HCV reinfection as a positive indication of high‐risk population treatment access

Recommended Reading
High response and re-infection rates among people who inject drugs treated for hepatitis C in a community needle and syringe programme
We show that it is feasible to recruit people who inject drugs(PWID) from a community-basedneedle and syringe programme (NSP) onto HCV treatment, and achieve over 80% SVR-12 andimpressive treatment adherence.

Commentary
HCV reinfection as a positive indication of high‐risk population treatment access

Gregory J Dore

First published: 25 February 2019
https://doi.org/10.1111/jvh.13092

Strategies to address HCV reinfection and limit its overall impact on HCV elimination are required, but the most important of these is ongoing engagement with high- risk individuals to enable detection of HCV reinfection and its retreatment without stigma and discrimination.

Download full-text article:

https://jumpshare.com/v/e6nm2pXcbAWHvAV3jKSr 

Article shared via Twitter by Henry E. Chang‏.

Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment

Combination interventions for Hepatitis C and Cirrhosis reduction among people who inject drugs: An agent-based, networked population simulation experiment
Bilal Khan, Ian Duncan, Mohamad Saad, Daniel Schaefer, Ashly Jordan, Daniel Smith, Alan eaigus,

Don Des Jarlais, Holly Hagan, Kirk Dombrowski 

Published: November 29, 2018

https://doi.org/10.1371/journal.pone.0206356 

Fig 1. Finite state diagram of the HCV model used in the experiments.
Once infected, agents face a series of stochastic and enforced progressions through a series of ever worsening liver function. Throughout the simulation, infected agents who have reached a chronic state (non-acute HCV infected agents) face a small but regular chance of moving directly to cirrhosis, decompensated cirrhosis, or hepatocellular carcinoma. In addition, their Metavir fibrosis level is incremented yearly, moving them gradually from early stage fibrosis to cirrhosis. Once in any of the three severe liver stages, agents face an increasing probability of death due to HCV infection, incremented on a five year basis.
https://doi.org/10.1371/journal.pone.0206356.g001

Full-text article:

PDF

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Abstract

Hepatitis C virus (HCV) infection is endemic in people who inject drugs (PWID), with prevalence estimates above 60% for PWID in the United States. Previous modeling studies suggest that direct acting antiviral (DAA) treatment can lower overall prevalence in this population, but treatment is often delayed until the onset of advanced liver disease (fibrosis stage 3 or later) due to cost. Lower cost interventions featuring syringe access (SA) and medically assisted treatment (MAT) have shown mixed results in lowering HCV rates below current levels. However. little is known about the potential cumulative effects of combining DAA and MAT treatment. While simulation experiments can reveal likely long-term effects, most prior simulations have been performed on closed populations of model agents—a scenario quite different from the open, mobile populations known to most health agencies. This paper uses data from the Centers for Disease Control’s National HIV Behavioral Surveillance project, IDU round 3, collected in New York City in 2012 to parameterize simulations of open populations. To test the effect of combining DAA treatment with SA/MAT participation, multiple, scaled implementations of the two intervention strategies were simulated. Our results show that, in an open population, SA/MAT by itself has only small effects on HCV prevalence, while DAA treatment by itself can lower both HCV and HCV-related advanced liver disease prevalence. More importantly, the simulation experiments suggest that combinations of the two strategies can, when implemented together and at sufficient levels, dramatically reduce HCV incidence. We conclude that adopting SA/MAT implementations alongside DAA interventions can play a critical role in reducing the long-term consequences of ongoing HCV infection.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0206356

Oxycodone use shifts in Australia after tamper-resistant versions introduced

Study -  CMAJ (Canadian Medical Association Journal

Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia

Healio

Tamper-resistant formulations of higher-strength oxycodone decrease use
March 26, 2018 Dispensing rates for higher-strength oxycodone formulations among Australians younger than 65 years decreased when tamper-resistant versions were implemented, according to findings recently published in the Canadian Medical Association Journal.

Oxycodone use shifts in Australia after tamper-resistant versions introduced

Canadian Medical Association Journal
After the introduction of tamper-resistant oxycodone in Australia, dispensing rates for higher-strength formulations decreased for people younger than 65 years, but there was no change in older adults, according to new research in CMAJ (Canadian Medical Association Journal).

Canada, the United States and Australia are the highest per capita consumers of opioids worldwide. Opioid use has increased 15-fold in Australia over 20 years (1992 to 2012), making it the country with the second highest per capita consumption of oxycodone. In 2014, the country introduced tamper-resistant controlled-release oxycodone.

