Showing posts with label addiction. Show all posts
Showing posts with label addiction. Show all posts

Monday, August 28, 2017

Syringe Exchange Program Aims To Slow Hepatitis C Infections In Alaska

August 29, 20172:53 PM ET
In Alaska, the virus is exploding among people ages 18 to 29. It's a trend that is mirrored nationwide. A recent study in Alaska found that the hepatitis C rate among young people doubled between 2011 and 2015. Rural parts of the state are being especially hard hit. In the remote islands of Southeast Alaska, where the capital Juneau is located, the rate nearly quintupled, rising by 490 percent.
"We talk mostly about opioid overdose deaths, but there's a lot more that happens related to opioid use than just deaths," explains Jay Butler, chief medical officer for Alaska's health department.

LINK - http://www.npr.org/sections/health-shots/2017/08/29/547054395/syringe-exchange-program-aims-to-slow-hepatitis-c-infections-in-Alaska

In Alaska, Hepatitis C Rate Rises Due To Injection Opioid Use
August 28, 20174:31 PM ET
Heard on All Things Considered 
In Alaska, the Hepatitis C infection rate is skyrocketing due to the high number of injection opioid users. The state is looking to needle exchanges to curb rising costs of drug addiction treatment. 

LINK - Listen or read transcript here.

Wednesday, August 23, 2017

NCAD: The opioid crisis is a political football, and that’s not good

NCAD: The opioid crisis is a political football, and that’s not good
August 22, 2017
by Julie Miller, Editor in Chief

While addiction remains a bipartisan issue, support for treatment and recovery is not guaranteed, according to Andrew Kessler, JD, principal of consulting firm Slingshot Solutions. Speaking at the National Conference on Addiction Disorders in Baltimore, Kessler noted the attention policymakers are giving the opioid crisis.

Federal and state legislatures have moved forward on funding and programs for opioid treatment and recovery, but resources are still quite scarce. One point of context to consider is the fact that not every addiction is an opioid addiction—deaths related to alcohol misuse still outpace opioids, and in some areas, methamphetamine is on the rise, Kessler said. It also begs the question of how treatment would be skewed for those with other health issues, including hepatitis C and HIV.

Saturday, August 19, 2017

Podcast - Listen to Mark Sulkowski MD discuss improving HCV patient care

Mark S. Sulkowski, MD - Emerging Issues and Challenges for Improving HCV Patient Care: Expert Perspectives on the Importance of Interdisciplinary Collaboration
Released Aug 16, 2017

Podcast
Listen to Mark Sulkowski, MD, Ira M. Jacobson, MD, and Trang M. Vu, MD, discuss HCV screening, testing, linkage to care, noninvasive tests for fibrosis, drug and alcohol use, treatment regimens in patients with cirrhosis, adherence to therapy and cure.

Although this patient friendly podcast and slideshow is aimed at clinicians, taking part in the program is beneficial for anyone who may consider being tested for HCV or have been diagnosed and thinking about treatment.

Listen Here
Listen to the podcast

Slideshow
Mark S. Sulkowski, MD - Emerging Issues and Challenges for Improving HCV Patient Care: Expert Perspectives on the Importance of Interdisciplinary Collaboration


Monday, August 14, 2017

Hepatitis C - Everyone Has The Right To Be Cured

"Life is inherently risky. There is only one big risk you should avoid at all costs, and that is the risk of doing nothing."
Denis Waitley

Greetings, I have this passion, an obsession if you will, it started at the tender age of ten, the moment my father flew us over Lake Superior in his Cessna. From that day on, I was hooked.

The Landing & A Life Lesson
I remember as we were heading in for a landing, my father turned to me and said, "Flying a plane is a lot like life, taking off is easy, but the landing can kill ya." We both laughed, but I will never forget what he said that day, it was my first life lesson, with more to follow.

My father was a man who took risks, we both did, I still do. Before his success he explored several business ventures, so he knew about failure. Knowing this, and now in my thirties, I asked him what he thought about a business I was about to start. Enter my second lesson.

Looking at me with that half smile, he offered this, "You may fail, but I would rather go somewhere than go nowhere at all." Off I went, the business was successful for years, but eventually it came to an end. However, it was a learning experience, one I completely embraced at the time. The good news? I knew when to get out. The bad news? I had to start all over.

Years later, when my father was very ill, he asked for a glass of water, for reasons I won't go into, it wasn't allowed. Again, I heard, "Take a risk, break the rules, if you won't get me a glass of water, can you get me a burrito." I smuggled in the water.

Some of us are risk-takers, some of us make mistakes, maybe from a lack of knowledge or a lapse in judgement. In any event, missteps, mess-ups happen to everyone, learning from the experience is what matters most, moving boldly forward isn't easy but it beats moving backward, or worse yet, going nowhere at all. 

My Misstep
While very much in love, no, while I fell into a lapse in judgement, I used IV drugs, twice. That's all it took. My next risk? I was tested for HCV 20 years later, I was in my early forties, went on treatment and came in for a smooth landing, I was cured. I seldom discuss my mistakes, but this one needs to be told.  I get the stigma, the fear of being tested, however, my journey to wellness was well worth it.  

If  HCV is, or was, your unfortunate misstep, where ya going next? You can't go backward, but you can move forward, take that first step, get tested. Start by making an appointment with your physician, or search for a testing organization near you. It's a fair compromise, right? Either you'll put this behind you, or have an opportunity to turn things around.

Ohhh That Stigma 
Today in our society the stigma associated with HCV and drug use is still ongoing, sadly this stigma plays a huge part in the number of people forgoing HCV testing. Years ago if you were battling addiction it was impossible to get into a clinical trial, or treatment was denied because of concerns over adherence to the therapy. But today, just like a message in the famous song; The Times They Are a-Changin'....

I hope you watch this video, its an important starting point. 



