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

Saturday, February 9, 2019

Mavyret - Safety and efficacy in patients receiving opioid substitution therapy/HCV genotypes 1-6

Int J Drug Policy. 2019 Feb 5;66:73-79. doi: 10.1016/j.drugpo.2019.01.011. [Epub ahead of print]

Safety and efficacy of glecaprevir/pibrentasvir in patients with chronic hepatitis C genotypes 1-6 receiving opioid substitution therapy.
Grebely J1, Dore GJ2, Alami NN3, Conway B4, Dillon JF5, Gschwantler M6, Felizarta F7, Hézode C8, Tomasiewicz K9, Fredrick LM3, Dumas EO3, Mensa FJ3.

Open Access

International guidelines recommend treatment of hepatitis C virus (HCV) infection in people who inject drugs (PWID), including those on opioid substitution therapy (OST). The pangenotypic combination of glecaprevir and pibrentasvir has shown high sustained virologic response at post-treatment Week 12 (SVR12) in clinical trials. Herein, we evaluate the safety and efficacy of glecaprevir/pibrentasvir in patients receiving OST.

Pooled data from patients with HCV genotypes 1-6 who were treated with glecaprevir/pibrentasvir for 8, 12, or 16 weeks in eight Phase 2 and 3 trials were categorized by use of OST. Treatment completion, treatment adherence, SVR12, adverse events (AEs), and laboratory abnormalities were evaluated for patients receiving and not receiving OST.

Among 2256 patients, 157 (7%) were receiving OST. Compared with patients not receiving OST, OST patients were younger (mean age, 46.8 vs 52.8 years), male (69% vs 54%), white (93% vs 80%), HCV treatment-naïve (86% vs 72%), had HCV genotype 3 (60% vs 26%), and had a history of depression or bipolar disorder (43% vs 19%). Most patients completed (OST: 98% [n/N = 154/157]; non-OST: 99% [n/N = 2070/2099]) and were adherent (received ≥90% of study drug doses) to glecaprevir/pibrentasvir treatment (OST: 98% [n/N = 121/123]; non-OST: 99% [n/N = 1884/1905] among patients with available data). In the intention-to-treat population, SVR12 rates in OST and non-OST patients were 96.2% (n/N = 151/157; 95% CI 93.2-99.2) and 97.9% (n/N = 2055/2099; 95% CI 97.3-98.5), respectively. For OST patients, reasons for nonresponse included virologic relapse (<1%; n = 1), premature study drug discontinuation (<1%; n = 1), and loss to follow-up (3%; n = 4). AEs occurring in ≥10% of OST patients were headache, fatigue, and nausea. Drug-related serious AEs, AEs leading to study drug discontinuation, and Grade 3 or higher laboratory abnormalities were infrequent in both groups (<1%). No HCV reinfections occurred through post-treatment Week 12.

Glecaprevir/pibrentasvir is highly efficacious and well tolerated in HCV-infected patients receiving OST.

Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.
KEYWORDS: Glecaprevir/pibrentasvir; Hepatitis C virus; Opioid substitution therapy; People who inject drugs

Wednesday, February 6, 2019

Treat All - Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore

Barriers and facilitators of hepatitis C treatment uptake among people who inject drugs enrolled in opioid treatment programs in Baltimore
Oluwaseun Falade-Nwulia, Risha Irvin, Alana Merkow , Mark Sulkowski, Alexander Niculescu, Yngvild Olsen, Kenneth Stoller , David L. Thomas, Carl Latkin, Shruti H. Mehta

Download full-text article
Shared On Twitter: Henry E. Chang 

•Most PWID with HCV have not been treated despite existence of effective treatments.
•Only 20% of PWID in Baltimore opioid treatment programs (OTPs) received HCV treatment.
•Recent drug use was identified as a barrier to HCV treatment.
•Peer support and HCV treatment at OTPs were identified as facilitators to HCV treatment.


Hepatitis C virus (HCV) infection is a major public health issue among people who inject drugs (PWID) with prevalence of 50–80% in the United States. Effective, simple, oral direct acting agents (DAA) of short duration with minimal side effects have been associated with cure rates > 95%. However, HCV treatment uptake among PWID remains low. We characterized the HCV care continuum, HCV treatment knowledge, as well as barriers and facilitators to HCV treatment uptake among PWID enrolled in two opioid treatment programs (OTPs) in Baltimore, Maryland, USA.

Between July and November 2016, 124 HCV infected PWID were recruited from two opioid treatment programs in Baltimore through convenience sampling. Participants completed a 50-item questionnaire to assess HCV treatment knowledge, attitudes, and practices. Progress through the HCV care continuum was assessed based on a series of questions assessing evaluation for HCV treatment, recommendation for HCV treatment by a provider, and HCV treatment initiation. HCV status was assessed based on participant self-report.

The median age was 52 years (IQR 44–58), 56% were male, the majority were African American (69%), and 19% reported HIV coinfection. Participants had been tested for HCV at their primary care provider's PCP's office (34%), drug treatment center (20%), emergency room (11%), or prison (9%), and most (60%) had been diagnosed with HCV over 5 years prior. The majority reported that HCV was a major health concern for them (91%), were aware there were new treatments for HCV (89%), and that the new treatments cure most people (69%). More than half (60%) had seen a health professional who could treat HCV, 40% had HCV therapy recommended by their HCV specialist, and 20% had started or completed treatment. In univariable analysis, PWID were significantly more likely to have been treated if they were HIV co-infected (OR 3.4 (95% CI 1.3–9.2)) or had a partner or friend concerned about their HCV (OR 3.4 (95% CI 1.2–9.7)), and were significantly less likely to have been treated if they had used any illicit drugs in the preceding 6 months (OR 0.4 (95% CI 0.2–0.99). In multivariable analysis, having a friend or partner concerned about their HCV remained significantly associated with HCV treatment (OR 5.0 (95% CI 1.4–17.7)). When questioned about what would facilitate HCV treatment, the majority (85%) reported that a friend telling them that HCV treatment had helped them and having HCV treatment provided at their opioid treatment program would make them more likely to engage in HCV treatment.