The study looked at whether reformulation changed use of controlled-release oxycodone and opioid-related harms in a sample cohort of 36 528 adults who had at least one filled prescription for oxycodone during the study period (July 2012 to November 2016). After reformulation, dispensing of oxycodone in both 10-30 mg and 40-80 mg strengths gradually decreased for people under age 65 years, for total decreases of 11% and 31.5%, respectively. People younger than 65 years, especially those younger than 45 years, were more likely to switch to morphine after reformulation, and there was an increase in participants of all ages switching to oxycodone/naloxone.

"The observed decline in dispensing of higher-strength oxycodone controlled-release in participants less than 65 years of age may be due to an increase in switching to other strong opioids, chiefly morphine, rather than an increase in ending use," writes Dr. Andrea Schaffer, University of New South Wales, Sydney, Australia, with coauthors. "This is of concern because it suggests that people may be seeking out opioids without tamper-resistant properties."

The authors note that as the study was observational, the results do not indicate causation between reformulation and changes in behaviour, but rather an association.

Despite reductions in dispensing of stronger oxycodone, poisonings from injected oxycodone did not decrease, as measured by calls to the New South Wales Poison Information Centre, which receives about 50% of all poisoning calls yearly in Australia.

"We did not find an increase in ending use of strong opioids in parallel with an increase in switching to other non-tamper-resistant strong opioids," write the authors.

They note that people under age 65 who were using higher-strength opioids and switched to different types of opioids had been identified as having a higher risk of opioid use problems and should be closely monitored by their physicians.

The study was funded by Australia's National Health and Medical Research Council Centre of Research Excellence in Medicines and Ageing.

"Person-level changes in oxycodone use after the introduction of a tamper-resistant formulation in Australia" is published March 26, 2018.

https://www.eurekalert.org/pub_releases/2018-03/cmaj-ous032118.php

Opioid abuse leads to heroin use, hepatitis C epidemic

Opioid abuse leads to heroin use, hepatitis C epidemic

Increasing rates of opioid use in the U.S. have public health consequences like heroin usage and the spread of hepatitis C, USC researchers say.

Heroin is worse than other drugs because people inject it much sooner, potentially resulting in increased risk of injection-related epidemics such as hepatitis C and HIV, a Keck School of Medicine of USC study shows.

As more people use opioids, many switch to heroin because it’s more potent and cheaper — a trend that complicates disease prevention as health officials crack down on opioids, said Ricky Bluthenthal, PhD, first author of the study and professor of preventive medicine at the Keck School.

Stigmatizing drug use is an ineffective way to address a public health outbreak, he added.

“The market is saturated with opiates. That cat is out of the bag,” Bluthenthal said. “At this point, we have to figure out what we’re going to do about opioid abuse because the opioid crisis is leading to downstream infectious disease epidemics such as acute hepatitis C.”

Published in the journal Drug and Alcohol Dependence on Feb. 15, the study surveyed 776 people in Los Angeles and San Francisco about their drug use. Researchers limited the investigation to heroin, methamphetamine or speed, powder cocaine and crack cocaine.

About 99 percent of participants who used heroin, regardless of demographics, eventually injected the drug — nearly three times the injection rate of people who used crack cocaine. The second most injected drug was meth or speed, with 85 percent of users reporting that they moved to injection.

Heroin had the shortest incubation period — about half a year — from initial drug use to drug injection. It took meth and speed users about twice that time and powder cocaine users nearly five times that length of time to begin injecting.

“Heroin is less expensive than opioids and more potent,” Bluthenthal said. “So transitioning to heroin is reasonable. Heroin is much more efficient when injected, and that’s why we see this trend.”

On the road to a solution

As the nation tries to clamp down on the opioid epidemic, it may inadvertently drive people to heroin more quickly, Bluthenthal said. The real solution, he noted, is to get people better treatment for their opioid addiction.

From 2002 to 2015, there was a six-fold increase in the number of overdose deaths involving heroin, according to the National Institute on Drug Abuse.

Hepatitis C linked to injection drug use has increased three-fold over a 10-year period, the study stated, citing research from the University of Cincinnati Medical Center.

“We want to interrupt people from escalating their drug use from legal prescription opioids to illicit heroin use,” Bluthenthal said.

Possible solutions include drug consumption rooms, supervised injection facilities, syringe exchange programs, overdose prevention education and naloxone distribution, Bluthenthal said. Naloxone is an antidote for opioid overdose.

“We’re always trailing the epidemic: We don’t know there is a problem until the bodies and infections start showing up,” Bluthenthal said. “We now know people are moving from opioids to heroin to injection. We missed the opportunity to change that progression, so we need to move more aggressively to reduce opioid abuse and to implement safer venues to consume drugs. The end result will benefit public health.”

Daniel Chu and Thomas Valente from the Keck School of Medicine, Alex Kral and Lynn Wenger from RTI International and Philippe Bourgois from the David Geffen School of Medicine at UCLA also contributed to this study.

The study was entirely supported by federal grants amounting to $1,656,797 from the National Institute on Drug Abuse (R01DA027689, R01 DA038965) and the National Cancer Institute (P30CA014089).