Uploaded by the Harm Reduction Coalition.
Harm Reduction Coalition - Wesbite
Blog - Demand Access

Articles & Stuff
Great Podcast for anyone who may consider being tested for HCV/diagnosed/or thinking about treatment, begin here....

Watch ASCEND Documentary: Patients, Providers, and Hepatitis C
Article - Expansion of Treatment for Hepatitis C Virus Infection by Task Shifting to Community-Based Nonspecialist Providers
"In this phase 4 prospective, observational study, task shifting of DAA-based HCV therapy to nonspecialist providers was safe and effective.

Primary Care Providers Can Treat Hep C
Primary care providers can successfully manage direct-acting antiviral (DAA) treatment for hepatitis C, though some complicated cases should still be referred to specialists, experts say.
* free registration may be required to view article, I know, I hate that too.

I have no idea how I contracted HCV
Today we have two different groups of people that are at risk for hepatitis C, young people who have used IV drugs and well, older people. The latter falls under the baby boomer generation, that is people born between 1945 and 1965. Rather you contracted HCV recently through drug use, or years ago from another route of transmission, it really doesn't matter, does it? Get tested.

Baby Boomers
If you're a baby boomer, and the whole stigma thing is keeping you from getting tested, know this, in 2016, the Lancet published research showing the hepatitis C epidemic in baby boomers, for the most part, can be traced to hospital transmissions caused by the practice of reusing glass and metal syringes in the 50’s and 60’s.

The bottom line? Living with HCV for years is reason enough to get tested, you are putting yourself at risk for serious liver damage, complications, and other liver related disease.

Disease Progression
Published in the November 2014 issue of Journal of Hepatology; Natural history of hepatitis C
Chronic hepatitis C infection causes cirrhosis in approximately 16% of patients over 20 years. However, fibrosis progression rates are extremely variable and can be influenced by host, viral and environmental factors. The rates of progression are not linear and may vary between fibrosis stages and accelerate with duration of infection or aging. In patients who have had hepatitis for 30 years cirrhosis rates are estimated at 41%, almost 3 times higher than the rates predicted at 20 years duration.
Getting back to HCV and young people, according to a report released this year by the CDC: New Hepatitis C Infections Nearly Tripled over Five Years
New hepatitis C virus infections are increasing most rapidly among young people, with the highest overall number of new infections among 20- to 29-year-olds. This is primarily a result of increasing injection drug use associated with America’s growing opioid epidemic.
The following links focus on research and access to care for people with HCV who use drugs. By using Twitter and Facebook you will find helpful resources with peer support in or around your community.

Start Your Recovery
StartYourRecovery.org is committed to using evidence-based methods that encourage people to find the support they need.
Hear Stories
Get Support

Here are a few research articles to get you started, never mind, skip down to those great Twitter and Facebook links.
High HCV cure rates for people who use drugs treated with DAA therapy at an urban primary care clinic
National Viral Hepatitis Roundtable
Twitter - NVHR
Follow On Facebook
Website
The National Viral Hepatitis Roundtable is a broad coalition working to fight, and ultimately end, the hepatitis B and hepatitis C epidemics.
Read - Tested Cured, Project Empowers Drug Users to Take Control of Their Health

Harm Reduction
On Twitter - Harm Reduction
Follow On Facebook
Website
Harm Reduction Coalition: promoting the health and dignity of those impacted by drug use.

HarborPath
Twitter HarborPath
Follow On Facebook
Website - HarborPath
HarborPath is a non-profit safety-net for Uninsured with HIV, hepatitis C; Clinics can access lifesaving medications through our online portal.

Open Society Foundations
International Harm Reduction Development Program works to advance the health & human rights of people who use drugs.
Twitter - OSF Harm Reduction‏ 
Follow on Facebook
Website

Deserve A Cure
Follow On Twitter - Deserve A Cure

Canada 
Twitter - Don Crocock
Follow On Facebook
This page is dedicated to the dissemination of information; research reports, trends and developments in the areas of Hepatitis C, substance use and misuse and addiction.

Twitter *French & English - CATIE
Follow On Facebook
Website
Canada’s source for HIV and hepatitis C information
Read - Views from the front lines: Getting to undetectable

Harm Reduction Canada
Twitter - Marilou Gagnon RNPhD‏ 
Nurse, Activist, Associate Prof / President, Harm Reduction Nurses Association / Co-President, Nursing Observatory

If you are newly diagnosed I suggest you learn everything you can about the disease, HCV Advocate is a great place to begin, rather you have been tested, been diagnosed, or starting therapy.

Homepage - HCV Advocate
News and Pipeline Blog - HCV Advocate 

Research
Twitter - Henry E. Chang‏ 
Read this - Sobering stats from a study on HCV cure vs. new infections in 91 countries in 2016 (~81% of global burden)

Helpful Links
Premier Hepatitis C Websites, Blogs and Support Forums

In the end just get tested. Like a wise man once said "Mistakes are not for the weak, only the strong make it right and move on." Yep, my dad said that, right after he finished reading my divorce papers. Ugh.

See you soon
Tina

Monday, August 7, 2017

New study generates more accurate estimates of state opioid and heroin fatalities

New study generates more accurate estimates of state opioid and heroin fatalities

Developing a statistical model to fill in the blanks on death certificates presented in the American Journal of Preventive Medicine

Image - Reported and corrected 2014 overdose death rates (per 100,000). view more 

Elsevier

Ann Arbor, MI, Aug. 7, 2017 - Although opioid and heroin deaths have been rising dramatically in the U.S., the magnitude of the epidemic varies from state to state, as does the relative proportion of opioid vs heroin poisonings. Further complicating the picture is that up to one-quarter of all death certificates fail to note the specific drug responsible for the fatality, complicating efforts to target enforcement and treatment programs at both state and federal levels. A new study in the American Journal of Preventive Medicine presents a correction procedure to refine this data, which results in significant shifts in state-by-state mortality rates. This truer picture helps to remove an important barrier to formulating effective policies to address this serious drug epidemic.