Despite a high prevalence of HCV among opioid treatment program patients and the availability of effective treatments, uptake remains low. We identified several key barriers and facilitators that can affect HCV treatment uptake.

Monday, February 4, 2019

Making OxyContin 'Tamper Proof' Helped Spread Hepatitis C

Reformulation of OxyContin to Discourage Abuse Linked to Higher Rates of Hepatitis C
Reformulation of the pain medicine OxyContin in 2010 to make it more difficult to abuse directly led to a large rise in hepatitis C infections as drug abusers switched from the prescription medication to injectable heroin, according to a new RAND Corporation study.

While hepatitis C infection rates increased broadly across the country during the years following the reformulation, researchers found that states with above-average rates of OxyContin misuse prior to the reformulation saw hepatitis C infections increase three times as fast as in other states.

Public health officials previously have blamed the shift from prescription opioids to injectable heroin as a cause of the rise in hepatitis C cases, but the new study provides the best evidence to date of a direct link between OxyContin reformulation and the infection surge. The findings are published in the February edition of the journal Health Affairs.

“These results show that efforts to deter misuse of opioids can have unintended, long-term public health consequences,” said David Powell, the study's lead author and a senior economist at RAND, a nonprofit research organization. “As we continue to develop policies to combat the opioid epidemic, we need to be careful that new approaches do not make another public health problem worse.”

The hepatitis C virus causes liver disease and is responsible for more deaths in the United States than any other infectious disease, accounting for 20,000 deaths in 2015. While the rate of new hepatitis C had remained steady for several years, the infection rate began rising at an alarming rate beginning in 2010.

Injection drug use has consistently been identified as a predominant risk factor for hepatitis C, leading experts to consider whether the opioid epidemic might be a driver of the recent rise in the infection.

Much of the early years of the opioid abuse epidemic was driven by misuse of prescription pain medicine. But one of the most abused drugs, OxyContin was reformulated in 2010, making the pill difficult to crush or dissolve, thus deterring the most-dangerous methods of abuse by injection or inhalation.

RAND researchers previously demonstrated that the reformulation of OxyContin caused some nonmedical users of the drug to switch to injectable heroin, which led to a sharp increase in heroin overdoses after 2010.

In the latest study, researchers from RAND and the Wharton School at the University of Pennsylvania examined rates of hepatitis C infections in each state from 2004 to 2015, examining differences between states based on the level of misuse of the drug before the reformulation occurred.

The analysis found that states with above-median OxyContin misuse prior to the reformulation experienced a 222 percent increase in hepatitis C infections after reformulation, while states with below-median misuse of OxyContin experienced a 75 percent increase in hepatitis C infections over the same period.

Before the reformulation, there was almost no difference in hepatitis C infections rates across the two groups of states.

“Even with recent advancements in the treatment for hepatitis C, the dramatic increase in infections represents a substantial public health concern that can have tremendous long-term costs if infected people are not identified and treated,” said Rosalie Liccardo Pacula, a study co-author, and co-director of the RAND Opioid Policy Tools and Information Center and the RAND Drug Policy Research Center.

As drug abuse policy continues to reduce access to abusable prescription opioids, researchers say the study suggests that there could be further unintended public health consequences if drug abusers switch to injected drugs.

“It is important that strategies that limit the supply of abusable prescription opioids are paired with polices to ease the harms associated with switching to illicit drugs, such as improved access to drug treatment and increased efforts to identify and treat diseases associated with injection drug use,” Pacula said.

Support for the study was provided by the National Institutes on Drug Abuse. Abby E. Alpert of the Wharton School at the University of Pennsylvania also co-authored the study.

The federally supported RAND Opioid Policy Tools and Information Center develops reliable data, rigorous methods and policy tools to inform evidence-based opioid policies.

Since 1989, the RAND Drug Policy Research Center has conducted research to help policymakers in the United States and throughout the world address issues involving alcohol, marijuana and other drugs.

Making OxyContin 'Tamper Proof' Helped Spread Hepatitis C
By Steven Reinberg
HealthDay Reporter
MONDAY, Feb. 4, 2019 (HealthDay News) -- An effort to make the opioid painkiller OxyContin harder to abuse drove addicted patients to heroin and caused a dramatic increase in hepatitis C, a new study suggests.
In a classic case of unintended consequences, Connecticut-based Purdue Pharma reformulated its powerful and popular drug OxyContin for the right reasons. It became harder to crush or dissolve, thus making it harder to snort or inject for a fast high.

Saturday, February 2, 2019

JAMA - Opioid overdose crisis is expected to worsen in the United States

JAMA Network
Original Investigation Substance - Use and Addiction
Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States
Qiushi Chen, PhD1,2,3; Marc R. Larochelle, MD, MPH4; Davis T. Weaver, BS2,5; et al
Published: February 1, 2019. doi:10.1001/jamanetworkopen.2018.7621

What is the projected effect of lowering incident nonmedical prescription opioid use on the future trajectory of the opioid overdose crisis in the United States?

