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Dr. Ayesha Appa - Addiction & Infectious Diseases Doctor

@ayeshaappamd

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👩🏽‍⚕️ Your doctor friend for bugs, drugs, health
🏥 Head of Medical @bouldercare
🦠 UCSF-trained Addiction + ID
✌🏾 Mom | 👯‍♀️ Millennial | Views mine

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Over 25,000 of you are here now, which is WILD and wonderful and also maybe confirms my mom’s suspicion that I am, unfortunately, becoming an influencer.

So: hi. I’m Ayesha!!

I’m an addiction medicine and infectious diseases doctor, and I spend a lot of time thinking about the health questions people are actually trying to answer in real life:

Should I worry?
What does the evidence actually say?
What are people getting wrong?
What would I do next?

I work in the overlap of addiction medicine, infectious diseases, and public health — which means you’ll see a lot here about bugs, drugs, risk, stigma, treatment, and the messy reality of how people make health decisions.

My goal is to make medicine feel less scary, less shame-y, and more understandable.

No panic or wellness fluff or pretending the answer is always simple. I think nuance is sexy.

Also: mom life, Bay Area shenanigans, pop culture for millennials, and my other weird idiosyncrasies

Thanks for being here. Tell me what health question you want me to answer next. by @ayeshaappamd

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Hellooooo peptide bros welcome to harm reduction.

If you’ve ever been intimidated by the term, “drug checking,” don’t be!! It’s this.

Seems so common sense to want to test an unregulated supply of drugs to make sure people stay safe and alive, right? That’s why harm reduction strategies have been part of evidence-based public health programs for decades.

Thank you to all the community-based harm reduction orgs out there who have been making this real for people for years despite shifting national tides 🌊

#peptides
#drugchecking
#harmreduction
#overdoseprevention by @ayeshaappamd

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We know what works to prevent HIV. But we’re really bad at actually helping people with it. Especially if you’re someone who injects drugs.

In Fiji, only 39% of people living with HIV know they have it!! And only 22% are on treatment. Among people starting HIV treatment in 2024, 48% were people who inject drugs.

And in a recent WHO assessment, all 56 people who inject drugs interviewed said they had at some point reused someone else’s needle or syringe because they couldn’t access sterile equipment.

Meanwhile, we have highly effective HIV prevention (PrEP) which is either pills or injections as little as twice yearly that have the power to completely block HIV.

And to be clear: NONE of this is simple. Building trust, changing policy and culture, expanding harm reduction, and creating reliable access to testing, PrEP (esp the $$ options) and treatment takes time, resources, and local leadership. But knowing how hard implementation is doesn’t make the gap any less heartbreaking.

We know what works. Let’s not forget that many of the factors that facilitated this striking rise in cases in Fiji have the potential to be true in the US as well…

Follow for more hot takes from a bugs and drugs doctor 👩🏽‍⚕️😘

Sources: @npr excellent reporting— and @who, Fiji’s HIV epidemic escalates: New rapid assessment highlights urgent gaps… (Dec 2025); WHO, WHO continues to support Fiji as it declares HIV a national emergency (Sept 2026)

#HIV #hivprevention #PrEP #harmreduction #addictionmedicine by @ayeshaappamd

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5 hours ago

ID doctor 👩🏽‍⚕️ take on how to tell if you’re too sick for a flu shot:

Have a cold but are up and about? Usually fine to get 💉— of course if you are able to reschedule or delay without trouble, this is personal preference.. but know that the sniffles (and even a fever if you’re not feeling terrible), isn’t a dealbreaker.

So sick you’re bed bound? Probably not the time for 💉 — wait till you’re better.

But not because the vaccine is dangerous when you’re sick. It’s mostly practical: a minority of adults — roughly 10–20% — get mild systemic symptoms like fatigue, aches, headache, or malaise after a flu shot, and there’s no need to pile that on top of an illness that’s already making you miserable.

And no: the flu shot cannot give you influenza.

References: CDC General Best Practice Guidelines for Immunization; Grohskopf et al., MMWR 2025; Levi et al., Sci Rep 2024; Tai et al., BMC Med Res Methodol 2018.

Plz share so people aren’t worried unnecessarily!!

#fluvaccine
#fluseason
#mythbusting
#infectiousdisease by @ayeshaappamd

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A small practical tip for friends, families of someone struggling with drugs or alcohol — you do not have to know whether someone “has an addiction” before you say something.

If you’re worried about someone’s drinking or drug use, start with what you can actually see and like many though conversations, use an “I” statement:

“I’ve noticed you’re drinking more.”
“You’ve missed work twice when normally you’re always on time.”
“You don’t seem as energetic lately.”
“I’m worried about you.”

You do not need to convince them (or yourself) of a diagnosis. And expecting that the first conversation ends with, “You’re right. I have a problem. I’m ready to change,” may be crushing when it’s harder than that.

That can take time.

Sometimes the goal is simply to open the door and make it a little safer for someone to tell you what’s going on.

Would love to hear if you’ve been on either side of this conversation, what helped? Or what worked well as a loved one?