On a national basis, these corrected mortality rates were 24% higher for opioids and 22% higher for heroin. For opioids, uncorrected mortality growth rates were considerably underreported in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by a significant margin in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.

According to author Christopher J. Ruhm, PhD, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, Virginia, "A crucial step to developing policy to combat the fatal drug epidemic is to have a clear understanding of geographic differences in heroin- and opioid-related mortality rates. The information obtained directly from death certificates understates these rates because the drugs involved in the deaths are often not specified."

This study develops correction methods to provide more accurate information. The corrected estimates often differ considerably from reported rates. To provide an example, in 2014, the opioid and heroin death rates based on death certificate reports in Pennsylvania were 8.5 and 3.9 per 100,000, respectively, but a drug category was specified in only half of fatal overdose cases in that year. Correcting for this understatement yields estimated actual opioid and heroin overdose deaths of 17.8 and 8.1 per 100,000.

Counts of drug deaths of U.S. residents were obtained from the 2008 and 2014 Centers for Disease Control and Prevention Multiple Cause of Death (MCOD) files. The MCOD data provide information from death certificates on a single underlying cause of death, up to 20 additional causes, and also provided age, race/ethnicity, gender, year, weekday, and place of death. The death certificate may also list one or more drugs involved as immediate or contributory causes of death, included separately as ICD-10 T-codes. T-codes 40.0-40.4 and 40.6 indicate the involvement of opioids and T-code 40.1 refers to heroin.

There were 36,450 fatal overdoses nationwide to U.S. residents in 2008 and 47,055 in 2014. However, for about half the overdose fatalities, unspecified drugs were mentioned, and in one-fifth to one-quarter of the cases, this was the only drug-related designation included. To develop corrected rates, information from death certificate reports where at least one specific drug category was identified were used to impute drug involvement for cases where drug involvement categories were left unspecified. These corrections were then applied on a state-by-state basis to produce opioid- and heroin-specific death rates.

Dr. Ruhm notes that these corrections have a substantial influence on state mortality rankings. "For instance, Pennsylvania had the 32nd highest reported opioid mortality rate and the 20th highest reported heroin death rate, but ranked seventh and fourth based on corrected rates. Similarly, Indiana's rankings moved from 36th and 29th to 15th and 19th, respectively, and Louisiana's from 40th and 31st to 21st and 20th, respectively. There were 19 states whose corrected and reported opioid rankings differed by at least five places and eight states where this occurred for heroin."

Understanding the inaccuracies resulting from the lack of specificity of drug involvement on death certificates is particularly important because federal policies often target states believed to have especially severe opioid or heroin problems. "More fundamentally, geographic disparities in drug poisoning deaths are substantial and a correct assessment of them is almost certainly a prerequisite for designing policies to address the fatal drug epidemic," concludes Dr. Ruhm.

Saturday, August 5, 2017

Cured HCV patients - Still at risk for reinfection, even by the same genotype

Michelle Long
Cure of hepatitis C (HCV) with use of direct-acting antiviral (DAA) therapy does not protect against reinfection with the virus. In particular, patients who engage in high-risk behaviors are at relatively high risk for reinfection. If HCV is to be eliminated, we will need to ensure access to DAA therapy, including for high-risk individuals. Public health programs, including opioid-substitution therapy and mental health programs, may help abate the risk of reinfection in high-risk individuals. More data are needed to understand how to best implement programs aimed at reducing the risk of reinfection.

Previously Cured HCV Patients Can Be Reinfected
by Pippa Wysong
Contributing Writer, MedPage Today
While direct-acting antiviral agents (DAAs) provide a cure for the vast majority of patients with hepatitis C virus (HCV) infection, patients are still at risk for reinfection, even by the same genotype.
Doctors and patients alike need to be aware that even with a cure, and even though a cured patient remains HCV antibody-positive, they are not protected against subsequent HCV infections, according to Vincent Lo Re, MD, co-director of the HIV/Viral Hepatitis Coinfection Scientific Working Group at the Penn Center for AIDS Research, Perelman School of Medicine, at the University of Pennsylvania in Philadelphia.
Article available @ AGA Reading Room

Wednesday, August 2, 2017

Kentucky - Syringe exchanges coupled with drug therapy, treatment could virtually eliminate hepatitis C

Syringe exchanges coupled with drug therapy, treatment could virtually eliminate hepatitis C
By Melissa Patrick
Kentucky Health News

Kentucky leads the nation in new infections of hepatitis C, a liver disease now driven mainly by intravenous drug use. It could be virtually eliminated, but that would require a committed strategy to increase syringe exchanges, medication-assisted therapies, and cutting treatment restrictions such as a ban on treating active intravenous drug users.

That was the overarching message to almost 300 people who attended the fourth annual Viral Hepatitis Conference in Lexington July 27. They also heard that Kentucky is working on all three fronts, but not going as far as some experts want when it comes to treating drug users.

Thursday, July 27, 2017

Prioritize Injection Drug Users for Hepatitis C Treatment

Coverage from the
International AIDS Society (IAS) 2017 Conference 

Prioritize Injection Drug Users for Hepatitis C Treatment
Ingrid Hein
July 27, 2017 
"Average drug users with HCV are likely to infect two to six people before they move away from drug use," he reported. "A focus on treating people who are HCV-positive and injecting is the only way to slow and prevent spread of the virus."
Targeting treatment to patients with advanced liver fibrosis "as a result of the virus has been shown to be a less-effective model for eliminating HCV," Dr Dillon told Medscape Medical News. By selecting patients most likely to spread the disease, the impact will be greater, he added.
In Scotland, more than 85% of the people with a diagnosis of hepatitis C inject drugs, Dr Dillon reported. To date, they have been considered by most treatment services to be "too chaotic to treat" because they are associated with poor adherence to therapy and rapid reinfection, he explained.
Continuer reading....

