Substance Abuse Linked to Tuberculosis Transmission and Treatment Failure in the United States

Although tuberculosis (TB) prevalence is low in the United States, local outbreaks among people with substance abuse have been reported. Researchers from the Centers for Disease Control and Prevention analyzed records of all reported TB cases in the United States from 1997–2006 to assess the role of substance abuse in the transmission and treatment of TB.

• Of the 153,268 people with TB included in the analysis, 19% overall reported substance abuse (defined by self-reported excessive alcohol use, non-injection drug use, or injection drug use in the year before TB diagnosis). Of the 76,816 US-born TB cases, 29% reported substance abuse.
• Prevalence rates were higher for substance abuse than for other risk factors, including recent immigration to the United States, HIV infection, residing in a congregate setting, homelessness, or working at a high-risk occupation (e.g., healthcare, correctional-facility, or migrant worker).
• A TB-positive sputum smear was more common among people with substance abuse, both in persons with HIV infection and without HIV infection.
• Treatment failure was more common among people with substance abuse, especially among women but also among men.
• People with substance abuse were more likely to be in a county-level genotype cluster (defined as 2 or more patients from the same county with identical TB genotypes).

Comments by Tom Delaney, MSW, MPA
This article is a timely reminder to substance abuse treatment providers that the incidence of TB among persons with substance abuse has decreased less than it has for the general population. Substance abuse clinicians and staff should not be lulled into overlooking TB as a health threat to their patients because of its lowered incidence overall. The treatment community has an important role to play in referring patients for TB screening, taking steps to reduce transmission, and encouraging client adherence to TB treatment regimens. This study also reinforces the need for substance abuse treatment to be integrated into the total health care of the patient.