Follow for more things I wish everyone knew about addiction 😘👩🏽‍⚕️

#addictionmedicine #substanceusedisorder #recovery #familysupport #alcoholaddiction by @ayeshaappamd

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5 days ago

Someone asked me to compare nicotine vapes, poppers, and THC, and I’m only slightly unhinged so: chuck, f*ck, marry — addiction doctor edition.

🚮 CHUCK: nicotine vapes
If you smoke cigarettes, a switch to vaping can be a meaningful way to stop 🚬. But if you don’t already smoke, you’re introducing a dependence-forming drug in a format that makes it very easy to use all day long —> end up with tobacco, which is a top global killer (heart disease, cancer, etc.)

💋 F*CK: poppers
Ok you might think this is weird but here we have one-night-stand energy: fast on, fast off, head rush, smooth-muscle relaxation (aka sphincter relaxation).

But here’s why brief is best: alkyl nitrites can cause large drops in blood pressure, especially with Viagra/Cialis, and more serious complications include methemoglobinemia and retinal toxicity with repeated exposure.

💍 MARRY: THC
Ha, marriage is complicated ok? 😬

Cannabis is absolutely not harmless: cannabis use disorder is real/more prevalent than we talk about, potency has climbed dramatically, psychosis risk matters for some people, and we’re still sorting out long-term cardiovascular effects.

But at the same time, we are just scratching surface on cannabinoids, and there is still a lot we’re learning about where they may have therapeutic value. Interesting data on reductions in certain types of inflammation, pain, etc.
So if I had to pick one to have around…

Important: this is NOT a safety ranking or me endorsing any of these substances. But I love helping people think about risk!!! And talk about things we’re not supposed to.

How violently do you disagree with me?
Which three should I do next?
Xoxox your friendly neighborhood addiction doctor 👩🏽‍⚕️

#addictionmedicine #harmreduction #poppers #vape #cannabis by @ayeshaappamd

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Consent is consent, b*tches.

As an addiction medicine doctor, I will happily talk to you about how to use ketamine more safely. Or how to know when someone has had too much. Or why mixing substances matters. Or what to do when things go sideways.

But the rules of consent do not change depending on what drug someone took.

If someone is confused, barely responsive, can’t communicate clearly, or doesn’t understand what’s happening, they cannot consent. This includes dissociative drugs and know someone can be conscious and not be able to consent.

Take care of your people. And FFS, do not have sex with someone who is too intoxicated to actively choose to be there.

Xo your friendly drugs and bugs doctor — pls tell me what questions you have!!

#consent #cornell #ketamine #sexualassault by @ayeshaappamd

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I’m a hard yes on this one as an Infectious Diseases doctor 🦠

BECAUSE there are consistent (and updated!) data from last year showing that your risk of being hospitalized from COVID goes down meaningfully.

In a large US study of last season’s updated vaccine, effectiveness against COVID-associated hospitalization was about 55% in the first couple of months after vaccination.

And this year’s vaccine has been updated again to better match what’s circulating (like flu gets updated).

So I’m in.. and don’t forget flu too!! @unbiasedscipod and @unambiguousscience had good content on this too, check it out.

Reference:
Wiegand RE, et al. Estimated Effectiveness of 2024-2025 COVID-19 Vaccines in Adults. JAMA Intern Med. 2026.

#covid #covidvaccine #infectiousdiseases #healthadvice by @ayeshaappamd

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10 days ago

If you and your doctor decide that it’s a good move for your health to lose weight, would you be as into making change if the only way to do that was to go to a locked facility where you would have no access to donuts? How might you feel when you return to your usual life?

What if instead someone knew that you loved to shake a tailfeather and suggested a dance class?

Asking for input and creating an environment where someone desiring change in a behavior can make the healthy choice as easily as possible is just common sense.

And OK of course, these cross condition metaphors are not right on everything, but hope that helps give you insight into a situation that it’s easier to pass judgement in (like anything in the drugs and alcohol department).

Please share so we spread the right word and would love your thoughts and questions in the comments <3

xo board-certified addiction doctor and mostly rational human

#addiction #addictionmedicine #recovery #overdose by @ayeshaappamd

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11 days ago

This @tmztv interview did not sit right with me as an addiction doctor for many a reason:

1) making very confident claims about what Presley Gerber “should have” received without being involved in their care — 🚩

2) Higher levels of care absolutely matter. Psychiatric hospitalization can be lifesaving when someone is acutely unsafe or psychiatrically unstable. Residential treatment can also be appropriate for some people.

BUT BUT neither is a magic reset button for addiction. Being physically separated from drugs for a period of time is not the same thing as treating a substance use disorder.

And 3) “medications” are not all the same.

Buprenorphine is an evidence-based treatment for people trying to use fewer opioids. For people who are benefiting from it, there is no arbitrary point when they have to stop! MOUD can appropriately continue long-term.

However benzodiazepines are a completely different can of worms/class of medication that is not data-driven to be used for substance use necessarily. They are used for short-term anxiety, alcohol withdrawal or anti-seizure meds, and I can’t comment on what was going on here… but peoples need to know that they shouldn’t be lumped into “MAT” which implies a level of evidence to treat a chronic process.

People and families deserve more precision than “get them off drugs” or “medications are the problem.”

OK now that I have a 🐝 in my bonnet, more tomorrow…

#addiction #overdose #addictionmedicine #mat by @ayeshaappamd

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