— Zen Vuong


February 26th, 2018|Announcements, Keck Net Intranet

Podcast Series: Diagnosis and Treatment Of Hepatitis C

In case you missed it, interesting podcast. 

Diagnosis and Treatment Of Hepatitis C
February 22, 2018

Hepatitis C (HCV) is the most-deadly infectious disease in America.

• More than 20,000 die every year because of HCV
• Half of people infected do not know that they have the virus
• HCV can remain undetected for decades

HCV is curable, even among past and current drug users. You can help turn the tide. Learn how to screen (hint: it's easy) and how screening can save lives.

Treatment is now simpler, more effective, and shorter than ever. And it should be offered to nearly everyone with HCV, regardless of the level of cirrhosis.

Tune in to START HCV Radio Hour to listen and learn as our expert faculty explore important topics, using patient stories in an engaging moderated DKBmed Talk, modeled after the famous and popular TED Talks.

• Learn how to detect HCV infection with a simple blood test
• Become familiar with revolutionary new treatment options that cure 99% of people who use them
• Prevent the spread of HCV and the morbidity and mortality that can follow

The expert faculty includes Mark Sulkowski, MD, professor of medicine and medical director of the Viral Hepatitis Center at the Johns Hopkins University School of Medicine; Alain Litwin, MD, professor of medicine at Albert Einstein College of Medicine in New York; Kathleen Brady, MD, Distinguished University Professor at the Medical University of South Carolina and Director of the South Carolina Clinical and Translational Research Institute; and Raymond Chung, MD, director of hepatology and the Liver Center at Massachusetts General Hospital in Boston.

Start HCV: Part 1

Start HCV: Part 2

Begin here.......

For Viral Hepatitis Elimination One Size Does Not Fit All

Health Is Global

A blog about Global Health. An open space for discussing equitable access to health for everyone, everywhere.

For Viral Hepatitis Elimination One Size Does Not Fit All
Jeffrey Lazarus

12 February 2018

“For elimination, one size does not fit all” was a refrain repeated in a number of different ways throughout the presentations and discussions at the European Association for the Study of the Liver (EASL) Monothematic conference on “Striving towards the elimination of HCV infection” that has just come to a close in Berlin.

Whether in discussions about prevention, interventions in drug users, improving linkage to care, or treatment itself, attendees agreed that there is no golden ticket for hepatitis C elimination. However, there are a number of evidence-based strategies for impact that were presented very effectively by over 30 speakers in the six thematic panel sessions.

Continue reading.....

Links

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English

español

Co-managing HIV, Hepatitis C, and Opioid Abuse

COMMENTARY
Co-managing HIV, Hepatitis C, and Opioid Abuse
Naveed Saleh, MD, MS
January 23, 2018

Infection and Opioids
Effective antiretroviral treatments for HIV and hepatitis C exist and are widely available. In fact, treatment for hepatitis C is curative, which hardly seemed imaginable only a few short years ago. But despite there being effective treatments for these diseases, barriers exist that make their treatment difficult. Chief among these barriers is intravenous use of opioids.

The stark reality is that people with hepatitis C or HIV, or both diseases, are much more likely to die of drug overdose than of chronic illness itself. Furthermore, according to the Centers for Disease Control and Prevention, in 2014 death from drug overdose was more common than death caused by motor vehicle accidents or firearms. Of note, 80% of people who inject drugs and are HIV-positive also have hepatitis C.

At IDWeek 2017, managing infectious disease in opioid users was an important topic of coverage. In a lecture titled "Co-management of Opioid Treatment, HIV, and Hepatitis C Treatment," Brianna Norton, DO, MPH, an assistant professor of infectious disease and internal medicine at the Albert Einstein College of Medicine, discussed evidence-based approaches to treating opioid use disorder in patients with HIV and hepatitis C.

Continue reading: https://www.medscape.com/viewarticle/891282?src=rsshttp://www.medscape.com/viewarticle/891282?src=rss

Free registration may be required

How Injection Drug Use Affects HCV Treatment

Clinical Care Options
How Injection Drug Use Affects HCV Treatment
Norah Terrault MD, MPH - 1/3/2018
Here’s my take on why colocalization of HCV treatment with other medical and social services may be ideal for persons who inject drugs.

In this viral hepatitis case series, we highlight common patient case scenarios and the critical decision making that informs selection of optimal patient management strategies. This commentary features a young woman recently diagnosed with HCV infection after initiating medication-assisted treatment for heroin use. Key considerations for her care are discussed, including how former injection drug use affects her candidacy for HCV treatment.