Findings In this system dynamics model study, under current conditions, the opioid overdose crisis is expected to worsen—with the annual number of opioid overdose deaths projected to reach nearly 82 000 by 2025, resulting in approximately 700 000 deaths from 2016 to 2025. Interventions focused on lowering the incidence of prescription opioid misuse were projected to result in a 3.0% to 5.3% decrease in opioid overdose deaths over this period.

Meaning Prevention of prescription opioid misuse alone is projected to have a modest effect on lowering opioid overdose deaths in the near future, and multipronged approach is needed to dramatically change the course of the epidemic.

Read the article:

Press Release
Study predicts worsening of overdose crisis, limits of focusing on prescription opioids
A study from investigators at the Massachusetts General Hospital (MGH) Institute for Technology Assessment projects that the opioid overdose epidemic in the U.S. is likely to increase in coming years, and that measures based on restricting access to prescription opioids will have a minimal impact in reducing overdose deaths. In their report published in JAMA Network Open, the team notes that the changing nature of the epidemic - which is now driven by the use of illicit opioids like heroin and fentanyl - has reduced the potential impact of programs targeting prescription opioids.

"The opioid epidemic started with a sharp increase in opioid prescriptions for pain in the 1990s; but since 2010 the crisis has shifted, with a leveling off of deaths due to prescription opioid overdoses and an increase in overdose deaths due to heroin," says Jagpreet Chhatwal, PhD, of the MGH Institute for Technology Assessment (MGH-ITA), corresponding author of the report. "In the past five years, deaths have accelerated with the introduction of the powerful synthetic opioid fentanyl into the opioid supply, leading to a continuing increase in overdose deaths at time when the supply of prescription opioids is decreasing."

Chhatwal's team used data from sources such as the National Survey on Drug Use and Health and the Centers for Disease Control and Prevention to develop the Opioid Policy Model, reflecting the trajectory of the opioid epidemic in the U.S. from 2002 to 2015. They then used that model to make projections for probable outcomes from 2016 to 2025.

Under a status quo scenario, in which no further reduction in the misuse of prescription opioids occurs in coming years, the model projects that the annual number of opioid overdose deaths will increase from 33,100 in 2015 to 81,700 in 2025, a 147 percent increase. The model also predicts that, during those years, a total of around 700,000 people will die from an opioid overdose, 80 percent from illicit drugs like heroin and fentanyl. The researchers also estimate that, by 2025, half of all new opioid users will begin with illicit rather than prescription drugs. In all scenarios tested, interventions directed towards reducing misuse of prescription opioids were projected to decrease overdose deaths by only 3 to 5 percent.

"The ongoing opioid epidemic involves several interrelated forces. Systems modeling, the mathematical approach used in our analysis, allows us to better understand the underlying dynamics and to quantify the impact of different interventions," says Qiushi Chen, PhD, lead author, an assistant professor in the Harold and Inge Marcus Department of Industrial and Manufacturing Engineering ( at The Pennsylvania State University, and an affiliated researcher at the MGH ITA.

Co-author Marc Larochelle, MD, MPH, of the Grayken Center for Addiction at Boston Medical Center, an assistant professor of Medicine at Boston University School of Medicine, says, "This study demonstrates that initiatives focused on the prescription opioid supply are insufficient to bend the curve of opioid overdose deaths in the short and medium term. We need policy, public health and health care delivery efforts to amplify harm reduction efforts and access to evidence-based treatment."

Chhatwal adds, "If we rely solely on controlling the supply of prescription opioids, we will fail miserably at stemming the opioid overdose crisis. Illicit opioids now cause the majority of overdose deaths, and such deaths are predicted to increase by 260 percent - from 19,000 to 68,000 - between 2015 and 2025. A multipronged approach - including strategies to identify those with opioid use disorder, improved access to medications like methadone and buprenorphine, and expansion of harm reduction services such as the overdose-reversal drug naloxone - will be required to reduce the rate of opioid overdose deaths." Chhatwal is an assistant professor of Radiology at Harvard Medical School.

Additional co-authors of the JAMA Network Open report are Davis Weaver, Anna Lietz, Peter Mueller, PhD, Sarah Mercaldo, PhD, Amy Knudsen, PhD, and Pari Pandharipande, MD, MPH, MGH Institute for Technology Assessment; Sarah Wakeman, MD, and Kenneth Freedberg, MD, MSc, MGH Department of Medicine; and Tiana Raphel, University of Texas Southwestern Medical School.

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH Research Institute conducts the largest hospital-based research program in the nation, with an annual research budget of more than $900 million and major research centers in HIV/AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, genomic medicine, medical imaging, neurodegenerative disorders, regenerative medicine, reproductive biology, systems biology, photomedicine and transplantation biology. The MGH topped the 2015 Nature Index list of health care organizations publishing in leading scientific journals and earned the prestigious 2015 Foster G. McGaw Prize for Excellence in Community Service. In August 2018 the MGH was once again named to the Honor Roll in the U.S. News & World Report list of "America's Best Hospitals." 

Sunday, January 27, 2019

Parents worried about risks, still think opioids are best for kids' pain relief

Parents worried about risks, still think opioids are best for kids' pain relief

CHICAGO - Headlines filled with frightening news of opioid abuse, overdoses and reports that 90 percent of addictions start in the teen years could make any parent worry. Yet parents remain conflicted about opioids: while more than half express concern their child may be at risk for opioid addiction, nearly two-thirds believe opioids are more effective at managing their child's pain after surgery or a broken bone than non-prescription medication or other alternatives, according to a nationwide survey commissioned by the American Society of Anesthesiologists (ASA).