Monday, July 24, 2017

Hepatitis C: The public-health worry lurking behind the opioid epidemic

Hepatitis C: The public-health worry lurking behind the opioid epidemic
Julianne Stanford

The National Institute on Drug Abuse estimates that every drug user infected with a blood-borne disease like hepatitis C is likely to infect at least 20 others through shared needles or contact with infected blood. Coles said she believes at least a third of the people who use her organization's services are infected with hepatitis C.


Nonetheless, state health officials are focused on immediate problems caused by the opioid crisis, rather than things that could be problematic down the road.

“We’re certainly looking at the big picture, but ... our focus is just on the opioid epidemic as it is, which is focusing on saving lives,” said Sheila Sjolander, ADHS assistant director of public health prevention services. "We’re really focused on preventing further deaths by expanding access to Naloxone, helping prescribers do best practices with opioid prescriptions and working with our partners to expand access to treatment.”

Tuesday, July 18, 2017

Hepatitis C and people who inject drugs: The family experience

Hepatitis C and people who inject drugs: The family experience

17 Jul 2017
“Having hep C is not a trivial thing, being around someone with it is not a trivial thing. It leaves marks and scars on the people around them.”

Today we are publishing our report “Marks and scars” on the impact of hepatitis C on the families of people who inject drugs.
Around half of people who inject drugs in England and Wales are thought to be infected with hepatitis C. For the first time, the families have been asked what it’s really like for them.
Drawing on evidence from online surveys and phone interviews, we have discovered that:
  • Most family members have heard of hepatitis C, but their knowledge is not always in depth.
  • Most family members are worried about the risk of their loved one contracting hepatitis C, although other drug-related issues are often more significant.
  • Hepatitis C causes a range of impacts on family life, including an increase in the intensity of the caring role, fears about transmission, strain on relationships and stigma.
  • Family members had mixed experiences of seeking information and support and playing a role in treatment.
Family members also told us how their experiences could be improved, for example by increasing awareness of hepatitis C, enabling family members to be more involved in the treatment process and providing support for families in their own right.
Read the report here.

Saturday, July 8, 2017

Looking at the Twin Epidemics of HCV

AGA Reading Room

Looking at the Twin Epidemics of HCV
by Pippa Wysong
Contributing Writer, MedPage Today

Younger cohorts at risk of HCV need more attention
They are a unique group of individuals in which most new infections are happening," he told MedPage Today. "Treating them is more complicated than simply giving them medical therapy." He was lead author of a recent large study in BMC Infectious Diseases that elucidated the characteristics of the twin epidemics.
When researchers look at the causes of mortality among this younger cohort, deaths are often related to acquisition-related causes such as injection drug use and drug overdose. Baby boomers, on the other hand, are more likely to present later with HCV and to die from chronic diseases and liver-related causes.
Continue reading....

Free registration may be required.

Thursday, July 6, 2017

Opioid Prescriptions Falling But Remain Too High, CDC Says

July 2017
CDC - Opioid Prescribing



Health News From NPR

Opioid Prescriptions Falling But Remain Too High, CDC Says
In a new report, the CDC says U.S. doctors are prescribing fewer opioids than they were in 2010, but that overall rates remain high.

The U.S. is in the midst of an opioid crisis. Millions of Americans are addicted to the powerful prescription painkillers, and tens of thousands are dying each year from overdoses.

A new report out Thursday offers a bit of hope: Doctors are prescribing opioids less often, and the average dose they're giving patients has dropped, according to the Centers for Disease Control and Prevention.

However, the number of patients getting opioids is still too high, and doctors are giving their patients prescriptions that last longer, according to the report in the CDC's Morbidity and Mortality Weekly Report.

Continue reading....

Thursday, June 22, 2017

10 year HCV treatment programme in people who inject drugs: No effect of recent or former injecting drug use on treatment adherence or SVR

Outcomes from a large 10 year hepatitis C treatment programme in people who inject drugs: No effect of recent or former injecting drug use on treatment adherence or therapeutic response
Omar Elsherif , Ciaran Bannan, Shay Keating, Susan McKiernan, Colm Bergin, Suzanne Norris

Full Text Article
Download PDF
View Online

Abstract
Background and aims
People who inject drugs (PWID) are historically viewed as having “difficult to treat” hepatitis C disease, with perceived inferior treatment adherence and outcomes, and concerns regarding reinfection risk. We evaluated for differences in treatment adherence and response to Peginterferon-alfa-2a/Ribavirin (Peg-IFNα/RBV) in a large urban cohort with and without a history of remote or recent injection drug use.

Methods
Patient data was retrospectively reviewed for 1000 consecutive patients—608 former (no injecting drug use for 6 months of therapy), 85 recent (injecting drug use within 6 months) PWID, and 307 non-drug users who were treated for chronic hepatitis C with Peg-IFNα/RBV. The groups were compared for baseline characteristics, treatment adherence, and outcome.

Results
There was no significant difference in treatment non-adherence between the groups (8.4% in PWID vs 6.8% in non-PWIDs; RR = 1.23, CI 0.76–1.99). The overall SVR rate in PWID (64.2%) was not different from non-PWIDs (60.9%) [RR = 1.05, 95% CI 0.95–1.17]. There was no significant difference in SVR rates between the groups controlling for genotype (48.4% vs 48.4% for genotype 1; 74.9 vs 73.3% for genotype 3). Former and recent PWID had similar adherence rates.

Conclusions
PWID have comparable treatment adherence and SVR rates when compared to non-drug users treated with Peg-IFNα/RBV. These data support a public health strategy of HCV treatment and eradication in PWID in the DAA era.