Continue to article: https://www.clinicaloptions.com/Hepatitis.aspx

Free registration required

Dr. Gabor Maté on the Trauma Underlying the Stigma of Addiction: An Interview

The Fix - Addiction and recovery, straight up

Dr. Gabor Maté on the Trauma Underlying the Stigma of Addiction: An Interview
By John Lavitt 12/12/17

There are legitimate uses of opioids in the treatment of physical pain. There is no legitimate use in the treatment of emotional pain.

When commenting on the neurobiology of addiction, you write how, “addiction is related psychologically, in terms of both emotional pain relief and neurobiological development, to early adversity.”

If the neurobiological development of a child is affected by trauma, how can such physical changes set in place long ago be reversed? Is it possible for an adult to “renew” their brain, and if so, how long would such a process of renewal take? What tools would be required?

When we do brain scans on adult addicts, you see several neural systems that just don’t work very well, including the opiate pain relief, pleasure, reward, attachment, and love circuitry. Other problematic systems include the stress regulation circuitry, the impulse regulation circuitry, and especially the dopamine-driven incentive motivation circuitry. As a result, doctors often conclude that because these brain circuits aren’t working well, there has to be a brain disease and that addiction is that disease.....

View Part 1 of a 2 part interview

Access to hepatitis C treatment for patients in drug substitution programmes: the fight is far from over

Viewpoint
Access to hepatitis C treatment for patients in drug substitution programmes: the fight is far from over
Francesco Negro, Liudmyla Maistat
DOI: 10.4414/smw.2017.14570
Swiss Med Wkly. 2017;147:w14570

Hepatitis C virus (HCV) is a parenterally transmitted human pathogen of global concern. Chronic HCV infection is associated with progressive liver disease culminating in an estimated yearly toll of around 400 000 deaths, mostly due to liver failure and hepatocellular carcinoma. Thus, in 2016, the World Health Organization issued a declaration aiming at the elimination of viral hepatitis as a global public health threat by 2030 [1]. Six indicators were identified to measure the progress in this ambitious effort: infant vaccination against hepatitis B virus (HBV), prevention of mother-to-child transmission of HBV by birth dose vaccination, blood and injection safety, harm reduction measures for people who inject drugs (PWID), identification of infected patients by means of appropriate screening strategies, and treatment of patients with potent antivirals.

Full Text
View Online
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Treating The New Hep C Generation On Their Turf

Treating The New Hep C Generation On Their Turf

By Pauline Bartolone

December 1, 2017

The opioid addiction crisis has engendered an unfortunate side effect — an epidemic of new hepatitis C infections, mainly among young people who share infected needles. Although people over age 52 still account for the largest share of chronic hepatitis C cases, the highest number of new infections occurs among people in their 20s.

“We ask for people to think beyond that baby boomer box,” Bauer said. Public health organizations “can take their services on the road, so to speak, and they can make an extra effort to reach populations that may be more at risk.”

Continue reading: https://californiahealthline.org/news/treating-the-new-hep-c-generation-on-their-turf/

Endocarditis - SPECIAL REPORT: London doctors’ simple strategy may stem a deadly toll

SPECIAL REPORT
London doctors’ simple strategy may stem a deadly toll
By Randy Richmond, The London Free Press
Friday, October 27, 2017 11:30:42 EDT AM

At University Hospital, Koivu started to notice more and more endocarditis deaths. When she asked her dying patients what they were using, almost all those who injected drugs said they were using HydromorphContin capsules.

To inject the drug, you first have to crush the capsules in a tiny container, usually a little pan called a cooker – the kind seen in movies and on television used to melt crack cocaine or crystal meth.

Cooking doesn’t dissolve the capsules, so you have to crush them as best as you can in a bit of water.

Then you place a tiny filter, sometimes called a sponge, over the hydro-laced mixture and draw liquid up with your needle.

Koivu theorized that when people drew up the crushed capsules in a syringe, even through a properly used filter, some particles were being drawn up as well.
Those particles scratch the heart valves...

Read the article here......

Of Interest
HIV and Hepatitis C Are No Longer the Most Serious Infectious Threats to People Who Inject Drugs
For whatever reason, endocarditis and other invasive bacterial infections are not nearly as feared as HIV and HCV, despite the fact that the former are far more immediately life threatening and way more difficult to treat.

Surgeon General: We will conquer HCV, opioids ‘one bite at a time’

Surgeon General: We will conquer HCV, opioids ‘one bite at a time’
During a session focused on the connection between the hepatitis and opioid epidemics at The Liver Meeting 2017, Jerome M. Adams, MD, MPH, Surgeon General of the U.S., advised physicians in attendance that hepatitis C elimination will require nontraditional partnerships and innovative strategies for education, prevention and screening.

“I want to ask you all a question that I hope all of you know the answer to,” Adams said to the audience. “How do you eat an elephant? One bite at a time. If you take one bite at a time, if you help all of our partners see which part of that elephant they can take a bite of, we will be able to consume that elephant that is the opioid epidemic.”

