness was related both to length of patient's stay and to the quality of treatment provided. HIV seropositivity among high-risk drug users is related to frequency of injections and needle-sharing contacts. Effective methadone treatment can stop these practices, but a widespread impact on the AIDS epidemic will require improvement of treatment in many programs.