Published: June 21, 2017 https://doi.org/10.1371/journal.pone.0178398
PLOS ONE

Thursday, May 25, 2017

Safe space for illegal drug consumption in Baltimore would save $6 million a year

Safe space for illegal drug consumption in Baltimore would save $6 million a year

Supervised facilities would also save lives, prevent infections and hospitalizations

Johns Hopkins University Bloomberg School of Public Health

A new cost-benefit analysis conducted by the Johns Hopkins Bloomberg School of Public Health and others suggests that $6 million in costs related to the opioid epidemic could be saved each year if a single "safe consumption" space for illicit drug users were opened in Baltimore.

It would also reduce overdose deaths, HIV and hepatitis C infections, overdose-related ambulance calls and hospitalizations - and bring scores of people into treatment, they found.

Carefully monitored "safe consumption" spaces, which are not legal in the United States but have been used in dozens of cities around the world, provide a clean indoor environment in which people can use their own drugs with medical personnel on hand to reverse overdoses should they occur. These facilities serve as access points to substance use disorder treatment and other vital social services for drug users, such as medical care and housing.

The authors of the study, published this month in the Harm Reduction Journal, say that the findings add economic evidence to the body of research that already links such spaces to a reduction in fatal drug overdoses and an increase in people seeking treatment. "Safe consumption" spaces are especially critical right now: Last year, the United States hit a record for the number of people who have died from drug overdose, and fentanyl, a more dangerous and powerful drug than heroin, is increasingly being added to heroin in places like Baltimore.

"No one has ever died from an overdose in a safe consumption space," says the study's senior author, Susan G. Sherman, PhD, MPH, a professor in the Department of Health, Behavior and Society at the Bloomberg School. "Thousands of lives have been saved. There are lots of doors people can walk through when they are addicted to drugs. We want them to walk through a door that may eventually lead to successful treatment - and keep them alive until they are ready for that."

Says Amos Irwin, MA, the study's lead author and program director at the Law Enforcement Action Partnership in Washington, D.C.: "Today, thousands of Baltimoreans are risking their lives to inject drugs instead of seeking treatment. We estimate that more than 100 new people would enter treatment every year if the city had a supervised injection facility. Bringing these people into a safe space actually helps reduce drug use, not increase it."

For their study, the researchers looked at the costs of operating a safe consumption space in Vancouver, the only one in North America. Then they estimated the impact on several health outcomes, based on Baltimore data.

They determined that running a 1,000-square-foot, 13-booth space in Baltimore for 18 hours a day would cost $1.8 million a year. Insite, the Vancouver facility, serves about 2,100 unique individuals a month, who perform roughly 180,000 injections per year in a space the same size.

Based on research done at Insite, they estimate that a Baltimore facility would generate $7.8 million in annual savings, preventing four HIV infections, 21 hepatitis C infections, 374 days in the hospital for skin and soft-tissue infections, six overdose deaths, 108 overdose-related ambulance calls, 78 emergency room visits and 27 overdose-related hospitalizations.

At the same time, an estimated 121 additional people would enter treatment.

"Six million dollars is a lot of money for one facility to save," Irwin says. "It is almost a third of Baltimore City's entire budget for HIV, sexually-transmitted infections and substance abuse treatment and prevention."

A bill allowing safe consumption spaces failed in the Maryland General Assembly this year. Last month, the Massachusetts Medical Society recommended opening safe consumption spaces in that state. These supervised injection facilities are a widely used public health intervention in 11 countries, mostly in Europe.

Sherman says many drug users in Baltimore are injecting on the streets or in abandoned houses, exposing them to possible violence, arrest and overdose death. Safe consumption spaces would provide clinical supervision and a clean environment, and they allow health professionals to connect drug users to critical health services. Such spaces maintain a strict prohibition on drug sharing or selling. These programs are not condoning illicit behavior, she says. They are meeting people where they are and connecting them with lifesaving resources.

The researchers did not estimate how many safe consumption spaces would be needed to service Baltimore's drug using population.

"We know what doesn't work when it comes to the so-called 'War on Drugs' in the United States because we have an opioid epidemic that is only getting worse," Sherman says. "The stakes are even higher now with so much heroin and other drugs adulterated with fentanyl. You can keep doing what you are doing or you can try something that has been proven by evidence and is considered usual care in a dozen nations."

"Mitigating the heroin crisis in Baltimore, MD, USA: a cost-benefit analysis of a hypothetical supervised injection facility" was written by Amos Irwin, Ehsan Jozaghi, Brian W. Weir, Sean T. Allen, Andrew Lindsay and Susan G. Sherman. Other collaborating institutions include the Criminal Justice Policy Foundation and the University of British Columbia.

The research was supported by grants from the National Institutes of Health's National Institute of Allergy and Infectious Diseases (P30AI094189) and the National Institute on Drug Abuse (T32DA007292) as well as Amherst College, the Criminal Justice Policy Foundation, the Law Enforcement Action Partnership and the Canadian Institutes of Health Research Postdoctoral Fellowship.

Monday, April 24, 2017

Solving the hepatitis C epidemic among people with substance abuse disorders

Solving the hepatitis C epidemic among people with substance abuse disorders
Innovations in HCV treatment at methadone clinics, corrections facilities
Date:April 24, 2017
Source:University at Buffalo
Summary:
One of the most dramatic medical success stories in recent years has been the introduction of new drugs that eradicate hepatitis C virus (HCV). But it's a different story among HCV patients with substance use disorders. This population typically does not have easy access to conventional health care so it is difficult to screen, diagnose and treat these individuals.

One of the most dramatic medical success stories in the past few years has been the introduction of new drugs that eradicate hepatitis C virus (HCV). But it's a different story among HCV patients with substance use disorders.

As an editorial published online on April 25 in the Annals of Internal Medicine notes, this population typically does not have easy access to conventional health care so it is difficult to screen, diagnose and treat these individuals.