Read article available online at Healio

The Liver Meeting® 2017- Conference Coverage

VIDEO: AASLD to speak on Capitol Hill on the public health burden of NAFLD

WASHINGTON — In this exclusive video from The Liver Meeting 2017, Arun Sanyal, MD, FAASLD, from the Virginia Commonwealth University…

Fewer HCC cases from HCV clearance improves quality of life, cost savings

October 23, 2017

WASHINGTON — Through treatment of hepatitis C genotype 1 with direct-acting antivirals, significant direct and indirect cost savings may…

View More Conference Coverage From - "Healio"

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HCV Sites With Key Data, Expert Review & Summary 

ACP Internist - Primary care takes on opioid addiction

ACP Internist

Opioids | October 2017

Primary care takes on opioid addiction

By Mollie Durkin

There's a lot that primary care clinicians can do to treat opioid addiction, but stigma about the condition, as well as laws and other regulations, throw up barriers.

People with opioid use disorder who receive opioid agonist treatment with methadone have less than one-third the mortality risk of those who do not receive it, according to a systematic review and meta-analysis published in 2017 by The BMJ. Opioid agonist treatment with buprenorphine also appears to be associated with a reduction in mortality, although this finding was based on fewer studies, the reviewers said. Patients who discontinued treatment with either drug had increased mortality risk.
                
But the legal stipulations around providing such treatment reflect the stigma surrounding the disease, said ACP Member Laura Fanucchi, MD, MPH, a primary care internist for patients with HIV and addiction and assistant professor at University of Kentucky College of Medicine in Lexington.

Other obstacles to treatment include physicians' attitudes and beliefs. “I hear comments like, ‘We don't want those patients in our office, in our waiting room,’ etc., but the reality is that addiction doesn't discriminate,” said internist and researcher Chinazo Cunningham, MD, MS, professor of medicine at Albert Einstein College of Medicine and associate chief of the division of general internal medicine at Montefiore Medical Center in New York City. “So I tell people that ‘those patients' are your neighbors, your colleagues, your family members, your friends.” 

Read the article: http://www.acpinternist.org/archives/2017/10/primary-care-takes-on-opioid-addiction.htm

Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents

Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents
Article Summary @ GastroHep
Reasons for lack of treatment included waiting for newer therapy, co-morbidities and alcohol/drug abuse. Dr Kanwal's team comments, "Half of patients with established HCV care were followed-up in the direct-acting anti-virals era and only 29% received DAAs."

Alimentary Pharmacology & Therapeutics
ORIGINAL ARTICLE

Full Text Article:  Available Online

Barriers to hepatitis C treatment in the era of direct-acting anti-viral agents
Authors M. Lin, J. Kramer, D. White, Y. Cao, S. Tavakoli-Tabasi, S. Madu, D. Smith, S. M. Asch, H. B. El-Serag, F. Kanwal

First published: 26 September 2017
DOI: 10.1111/apt.14328

Summary
Background
Direct-acting anti-virals (DAA) are safe, effective treatment of hepatitis C virus (HCV). Suboptimal linkage to specialists and access to DAAs are the leading barriers to treatment; however, data are limited.

Aim
To determine predictors of follow-up, receipt of DAAs, and reasons for the lack thereof.

Methods
We used clinical data from retrospective cohort of HCV-infected patients with previously established HCV care in the US Department of Veterans Affairs to examine predictors of follow-up in HCV clinics and DAA treatment (during 12/1/2013-4/30/2015). We then conducted a structured review of medical charts of HCV patients to determine reasons for lack of follow-up and treatment.

Results
We identified 84 221 veterans who were previously seen in HCV clinics during the pre-DAA era. Of these, 47 165 (56.0%) followed-up in HCV specialty clinics, 13 532 (28.7%) of whom received DAAs. Older age, prior treatment, presence of cirrhosis or HCC, HIV/HBV co-infection and psychiatric illness were predictors of follow-up. Alcohol/drug abuse and medical co-morbidity were predictors of lack of treatment. Of the 905 prospectively recruited patients, 56.2% patients had a specialist visit and 28% received DAAs. Common reasons for lack of follow-up were relocation (n = 148, 37.4%) and missed/cancelled appointments (n = 63, 15.9%). Reasons for lack of treatment included waiting for newer therapy (n = 99, 38.8%), co-morbidities (n = 66, 25.9%) and alcohol/drug abuse (n = 63, 24.7%).

Conclusions
Half of patients with established HCV care were followed-up in the DAA era and only 29% received DAAs. Targeted efforts focusing on patient and system-levels may improve the reach of treatment with the new DAAs.

Continue to article.......

People enrolled in harm-reduction program five times more likely to go into recovery

Recommended Reading 

Solving the hepatitis C epidemic among people with substance abuse disorders

"We're seeing infection hotspots," Talal said, noting that this is partly a result of the opioid epidemic, particularly where needle exchange programs, for example, are not available.