"The survey results shed light on the country's conflicted relationship with and understanding of opioids. While most parents said they were concerned about side effects and risks such as addiction, improper or recreational use and overdose, they still thought opioids work best to manage pain," said ASA President Linda J. Mason, M.D., FASA. "Opioids may not always be the best option. It really depends on the type of surgery and how long they are required. It is, however, important for parents to know that there are many alternatives available that are as - or more - safe and effective for pain management. But only about a third of parents whose children were prescribed opioids even asked their doctor about pain management alternatives."

Although short-term use of opioids can be effective when managed safely and the risks minimized, more than 2 million Americans abuse them and more than 90 people die of an opioid overdose every day. Opioid-related deaths among children and adolescents nearly tripled between 1999 and 2016, driven mostly by prescription opioids.* During Physician Anesthesiologists Week (Jan. 27 - Feb. 2), ASA wants parents to know that a physician anesthesiologist or other pain management specialist can create an individualized plan to best address patients' pain based on the condition or type of surgery and decrease the risk of opioid misuse and addiction.

The new survey of more than 1,000 parents of children aged 13-24, one-third of whom had been prescribed opioids, revealed that while 83 percent of parents believe they are prepared to safely manage their child's opioid use if prescribed, the facts don't quite bear out. The results suggest there is a need for improved awareness on: opioid alternatives; safe storage and proper disposal; talking to children about risks; and the benefits of naloxone, an emergency medication that reverses the effects of an opioid overdose.

Parents aren't asking about effective alternatives

While opioids can help with pain management for a few days after surgery or injury, there are effective alternatives that do not have the side effects and risks of opioids, including non-opioid medications and non-drug therapies. But the survey results suggest parents often don't ask about alternatives, or aren't aware of the range of options.

59 percent said they would talk to their physician about pain management options, but only 37 percent of those whose children were prescribed opioids actually did.

88 percent recognized non-opioid, over-the-counter medications, such as acetaminophen (Tylenol), ibuprofen (Advil or Motrin) and aspirin, are used to effectively help treat pain. However, few were aware the same applies to other non-opioid options, including steroids (23 percent), antidepressants (9 percent), and anti-seizure medications (7 percent).

15 percent incorrectly said antibiotics are an effective pain reliever.

Beyond medications, a number of non-drug therapies can help with ongoing pain, including nerve blocks, physical therapy, biofeedback, meditation, virtual reality, massage and acupuncture.

Parents are unaware that safe storage and proper disposal are key

More than half of people who misuse prescribed opioids get them from a friend or relative. That's why safe storage and proper disposal of the drugs are important to help curb the epidemic. But the survey results suggest parents don't fully understand the benefits and appropriate methods of safe storage and disposal.

Only 50 percent said they stored or would store opioids in a safe and secure place (not the medicine cabinet, where they can be accessed by others).

60 percent of those whose children took opioids said they needed fewer than were prescribed and, consequently, had leftover medication. But only 39 percent of all parents disposed or would dispose of leftover opioids as recommended, including taking them to a local pharmacy or health clinic, flushing them down the toilet or mixing them with dirt, kitty litter or coffee grounds before throwing them away.

Yet, 61 percent correctly identified the ideal method of disposing leftover opioids, which involves taking them to a collection center at a local police station or drug disposal program at a pharmacy or health clinic.

Parents understand importance of communication

When a child is prescribed opioids, parents need to have an open and honest discussion about the potential side effects and risks - not only with the child taking the medication, but other family members as well. Surveyed parents generally understood that.

74 percent said they have talked to their child about the dangers of abusing prescription and over-the-counter medications and 20 percent said they intend to have the conversation.

89 percent of those whose children have been prescribed opioids said they've had those discussions.

91 percent said they are confident their children know that prescribed and over-the-counter medications can be just as dangerous as illegal drugs.

Parents recognize naloxone saves lives

Naloxone (Narcan®) is a lifesaving medication administered via nasal spray or injection that rapidly reverses the effects of an overdose. It's important to know about naloxone because anyone who uses opioids - even if they've been prescribed by a doctor - may be at risk for an overdose.

The availability of naloxone varies by state. In most states it is available by prescription and some pharmacies sell it over the counter. Most parents recognize naloxone's value.

71 percent agreed that having naloxone on hand is the same as having other life-saving medication available for people who suffer from conditions such as allergies, asthma or diabetes.

29 percent were concerned that having it on hand encourages risky opioid use.

80 percent said they would be more comfortable having it at home if their child or another family member was taking opioids.

92 percent thought all first responders should carry it.

"It's critical that we recognize the gaps in opioid knowledge and work to correct them, ensuring everyone understands how to use them safely and minimize their risks. A physician anesthesiologist or other pain management specialist can help parents address their child's pain and decrease the risk of opioid misuse and addiction," said Dr. Mason. "We also need to reassure parents that naloxone saves lives and needs to be widely available."

The 17-question Engine CARAVAN® Omnibus Survey was conducted online November 25-December 2, 2018 among 1,007 parents of children ages 13-24. If their children were ever prescribed opioids, parents were asked to think of their child with the most recent prescription when answering the questions. If their children were never prescribed opioids, parents were asked to answer for their oldest child between the ages of 13 and 24.

Monday, January 21, 2019

Opioid and HCV Epidemics - Spreading rapidly in new generations, but boomers bear biggest burden

For Patients: Basic HCV Information
In this program launched by PeerView, Dr. Mark Sulkowski heads an expert panel addressing the evolving opioid and Hepatitis C epidemics. The good doctor will discuss basic HCV information for both the baby boomer generation (born between 1945 and 1965) and a younger at risk population, people less than 40 years old. 