"People with substance use disorders can account for as much as 80 percent of infected individuals in developed countries, a direct result of the opioid epidemic in the U.S.," said Andrew H. Talal, MD, the lead author of the editorial and professor, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Talal, a leading expert in liver disease, is a researcher with the Clinical and Translational Science Institute at the University at Buffalo, funded by a National Institutes of Health Clinical and Translational Science Award. He is currently principal investigator with other UB faculty on a $7 million Patient-Centered Outcomes Research Institute award dedicated to developing innovative ways to treat HCV in persons with substance use disorders. The award funds efforts with these patients throughout New York State, including New York City, Buffalo, Rochester, Syracuse and the Hudson Valley.

According to Talal, a combination of factors all work to prevent these patients from receiving the diagnoses and care they need. Such factors range from discomfort in conventional health care settings and lack of HCV-related knowledge to fear of stigmatization that can result from an HCV diagnosis. That's in addition to insurance barriers and physicians' general reluctance to treat this population.

According to the editorial, "New approaches for persons with substance use disorders are required at every step in the HCV care paradigm."

The reason is that following a decade of fairly steady declines in this population, there have been recent sharp increases in HCV.

"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.

Such programs are key, Talal said, citing a report issued earlier this month by the National Academies that found that people who inject drugs account for approximately 75 percent of all new HCV infections.

To better reach persons with substance use disorders, the editorial states, HCV screening and linkage to care must improve. Screening can be especially problematic because it typically requires two steps: confirmation that the person has been exposed to HCV through an antibody test followed by additional blood work to determine if the infection is active. Currently, the second step must be conducted in a conventional laboratory, a setting these patients rarely access. Recent advances, however, are designed to assess whether all of required analyses could be done onsite.

Once a diagnosis is made, getting patients connected with providers is another major hurdle.

"At best, only 20 percent of these patients connect with a provider for treatment," Talal explained, "and often it's far less than that."

Talal and his colleagues at UB and other institutions and care facilities have been developing promising ways to better connect these patients with the care that they need by integrating HCV screening and treatment into methadone clinics that these patients already regularly attend and by reaching patients in the corrections system via telehealth techniques.

Story Source:
Materials provided by University at Buffalo. Note: Content may be edited for style and length.

Journal Reference:
Gregory J. Dore, Frederick Altice, Alain H. Litwin, Olav Dalgard, Edward J. Gane, Oren Shibolet, Anne Luetkemeyer, Ronald Nahass, Cheng-Yuan Peng, Brian Conway, Jason Grebely, Anita Y.M. Howe, Isaias N. Gendrano, Erluo Chen, Hsueh-Cheng Huang, Frank J. Dutko, David C. Nickle, Bach-Yen Nguyen, Janice Wahl, Eliav Barr, Michael N. Robertson, Heather L. Platt. Elbasvir–Grazoprevir to Treat Hepatitis C Virus Infection in Persons Receiving Opioid Agonist Therapy. Annals of Internal Medicine, 2016; DOI: 10.7326/M16-0816

https://www.sciencedaily.com/releases/2017/04/170424170814.htm

Wednesday, April 19, 2017

International Liver Congress 2017 - Early treatment of HCV reduces extrahepatic morbidity, mortality

Early treatment of HCV reduces extrahepatic morbidity, mortality
April 19, 2017
AMSTERDAM — Dealing with hepatitis C virus as a systemic disease, and not just a complication of the liver, may aid clinicians in reducing extrahepatic manifestations of the infection, according to experts at the International Liver Congress.

Francesco Negro, MD, of the departments of clinical pathology, gastroenterology and hepatology at University Hospital in Geneva, Switzerland, suggested that there is strong evidence that people with HCV often die of non–liver-related causes. “Of course, the leading cause of death is from the liver, but a group in Hong Kong observed many other reasons for dying, including renal, metabolic and cardiovascular disease,” he said. “These complications are not linked to the viral infection.”
Continue reading @ Healio

VIDEO: HCV elimination requires equitable care for injection drug users
AMSTERDAM — In this exclusive video from International Liver Congress, Jason Grebely, PhD, from the Kirby Institute at the University of New South Wales, Sydney, reviews strategies discussed at the conference for enhancing prevention and treatment of hepatitis C among people who inject drugs.
Continue reading @ Healio

Meeting Coverage Healio
International Liver Congress

International Liver Congress™ 2017
Updates On This Blog

Monday, March 27, 2017

HIV and Hepatitis C are No Longer the Most Serious Infectious Threats to People Who Inject Drugs

Paul E. Sax, MD
Contributing Editor
NEJM Journal Watch
Infectious Diseases


HIV and ID Observations
An ongoing dialogue on HIV/AIDS, infectious diseases,
all matters medical, and some not so medical.

In Case You Missed It

HIV and Hepatitis C are No Longer the Most Serious Infectious Threats to People Who Inject Drugs

I had dinner with my daughter Mimi the other evening, and was ruminating about how things have changed since I started work as an Infectious Diseases doctor around 25 years ago.

Here’s an excerpt of our chat:

Me:  There are way more cases of endocarditis in young people than there used to be, a complication of injecting drugs. People in their 20s and 30s with life-threatening infections, getting admitted to the hospital, needing antibiotics for weeks, sometimes surgery … it’s awful. [I didn’t mean for this to sound like a cautionary speech to my 21-year-old daughter, but reading it now — guilty as charged.]
Mimi:  Endocarditis?
Me:  Infection of the heart valves. It’s an incredibly serious problem, much more difficult to treat than HIV and HCV. Even with our best antibiotics, some people need major heart surgery — their lives are never the same. And sometimes the infection spreads through the blood to the lungs, spine, brain… Some even die!

Continue reading....