High HCV cure rates for people who use drugs treated with DAA therapy at an urban primary care clinic

Regardless of active drug use or Opioid agonist therapy (OAT), patients who received DAA therapy at an urban primary care clinic achieved high HCV cure rates. We found no clinical evidence to justify restricting access to HCV treatment for patients actively using drugs and/or receiving OAT.

Opioid epidemic causing rise in hepatitis C infections and other serious illnesses
Many Americans now know that, over the past decade, opioid addiction and deaths from opioid overdose in the U.S. have skyrocketed.

HuffPost:

‘Our Compassion Is Being Challenged’: A West Virginia Doctor’s War Against Opioids

By Tom Kutsch
09/27/2017 08:41 am ET

Brumage, executive director and health officer of the Kanawha-Charleston Health Department, runs a harm-reduction program that includes overseeing a clean needle exchange for opioid users. It’s powered not with federal or state dollars, but with donations, grants and volunteers. In just over two years, it has grown as large as a similar program run by the city of Baltimore after 20 years ― serving some 3,700 patients. People enrolled in a harm-reduction program are five times more likely to go into recovery than if they’re not a part of it, he said...

Can you briefly describe the extent of the problem that you’re up against with the opioid crisis?

As you really peel back the onion, it’s not an epidemic. It’s an epidemic of epidemics, because you have everything from overdose deaths to the hepatitis C rate, which is now the No. 1 infectious killer in America. You have children who have been abandoned because their parents are using drugs. You have needles which are in public spaces, which is an environmental hazard. And just so many other aspects of this. This is a very, very complex public health emergency. And I’m not quite certain that most Americans or even most policymakers have grappled with the true complexities of where we are on a day-to-day basis.

Continue reading......

Blog Updates on Hepatitis - Inactivated Zoster Vaccine, Harvoni Cures Hep C patient & Opioids

Thanks for stopping by, here's your blog updates from around the web.

Harvoni Cures Hep C patient Brenda in Clinical Trial part 1

September 19, 2017

This week on Life Beyond Hep C we’re hearing Hep C patient Brenda’s courageous Hep C treatment fight and experience.

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All Swiss hepatitis C sufferers can access costly drugs like Harvoni

swissinfo.ch

All patients suffering from hepatitis C can be treated with the drugs Harvoni and Epclusa from next month, after the Federal Office of Public Health lifted ...

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Opioid overdoses shorten US life expectancy by 2½ months

By Nadia Kounang, CNN

Opioid drugs -- including both legally prescribed painkillers such as oxycodone and hydrocodone, as well as illegal drugs such as heroin or illicit fentanyl -- are not only killing Americans, they are shortening their overall life spans. Opioids take about 2½ months off our lives, according to a new analysis published in the medical journal JAMA.

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States expand investigation of opioid makers, distributors
Geoff Mulvihill, Associated Press - Houston Chronicle
Attorneys general from most states are broadening their investigation into the opioid industry as a nationwide overdose crisis continues to claim thousands of lives. They announced Tuesday that they had served subpoenas requesting information from five companies that make powerful prescription painkillers and demanded information from three distributors. Forty-one attorneys general are involved in various parts of the civil investigation.

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Addiction clinics need physician education, lifted restrictions to treat HCV

HCV Next - HEALIO - Meeting News
Opioid agonist therapy clinics represent an important conduit for people who inject drugs to receive information, screening and treatment for hepatitis C. Within these clinics, however, physicians and addiction specialists self-reported low competence regarding current HCV treatments. Additionally, policies that restrict treatment for current and recent drug users present an ongoing barrier.
Continue reading....

My 2 cents: College friend doing good work

Written by Karen Shuey - Staff Writer For Reading Eagle.

The proposal in Philadelphia would be modeled on a supervised injection center in Vancouver, British Columbia, called Insite that has showed tremendous promise over the last 14 years. Statistics show Insite has saved lives, proponents say, reversing nearly 5,000 overdoses since 2003, with no deaths. At the same time, studies show the center has prevented the spread of diseases such as HIV and hepatitis C and reduced dangerous litter, including needles strewn on local streets.
Continue reading.....

Ontario study to lift six-month-sober rule for liver transplant patients

Tom Blackwell - National Post 

Faced with a widow's legal challenge, Ontario will transplant livers into almost 100 alcoholic-liver-disease patients, as evidence suggests they do as well as others.