Here are a few highlights to get you started, followed by tips for navigating the presentation.

Did you know?
Hepatitis C is spreading rapidly in new generations, but boomers bear the biggest burden.
Dr. Sulkowski: This group is critically important, because they’ve lived so long with the infection. They’re now presenting with liver disease, such as cirrhosis, decompensation—and they’re what’s behind the rise in liver cancer.. We’ll talk a bit more about that in a minute. And these individuals are dying about 15,000 deaths per year.

Dr. Sulkowski: So, let’s move into the first lecture portion of this, where we’re going to try to cover some of the basics about the burden of hepatitis C, where we stand with treatment and cure, and then we’re going to focus more on the local picture. Hep C is a major cause of mortality in America, more than any other infectious disease, even when you combine them. And I’ll come back to that with some actual data from the CDC. So, [HCV is] a major problem in the United States.

Opiate epidemic in the United States 
18-to 29-year-olds and 30- to 39-year-olds.
Dr. Sulkowski: In parallel with that is hepatitis C. One thing that characterizes this virus is it is very transmissible by blood contamination. But it’s not just reuse of needles; it’s reuse of any of the works, including water, that have been used to prepare drugs.

And it’s so contagious that people acquire it unknowingly. So, you can see that staggering increase in hepatitis C among this population, and that’s what’s driving that second hump on our epidemiology graphics in California but also here in Maryland.

A Closer Look at the Burden of HCV Infection in a New Era of Treatment and Cure
Hepatitis C and Injection Drug Use in the Urban Setting: Perspectives From the Front Lines 
Hepatitis C and Injection Drug Use in the Rural Setting: Perspectives From the Front Lines 
Practice Aids, Slides, Monograph and Live Roundtable Discussion Summary 
Experts discuss working with patients with substance use disorder 

For Patients: How To Navigate The Program 
Begin: Click here
-Select any specialty or profession
-The program will begin
-Interactive questions will appear; respond by clicking "N/A" or click "Next Button" on the top of your screen.
-Pause program click on the video presentation. 
-No registration is required

Recommended Reading
Screening For HCV Is Lacking - Baby Boomers
Screening strategies have been in place for baby boomers since 2012, but according to research, and the American Liver Foundation, "Few boomers are getting screened for hep C'

Screening For HCV Is Lacking - Young People At Risk
Screening young people most at risk for HCV is lacking as well, last month an article written by Michelle Andrews, published by Kaiser Health News (KHN) found facilities ready to serve people who use drugs are not always screening patients, read the article here.

The opioid epidemic is a major contributor to the current rise in HCV infections. Recently, HepVu launched a map on the impact of hepatitis C across the U.S. In some states the map shows a concentration of infections most impacted by the opioid epidemic.

Taking Down the Opioid Crisis 
Andrew Reynolds writes about the opioid crisis online at POSITIVELY AWARE (PA)
This article will provide you with a broad overview of the scope of the problem, basic information to understand what opioids are and how they lead to overdoses, and some harm reduction tips and resources so that you, or someone you know who uses drugs, can be safe. 
Read it here, follow Andrew on twitter. Visit Project Inform to read additional articles about the opioid crisis. 

Andrew Reynolds
Andrew Reynolds is the Hepatitis C Education Manager at Project Inform, and facilitates several HCV support groups in the San Francisco Bay Area. He's also a counselor on the HELP-4-HEP HCV phoneline (877-435-7443). Call him if you have any questions about HCV care and treatment.

Healio’s Opioid Resource Center
Healio’s Opioid Resource Center compiles the latest stories across a range of specialties, covering the latest research into the epidemic, FDA decisions on treatments and other related announcements.

Thanks for stopping by

Thursday, January 17, 2019

Naloxone - FDA clears the way to increase access and lower cost

In The News
FDA clears the way to increase access and lower cost of life-saving opioid overdose treatment drug
-Naloxone is used in emergency rooms across the U.S. to reverse a drug overdose from opioids.
-The FDA is streamlining the labeling for naloxone.
-The change clears the way for drugmakers to sell it without a prescription.

FDA Press Release
Statement from FDA Commissioner Scott Gottlieb, M.D., on unprecedented new efforts to support development of over-the-counter naloxone to help reduce opioid overdose deaths
SILVER SPRING, Md., Jan. 17, 2019 /PRNewswire/ -- With the number of overdose deaths involving prescription and illicit opioids more than doubling over the last seven years to nearly 48,000 in 2017, it's critical that we continue to address this tragedy from all fronts. This includes new ways to increase availability of naloxone, a drug used to treat opioid overdose.

When someone overdoses on an opioid, the person may lose consciousness and breathing may become shallow or stop. This can rapidly lead to death if there's no medical intervention.

However, if naloxone is administered quickly, it can counter the overdose effects, usually within minutes. While the person administering naloxone should also seek immediate medical attention for the patient, the bottom line is that wider availability of naloxone and quick action to administer it can save lives.

Naloxone is a critical drug to help reduce opioid overdose deaths. Prevention and treatment of opioid overdose is an urgent priority. Increased availability of naloxone for emergency treatment of overdoses is an important step. One potential way to improve access to naloxone is to make it available for over-the-counter (OTC) sale. FDA-approved versions of naloxone currently require a prescription, which may be a barrier for people who aren't under the care of a physician or may be ashamed or even fearful of admitting to issues with substance abuse. Having naloxone widely available, for example as an approved OTC product, is an important public health advance, and a need that we've been working on at the FDA.