Sunday, February 19, 2017

NEJM Listen To Interview - Addressing the Fentanyl Threat to Public Health

Addressing the Fentanyl Threat to Public Health
Richard G. Frank, Ph.D., and Harold A. Pollack, Ph.D.
N Engl J Med 2017; 376:605-607
DOI: 10.1056/NEJMp1615145

Interview with Dr. Richard Frank on the increasing number of deaths involving fentanyl in the United States.
Supplement to the N Engl J Med 2017; 376:605-607

Article
Addressing the Fentanyl Threat to Public Health
Fentanyl, a powerful synthetic opioid, poses an increasing public health threat. Low production costs encourage suppliers to “cut” heroin with the drug, particularly white powder heroin sold in the eastern United States.1 Fentanyl also appears as a prevalent active ingredient in counterfeit OxyContin (oxycodone) tablets. The result is that fentanyl plays a major role in rising mortality due to heroin or opioid overdose. It poses a serious overdose risk because it can rapidly suppress respiration and cause death more quickly than do other opioids.

Sunday, January 22, 2017

Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: Is elimination possible in a high prevalence setting?

Research Report

Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: Is elimination possible in a high prevalence setting?
Gountas I, et al.
Addiction. 2017

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/add.13764

Download Accepted Article; Treatment and primary prevention in people who inject drugs for chronic hepatitis C infection: Is elimination possible in a high prevalence setting?

Abstract
AIMS: To project the impact of scaling up oral antiviral therapy and harm reduction on chronic hepatitis C (CHC) prevalence and incidence among people who inject drugs (PWID) in Greece, to estimate the relationship between required treatment levels and expansion of harm reduction programs to achieve specific targets and to examine whether hepatitis C viruse (HCV) elimination among PWID is possible in this high prevalence setting.

DESIGN: A dynamic discrete time, stochastic individual-based model was developed to simulate HCV transmission among PWID incorporating the effect of HCV treatment and harm reduction strategies, and allowing for reinfection following treatment.

SETTING/PARTICIPANTS: The population of 8,300 PWID in Athens Metropolitan area

MEASUREMENTS: Reduction in HCV prevalence and incidence in 2030 compared with 2016.

FINDINGS: Moderate expansion of HCV treatment (treating 4%-8% of PWID/year), with simultaneous increase of 2%/year in harm reduction coverage (from 44% to 72% coverage over 15 years), was projected to reduce CHC prevalence among PWID in Athens by 46%-90% in 2030, compared with 2016. CHC prevalence would reduce below 10% within the next 4-5 years if annual HCV treatment numbers were increased up to 16%-20% PWID/year. The effect of harm reduction on incidence was more pronounced under lower treatment rates.

CONCLUSIONS: Based on theoretical model projections, scaled-up hepatitis C virus (HCV) treatment and harm reduction interventions could achieve major reductions in HCV incidence and prevalence among people who inject drugs (PWID) in Athens, Greece by 2030. Chronic hepatitis C could be eliminated in the next 4-5 years by increasing treatment to more than 16% of PWID per year combined with moderate increases in harm reduction coverage.

This article is protected by copyright. All rights reserved.


Addiction 2017
© Society for the Study of Addiction
Browse All  Accepted Articles
Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.

Article Link
I highly suggest you follow Henry E. Chang on Twitter if you are interested in reading full text articles about the treatment and management of hepatitis C, the above PDF link was tweeted today by Henry E. Chang

Wednesday, November 16, 2016

Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study

Hepatitis C Treatment Uptake among Patients Who Have Received Opioid Substitution Treatment: A Population-Based Study
Håvard Midgard , Jørgen G. Bramness, Svetlana Skurtveit, John W. Haukeland, Olav Dalgard Published: November 15, 2016 http://dx.doi.org/10.1371/journal.pone.0166451

Full Text

Abstract
Background and Aims
There is limited data on hepatitis C (HCV) treatment uptake among people who inject drugs including individuals receiving opioid substitution treatment (OST). We aimed to calculate cumulative HCV treatment uptake, estimate annual treatment rates, and identify factors associated with HCV treatment among individuals who have received OST in Norway.

Methods
This observational study was based on linked data from The Norwegian Prescription Database and The Norwegian Surveillance System for Communicable Diseases between 2004 and 2013. Both registries have national coverage. From a total of 9919 individuals who had been dispensed OST (methadone, buprenorphine or buprenorphine-naloxone), we included 3755 individuals who had been notified with HCV infection. In this population, dispensions of HCV treatment (pegylated interferon and ribavirin), benzodiazepines, selective serotonin reuptake inhibitors and antipsychotics were studied.

Results
Among 3755 OST patients notified with HCV infection, 539 (14%) had received HCV treatment during the study period. Annual HCV treatment rates during OST ranged between 1.3% (95% confidence interval [CI] 0.7–2.2) in 2005 and 2.6% (95% CI 1.9–3.5) in 2008 with no significant changes over time. HCV treatment uptake was not associated with age or gender, but associated with duration of active OST (adjusted odds ratio [aOR] 1.11 per year; 95% CI 1.07–1.15), high (> 80%) OST continuity (aOR 1.62; 95% CI 1.17–2.25), and heavy benzodiazepine use (aOR 0.65; 95% CI 0.49–0.87).

Conclusions
Cumulative HCV treatment uptake among OST patients notified with HCV infection in Norway between 2004 and 2013 was 14%. Annual treatment rates during OST remained unchanged below 3% per year. High continuity of OST over time and absence of heavy benzodiazepine use predicted HCV treatment uptake. Increased awareness for HCV among OST patients is needed as tolerable and efficient directly acting antiviral treatment is being introduced.

Discussion Only
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This population-based observational study evaluated HCV treatment uptake in Norway between 2004 and 2013 among individuals who had received OST and were notified with HCV infection. Cumulative HCV treatment uptake was 14% and annual treatment rates during OST ranged between 1.3% and 2.6% with no significant changes over time. HCV treatment was associated with duration of active OST, high OST continuity and absence of heavy benzodiazepine use, but was not associated with age or gender. This study provides unique baseline data on HCV treatment uptake among OST patients over a ten-year period prior to the availability of DAA treatment.