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What parents should know about tattoos

Posted September 19, 2017,
Claire McCarthy, MD, Faculty Editor, Harvard Health Publications
These days, tattoos are increasingly common. According to a 2015 Harris poll, three in 10 American adults have a tattoo — up from two in 10 in 2012. They are particularly popular in young people; among Millennials, nearly half have a tattoo. To help parents make this tough decision, the American Academy of Pediatrics (AAP) released a clinical report entitled “Adolescent and Young Adult Tattooing, Piercing, and Scarification.” Here are some highlights — and some points parents and teens really need to talk about.
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Fighting Hepatitis in Cambodia: Beginnings and Endings
Theresa Chan - Theresa is an MSF doctor, currently working at a hepatitis C clinic in Cambodia.
Beginnings and endings have been leaking into my to-do list as well. Right now I’m working on writing the MSF guidelines for treating hepatitis C, which will be the basis for the Cambodian national guidelines one day when our clinic is turned over to the Ministry of Health, so even as we are recovering from the busy beginning of this clinic, we are contemplating its end.
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Inactivated Zoster Vaccine Soon to Be Approved — Should Patients Wait for It?
Paul E. Sax, MD - Contributing Editor NEJM Journal Watch 
For the last year or so, conversations with patients about getting the zoster vaccine have gone something like this:

Patient: So should I get the shingles vaccine? I saw an ad for it on TV.
Me:  Well, yes … and no.
Patient (confused — he/she has never heard me say anything but an enthusiastic “Yes!” to vaccines):  What does that mean?
Me:  There’s a better shingles vaccine coming soon, likely within a year. So I’d wait.

Now it looks like that wait is almost over.
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Can Restricting Fructose Intake Reduce Fatty Liver Disease in Children?
Kristine Novak - Dr. Kristine Novak is the science editor for Gastroenterology and Clinical Gastroenterology and Hepatology.
Reducing dietary fructose for as little as 9 days decreases liver fat, visceral fat, and de novo lipogenesis and increases insulin sensitivity, secretion, and clearance in children with obesity and metabolic syndrome, researchers report in the September issue of Gastroenterology. These findings support efforts to reduce sugar consumption.
Read more 

Only One-Quarter of Hepatitis C Patients Got Treatment Before Widespread DAA Use

SEPTEMBER 19, 2017

Gail Connor Roche - MD Magazine

Only one-quarter of patients worldwide with the chronic hepatitis C virus (HCV) received antiviral treatment before the widespread use of direct-acting antiviral (DAA) drugs, a review that considered almost 500,000 people has found.

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Adolescents With HCV Achieve 98% Cure Rate in Direct-Acting Antiviral Study
Gail Connor Roche - MD Magazine
Adolescents treated for hepatitis C achieved a 98% cure rate with a direct-acting antiviral drug (DAA) therapy, a study has found.
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HCV Drug Resistance: Infrequent, and Frequently Overcome
Kenneth Bender - MD Magazine
Hepatitis C virus (HCV) mutations that can resist drug treatment are infrequent, and are unlikely to withstand longer treatment durations or the addition of a synergistic drug, according to new analysis of resistance testing, treatment response and re-treatment interventions. Resistance testing does appear to Wyles and Luetkemeyer to be indicated, however, in patients with genotype 1a before treatment with elbasvir/grazoprevir (Zepatier, Merck), and should be considered prior to treatment with ledipasvir/sofosbuvir (Harvoni) for those with genotype 1a and cirrhosis or with prior NS5A treatment failure...
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Hepatitis A: frequently asked questions

Paul Sisson Contact Reporter The San Diego Union-Tribune

In an effort to combat a deadly hepatitis A outbreak, San Diego will begin washing streets in ...

Q: If I've had hepatitis B or hepatitis C am I immune to hepatitis A?

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Cannabis in Gastroenterology: Physicians Lack Answers as Patient Interest Peaks
Healio Gastroenterology, September 2017
Despite a lack of high quality evidence due to federal regulations on research, many state medical marijuana programs have designated GI conditions like severe nausea, inflammatory bowel disease (IBD) and hepatitis C as qualifying conditions, and studies show that many patients are self-medicating with marijuana. Experts agreed physicians should equip themselves to explain the known risks and benefits to inquiring patients, and understand the legal frameworks of their state medical marijuana programs.

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Rationale for cannabis-based interventions in the opioid overdose crisis
Harm Reduction Journal https://doi.org/10.1186/s12954-017-0183-9

Published: 18 August 2017

The growing body of research supporting the medical use of cannabis as an adjunct or substitute for opioids creates an evidence-based rationale for governments, health care providers, and academic researchers to consider the implementation and assessment of cannabis-based interventions in the opioid crisis.
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Watch Opioid Nation -- An American Epidemic

One hour in-depth program on opioids in Detroit

Opioid Nation -- An American Epidemic



https://www.clickondetroit.com/opioids-epidemic/watch-at-10-pm-opioid-nation-an-american-epidemic

Devin Scillian looks at how we got this point in the opioid epidemic.

Dr. McGeorge delves into the role doctors played in this crisis and how their job has changed when it comes to prescribing medication. He will also have the checklist you can follow in your own life to help protect yourself or a loved from from abusing opioids.