Although FDA-approved prescription naloxone formulations have instructions for use in product labeling, they don't have the consumer-friendly Drug Facts label (DFL), which is required for OTC drug products. Before submitting a new drug application or supplement for an OTC drug product, companies must develop a DFL and conduct studies to show that consumers can understand how to use the product without the supervision of a health care professional. Some stakeholders have identified the requirement to perform these studies as a barrier to development of OTC naloxone products.

To encourage drug companies to enter the OTC market and increase access to naloxone, the FDA took an unprecedented step: we developed a model DFL with easy-to-understand pictograms on how to use the drug. We also conducted label comprehension testing to ensure the instructions were simple to follow.

This is the first time the FDA has proactively developed and tested a DFL for a drug to support development of an OTC product. We proactively designed, tested and validated the key labeling requirements necessary to approve an OTC version of naloxone and make it available to patients. One of the key components for OTC availability is now in place. In short, we've crafted model labeling that sponsors can use to obtain approval for OTC naloxone and increase its access. This action was part of our broader commitment to addressing the opioid crisis.

Today, we're announcing the results of our work, including posting two model DFLs (one for use with a nasal spray and one for use with an auto-injector) and the supporting FDA review. These efforts should jumpstart the development of OTC naloxone products to promote wider access to this medicine. The model DFL contains the information (except for individual product-specific information) that a consumer needs to administer naloxone safely and effectively.

During this period without a FY19 appropriation for the FDA, we've been focused on making sure that we continue critical aspects of our work, to the extent permitted by law. At this time, for products (such as naloxone) that are covered by a user fee program, our review of existing medical product applications and associated policy development regarding our review are funded by limited carryover user fee balances. We'll continue to update the public on how we're approaching our work during the lapse in appropriations.

Consumer comprehension of the model DFL was iteratively tested by an independent research contractor in a prespecified research design involving over 700 participants across a wide range of potential OTC naloxone users. This included people who use heroin; people who use prescription opioids; family and friends of people who use opioids; adolescents; and the general public. An FDA review team not directly involved in the conduct of the study independently reviewed the study report and determined that the comprehension results were satisfactory. Overall, the study demonstrated that the model DFL was well-understood by consumers and is acceptable for use by manufacturers in support of their OTC naloxone development programs. Using this information, naloxone manufacturers can now focus their efforts on final label comprehension testing of how well consumers understand the product-specific information that hasn't been already tested in the model DFL. I personally urge companies to take notice of this pathway that the FDA has opened for them and come to the Agency with applications as soon as possible.

The model DFL comes in two versions. One is for use with a nasal spray and one for use with an auto-injector. But the product-specific instructions in each version are placeholders that have not been tested by the FDA for comprehension or human factors performance. Sponsors can replace these placeholders with their own product-specific information and test it if necessary. Apart from this product-specific information, the model DFL otherwise contains all the key information needed for an untrained bystander to administer naloxone. In designing the model DFL, the FDA team sought input from multiple stakeholders in the addiction care community, as well as from the FDA internal experts, to streamline the DFL to contain only the most critical information, so that it could be easily understood in an emergency. We're grateful to the hundreds of study participants who helped us see this DFL through their eyes, which enabled us to refine the DFL multiple times until we reached a final version. These research participants enabled these efforts.

This work builds on our ongoing efforts to get this life-saving drug into the hands of those who need it most. In addition to the approval of injectable naloxone for use in a health care setting and both prescription auto-injector and intranasal forms of naloxone, which facilitate use by laypersons, we also released draft guidance to advance development of generic naloxone hydrochloride nasal spray.

Additionally, we also held a two-day advisory committee meeting last month to solicit input and advice on strategies to increase the availability of naloxone products intended for use in the community. We asked our external advisors from the FDA's Anesthetic and Analgesic Drug Products and the Drug Safety and Risk Management Advisory Committees to consider various options for increasing access to naloxone.

As part of HHS' ongoing efforts to combat the opioid crisis and expand the use of naloxone, in April 2017, the Department announced its 5-Point Strategy to Combat the Opioids Crisis. Those efforts include: better addiction prevention, treatment, and recovery services; better data; better pain management; better targeting of overdose reversing drugs; and better research. In April 2018, Surgeon General VADM Jerome Adams issued an advisory encouraging more individuals, including family, friends, and those who are personally at risk for an opioid overdose to carry naloxone. In December 2018, Adm. Brett P. Giroir, MD, Assistant Secretary for Health and the Secretary's Senior Advisor for Opioid Policy, released guidance for health care providers and patients detailing how naloxone can help save lives.

We're taking many steps to improve availability of naloxone products and we're committed to working with other federal, state and local officials; health care providers; patients; and communities across the country to combat the staggering human and economic toll created by opioid abuse and addiction.

For More Information:
FDA: Information about Naloxone

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation's food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Media Inquiries: Sarah Peddicord, 301-796-2805,
Consumer Inquiries: 888-INFO-FDA
SOURCE U.S. Food and Drug Administration

Monday, January 14, 2019

Americans have greater chance of dying of an accidental opioid overdose than in a car crash

For the First Time, We're More Likely to Die From Accidental Opioid Overdose Than Motor Vehicle Crash - 

A person is more likely to die from an accidental opioid overdose than from a motor vehicle crash, according to the National Safety Council analysis, per a report labeled "Injury Facts"

ITASCA, Ill., Jan. 14, 2019 /PRNewswire/ -- For the first time in U.S. history, a person is more likely to die from an accidental opioid overdose than from a motor vehicle crash, according to National Safety Council analysis. The odds of dying accidentally from an opioid overdose have risen to one in 96, eclipsing the odds of dying in a motor vehicle crash (one in 103). The National Safety Council unveiled the analysis on Injury Facts – the definitive resource for data around unintentional, preventable injuries – commonly known as "accidents." The nation's opioid crisis is fueling the Council's grim probabilities, and that crisis is worsening with an influx of illicit fentanyl.