The results from this study are consistent with findings from a Norwegian cohort of PWID who previously had been admitted for residential drug dependency treatment, in which 19% of individuals with chronic HCV infection had received HCV treatment during a 16 years observation period [45]. The majority of treated individuals in the present study had received HCV treatment during OST. Still, annual treatment uptake during OST was only marginally higher than treatment rates reported in community-based cohorts of PWID not engaged in OST [1215]. Although the Norwegian OST program was expanding during the study period, this did not translate into increasing HCV treatment uptake. This could be explained by a reluctance to offer OST patients IFN-based treatment, but might also suggest a low awareness of HCV infection in OST programs in general. Prescription of OST to more vulnerable individuals during the final part of the study period could also have played a role. Stable low treatment rates in this population might therefore reflect ongoing drug use as a barrier to HCV care on both patient- and provider-levels [19]. However, there has been a trend in Norway to increasingly provide HCV treatment for active PWID [43].

Cumulative HCV treatment uptake was similar in all age groups and there was no association between age and HCV treatment. Among diseased HCV RNA positive individuals in a large Norwegian cohort of PWID, advanced liver fibrosis or cirrhosis on autopsy was seen in 35% of those who died 25 years or more after exposure to the virus [46]. In the same cohort, liver disease was the cause of death in 30% of deceased individuals above 50 years of age [4]. Given the high burden of HCV-related liver disease reported from this and other ageing cohorts of PWID with untreated HCV infection [47], it is a concern that treatment uptake was only 15% among individuals above 50 years at the end of the observation.

Certain characteristics of OST were associated with HCV treatment. The odds of receiving HCV treatment increased by 11% for every year spent in active OST. OST continuity by itself was also important; in fact, individuals in active OST more than 80% of the time had 64% increased odds of receiving HCV treatment compared to those with low OST continuity. These are novel findings that raise the hypothesis that retention in OST could promote health-seeking behaviour and facilitate HCV treatment.

This study also found associations between specific drug dispensions and HCV treatment. Heavy, but not moderate benzodiazepine use was associated with decreased odds of receiving HCV treatment, a finding that might reflect a psychosocial vulnerability that characterizes a group of OST patients. Benzodiazepine use is common among Norwegian OST patients and is shown to be associated with negative outcomes including poor social functioning and reduced retention in OST programs [48]. Psychiatric disease is a well-known barrier for IFN-based HCV treatment [18], but no association between dispensions of antipsychotics and HCV treatment was found in this study. SSRI use, however, was more common in patients treated for HCV, but this difference could be attributed to SSRI use initiated during or after HCV treatment. This finding might imply that the increased SSRI use was a consequence of psychiatric side effects of IFN-based treatment [49].

The main strength of this study is its population-based approach, providing a large sample of individuals with opiate dependency who had received OST during a ten-year period. A liberal inclusion of individuals with only sporadic or short-term exposure to OST has ensured a study population more representative of Norwegian PWID. This study is the first to document HCV treatment uptake in this essential target group for HCV treatment, providing important baseline data prior to the availability of DAA treatment.

An inherent limitation of this study is the lack of clinical data available from the registries. This may have impeded detection of factors associated with HCV treatment, although novel pharmaco-epidemiological associations have been identified. Another limitation is that OST administered to institutionalized patients was not registered in NorPD prior to 2008. HCV treatment, however, has almost exclusively been initiated in the outpatient setting and has therefore been captured by the registry throughout the study period. Consequently, annual HCV treatment rates during OST may have been underestimated prior to 2008, since some individuals probably have been misclassified as being treated prior to OST. This might explain the lower trend in treatment rates observed in this period. This bias may also have undervalued OST duration and OST continuity in some individuals, but cumulative HCV treatment uptake has not been affected.

The quality of the MSIS data brings important limitations to this study. Firstly, the registry does not adequately discriminate chronic HCV infections from acute HCV infections with spontaneous clearance. Thus, by including all notified individuals regardless of the method of detection, treatment uptake may have been underestimated. Secondly, the low notification rate is a recognized problem that probably reflects vulnerable notification routines and lacking notifications of chronic infection prior to 2008, as well as low testing activity in OST programs. Also, this study may have missed some individuals notified prior to the study period. Nevertheless, this study has shown that only 38% of OST patients were notified with HCV infection and that only 57% of patients treated for HCV were notified. Although notifications rates among treated individuals improved, it is still a concern that one in four individuals treated for HCV remained un-notified towards the end of the study period.

Restricting the study population to individuals notified with HCV infection has limited the sample size and excluded more than 40% of all patients actually treated for HCV. Although most characteristics were similar between notified and un-notified individuals, un-notified patients were on average three years older than notified individuals. This suggests that the linkage to MSIS may have introduced an age-related selection bias, excluding a group of older HCV infected individuals. Treatment uptake in older age groups may therefore have been underestimated. However, this bias has probably not altered the main finding of the study. Cumulative HCV treatment uptake among all OST patients was 9.5%, and assuming 60% HCV RNA prevalence in the ageing OST population [26, 37], this finding would correspond to 16% treatment uptake among all individuals with presumed chronic HCV infection.

The current availability of tolerable, short-duration and highly efficient DAA regimens has led to significant therapeutic optimism with possibilities for broadened treatment uptake and subsequent HCV elimination among PWID [23, 5052]. Although derived from IFN-based treatment, the findings from this study are highly relevant, providing baseline data on HCV treatment uptake prior to the introduction of DAAs. Collectively, the findings from this study underscore the need for increased awareness for HCV infection in a growing population of PWID including OST patients now being eligible for HCV treatment. The results should inform health political decisions and support improved HCV testing activity and linkage to HCV care among individuals receiving OST. Although treatment uptake is expected to increase, challenges concerning drug pricing and delivery of care will probably remain. Future studies should therefore monitor treatment rates in this population.

In conclusion, this study has shown that HCV treatment uptake among patients who have received OST in Norway was low and stable during the final ten years of the IFN-based treatment era. Although long-term stability in OST might facilitate HCV treatment, the findings from this study highlight the need for improved awareness for HCV infection in this increasingly important target group for HCV treatment.