Kimberly Gill has a candid conversation about how this addiction does not discriminate.

Defender Karen Drew gains special access to border patrol agents and discovers what lengths people are going to in order to smuggle these drugs into the country.

Defender Kevin Dietz learns from a former dealer what parents should know to protect their children from addiction.

Steve Garagiola takes us inside a local drug court trying to fix the drug problem and not just put people in jail

People who use drugs require prioritization, not exclusion, in HCV elimination

People who use drugs require prioritization, not exclusion, in HCV elimination

Global health experts are today are calling for the removal of restrictions preventing people who use drugs from accessing new hepatitis C cures. So long as these restrictions exist, the goal of disease elimination will remain out of reach, they say.

They are gathered in Oslo for the 5th International Symposium on Hepatitis Care in Substance Users, where new research continues to highlight not just the pivotal role treatment for people who use drugs plays in reducing hepatitis C transmission, but also how it can be rolled out to achieve best results.

"The science is clear. We now need to focus on overcoming barriers to access, and harness latest research to implement programs that work," said President of the International Network of Hepatitis C in Substance Users (INHSU), Associate Professor Jason Grebely, the Kirby Institute, UNSW Australia.

"To delay further is unethical and undermines public health," he added.

Hepatitis C—which if left untreated can lead to cirrhosis and liver cancer—affects approximately 64-103 million people around the world, resulting in around 700 000 deaths per year. In countries such as the US and Australia, hepatitis C now kills more people than HIV. In the UK, the number of annual deaths due to hepatitis C has quadrupled since 1996.

New, highly effective curative treatments have sparked hope of a world free of hepatitis C. The World Health Organisation (WHO) has set ambitious elimination targets of 90% diagnosed, 80% treated and a 65% reduction in hepatitis C-related mortality by 2030. In most high income countries, the vast majority (80%) of new infections are in people who inject drugs, but this group has faced widespread exclusion from the new therapies.

Reasons given for this exclusion include the price of new medications, fears of poor adherence, fears of reinfection and concerns over efficacy. However, international research debunks these myths.

The world's largest study of new hepatitis c curative therapies – the C-EDGE CO-STAR Clinical Trial – has now found that illicit drug use prior to and during hepatitis C therapy had no impact on the effectiveness of the therapy, and that reinfection is low, at 4%. The results also showed excellent treatment adherence. Cure rates were comparable to results in hepatitis C populations that exclude people who use drugs.

Further, mathematical modelling suggests that even moderate levels of treatment uptake in people who use drugs could offer considerable prevention benefits.

One study looking at settings in Scotland, Australia and Canada indicated a 3-5 fold increase in treatment uptake among people who inject drugs could halve hepatitis C prevalence in 15 years.

Other studies modelled on people who inject drugs in the UK and France concluded realistic treatment scale-up could achieve 15-50% reduction in chronic hepatitis C prevalence in a decade.

To add to the benefits, treating people who use drugs with moderate or mild hepatitis C with new therapies is cost-effective in most settings compared to delaying until cirrhosis.

Several countries have introduced hepatitis C elimination programs, with Australia, France and Iceland offering unrestricted access. All eyes are now turned on Australia, where over 20 000 people (10% of the chronic HCV population) have initiated treatment in the first four months since subsidised treatment has become available.

"Countries such as Australia and France have taken the lead in adopting evidence-based policies that will save lives. Now it's time for other countries, including the US and Norway, to follow their lead and allow all patients with chronic hepatitis C to be treated with the new drugs," said Professor Olav Dalgard, Chair of the INSHU 2016 Symposium.

"We strongly recommend that all restrictions on access to new hepatitis C treatments based on drug or alcohol use or opioid substitution treatment be removed. There is no good ethical or health based evidence for such discriminations. Nor do the restrictions make clinical, public health or health economic sense," he said.

"Providing treatment to people who inject drugs, integrated with harm reduction programs and linkage to care, is the key to hepatitis C program success. And our experience in Copenhagen shows this can work. Such efforts need to be initiated and scaled up globally," added Professor Jeffrey Lazarus, Centre for Health and Infectious Disease Research, Rigshospitalet, University of Copenhagen, Denmark, who is presenting at the Symposium.

http://www.ashm.org.au/news/no-treatment-no-elimination-says-new-research/

Carlos Romero-Marrero on Hepatits B Cures, HCV Targeting, and the Opioid Epidemic

MD Magazine

AUGUST 30, 2017

Kevin Kunzmann

Carlos Romero-Marrero, MD, Section Head of Hepatology at the Cleveland Clinic, sat down with MD Magazine recently to discuss what he believes are some of the major issues in hepatitis B and C care now, how far treatment has come, and how much further it has to go in light of the opioid epidemic....

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