"We've made significant strides in overall longevity in the United States, but we are dying from things typically called accidents at rates we haven't seen in half a century," said Ken Kolosh, manager of statistics at the National Safety Council. "We cannot be complacent about 466 lives lost every day. This new analysis reinforces that we must consistently prioritize safety at work, at home and on the road to prevent these dire outcomes."

NSC analysis also shows that falls – the third leading cause of preventable death behind drug overdose and motor vehicle crashes – are more likely to kill someone than ever before. The lifetime odds of dying from an accidental fall are one in 114 – a change from one in 119 just a year ago.

To keep the public up to date on the latest injury and fatality trends, the Council has added "Poisonings," "Older Adult Falls," "Fire-Related Fatalities and Injuries," and "Deaths by Transportation Mode" to Injury Facts. To demonstrate why Americans should be more concerned about preventable injuries than headline-grabbing catastrophes, the Council also added designated pages about airplane crashes, railroad deaths and consumer products – all issues that tend to spark nationwide anxiety but lead to far fewer fatal incidents than routine, everyday activities such as taking medication, driving or getting out of bed.

Preventable injuries are the third leading cause of death, claiming an unprecedented 169,936 lives in 2017 and trailing only heart disease and cancer. Of the three leading causes of death, preventable injuries were the only category to experience an increase in 2017, according to NSC analysis of the CDC data issued in December. A person's lifetime odds of dying from any preventable, accidental cause are one in 25 – a change from one in 30 in 2004.

Thursday, January 10, 2019

CDC - Rising rates of drug overdose deaths among women

Morbidity and Mortality Weekly Report (MMWR)
Drug Overdose Deaths Among Women Aged 30–64 Years — United States, 1999–2017
Weekly / January 11, 2019 / 68(1);1–5

What is already known about this topic?
The U.S. drug epidemic is evolving, including among women. Studies have highlighted rising rates of drug overdose deaths among women aged 45–64 years.

What is added by this report?
From 1999 to 2017, the death rate from drug overdose among women aged 30–64 years increased by 260%. Drug overdose deaths involving antidepressants, benzodiazepines, cocaine, heroin, prescription opioids, and synthetic opioids all increased. Among women aged 30–64 years, the average age at death for drug overdose deaths increased by nearly 3 years.

What are the implications for public health practice?
Overdose deaths continue to be unacceptably high, and targeted efforts are needed to reduce the number of deaths in this evolving epidemic, including those among middle-aged women


Discussion Only:
From 1999 to 2017, the crude rate of drug overdose deaths among women aged 30–64 years in the United States increased by 260%. The rates of overdose deaths increased for all drug categories examined, with a notable increase in rates of deaths involving synthetic opioids (1,643%), heroin (915%), and benzodiazepines (830%). These findings are consistent with recent reports highlighting an overall increasing trend in deaths involving drugs, especially with shifts in the type of drugs involved (e.g., heroin) (4).

Other reports have highlighted the overall increase in overdose deaths and emergency department visits related to drug use, especially among women aged 45–64 years (1). In addition to demonstrating the varying drug overdose rate increases by age group, this study determined that the age distribution of decedents shifted from 1999 to 2017, and the average age of women aged 30–64 years dying from drug overdoses increased for every drug class analyzed except synthetic opioids. Prevention programs might need to shift response options as the overdose epidemic experiences demographic shifts. Further, as women progress through life, individual experiences can change in the type of substance used or misused and in the experiences of pain that might result in an opioid prescription (5–8).

The findings in this report are subject to at least three limitations. First, rate estimates of specific drugs involved with deaths might be affected by factors related to death investigation, such as the substances tested for or the circumstances under which tests are performed. For example, toxicology testing cannot distinguish between pharmaceutical fentanyl and illicitly manufactured fentanyl. Second, drug categories presented are not mutually exclusive, and deaths might have involved more than one substance. Increases in deaths involving certain drugs might be the result of increases in certain drug combinations. Finally, the percentage of deaths with specific drugs identified on the death certificate varies over time. Changes in testing and reporting of drugs might have led to observed increases in some drug entities involved in drug overdose deaths.

Substantial work has focused on informing women of childbearing age about the risk and benefit of the use of certain drugs, particularly for the risk posed by neonatal abstinence syndrome as a result of opioid use during pregnancy (9,10). The current analysis demonstrates the remaining need to consider middle-aged women who remain vulnerable to death by drug overdose. A multifaceted approach involving the full spectrum of care services is likely necessary. For example, health care providers who treat women for pain, depression, or anxiety can discuss treatment options that consider the unique biopsychosocial needs of women (2). Providers can consider implementing the CDC Guideline for Prescribing Opioids for Chronic Pain (3), and Medicaid programs can also examine whether prescribing of controlled substances to their clients meets established guidelines. Access to gender-responsive substance use disorder treatment services, especially for pregnant women and women with drug use disorders, can reduce harmful outcomes. Overdose deaths continue to be unacceptably high, and targeted efforts are needed to reduce the number of deaths in this evolving epidemic among middle-aged women.

Read Full Report: 

Wednesday, January 2, 2019

Facing Opioids in the Shadow of the HIV Epidemic

January 3, 2019
N Engl J Med 2019; 380:1-3
DOI: 10.1056/NEJMp1813836

Facing Opioids in the Shadow of the HIV Epidemic
Caroline M. Parker, M.A., Jennifer S. Hirsch, Ph.D., Helena B. Hansen, M.D., Ph.D., Charles Branas, Ph.D., and Sylvia Martins, Ph.D.

The United States is in the midst of an opioid crisis. An estimated 2.1 million Americans had an opioid use disorder in 2016. The rate of opioid overdose deaths has increased by 500% since 1999, and each day an estimated 115 Americans die from opioid overdose.1 Despite the proven effectiveness of medication-assisted treatment (MAT) for opioid use disorders, the opioid mortality rate has now surpassed that of the AIDS epidemic during its peak in the early 1990s — a time when there was no effective treatment for HIV/AIDS.2

Saturday, December 22, 2018

HCV Next Is Saying Goodbye

I was overcome with great sadness this morning after reading HCV Next, a monthly publication available online at Healio, has published their last issue.

Thank You Healio
Thank you to all those amazing people who made HCV NEXT possible each month. I am so grateful for every outstanding interview, expert analysis, news article and in-depth editorial that was published over the last five years. Please know each issue made a difference in the lives of hepatitis C patients struggling to reach the finish line. 
Your publication will be missed!

Healio HCV News
Please continue to keep up on your HCV news via our other news outlets: Healio Gastroenterology and Liver Disease, Infectious Disease News and, launching soon, Healio Primary Care. 

Hepatitis C -  Barriers To Eradication
Despite all of the advances in hepatitis C treatment, it remains a “silent epidemic” with more than 70 million people infected worldwide. In this months issue of HCV Next, Michael S. Saag, MD., writes about HCV eradication and the huge barriers standing in the way; Passing the Torch from Implementation to Eradication

Are You At Risk?
Today, two different groups of people are at risk for hepatitis C; baby boomers, that is people born between 1945 and 1965 and young people - or - people who inject drugs. Although, HCV screening strategies for baby boomers have improved, the same is not true for people who use drugs, as reported by the good people at Imagine Hope recently over at NPR;
"Health care facilities that serve people who use drugs are well-positioned to initiate screening, studies show that often doesn't happen."
CEO of the American Liver Foundation added;
"It's a disease that can be cured the moment we identify somebody," says Tom Nealon, "Not testing is incomprehensible when you look at what hepatitis C does to their bodies and their livers."
Read the article: Why Aren't More Users Of Opioids Or Meth Screened For Hepatitis C?

During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state?
December 21, 2018
Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.
Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure. The urgency for action and the resources necessary will vary by jurisdiction.

In The News
Dec 21, 2018
JAMA In The News: Hepatitis C Cases Cluster in States Hit Hard by Opioids
FRIDAY, Dec. 21, 2018 (HealthDay News) -- More than half of Americans with hepatitis C are living in just nine U.S. states -- five of those in a region hit hard by the opioid epidemic, a new study shows.

Dec 19, 2018
Medscape: Hep C and Drug Abuse Often Go Hand in Hand, but Screening Lags
Recent studies have shown that health care facilities often fail to screen people who use drugs. Not testing these patients for hepatitis C is an enormous missed opportunity, public health experts agree.

Young People with Hepatitis C Face Cirrhosis at Younger Age 
Dec 16, 2018
One-third (32%) of people who contract hepatitis C virus (HCV) as a child will go on to develop cirrhosis at a median of 33 years post-infection, according to new research.

Until next time.

Wednesday, December 19, 2018

December Newsletters: Curing Hep C May Dial Back Liver Damage

Hi folks, over the next few weeks I'll be taking a holiday break to spend time with the family. Can't wait to start my Christmas shopping, trick out my tree, and bake some millennial sugar cookies. Using Pillsbury ready to make slice-and-bake cookies, add sprinkles after baking. Bad Nana!

In any event, here's your list of December newsletters with blog updates from across the web.

News & Review 
Catch up on what you missed this week by reading one of two HCV week in review publications:
The Weekly Bull is published by the Canadian non-profit organization HepCBC, the second publication by Caring Ambassadors Program, is filled with news as well, in addition to a monthly review of relevant HCV research published on PubMed.

News Update
Jan 1, 2019
CDC: Could be a tough flu season based on early viruses, hospitalizations
By Anne-Gerard Flynn
The country could be in for another challenging flu season. There are already 11 pediatric deaths associated with the flu and hospitals rates among very young children are high, according to the Centers for Disease Control and Prevention.

Dec 19, 2018
NPR - Even in a setting with an identified risk factor in opioid-use disorder, too few youths are being screened for hepatitis C
As the number of people who inject drugs and share needles has soared, the rate of infection with Hep C has climbed too. Yet many drug treatment patients aren't tested for the liver-damaging virus.

Dec 17, 2018
Great news for New Zealanders pangenotypic regimen Maviret unrestricted access from Feb 2019 with $0 co-payment - PHARMAC funding decision gives Kiwis with hepatitis C access to a potential cure

December Newsletters
The aim of is to develop a high-quality online resource to increase awareness of viral hepatitis, its treatment, and the needs of people living with viral hepatitis in Europe. 
The December edition of the infohep bulletin is now online: 
Global trends in non-alcoholic fatty liver disease
NAFLD can occur in lean people too
Hepatitis C and the US opioid epidemic
Resistance testing for hepatitis C
Rwanda aims for hepatitis C elimination
Egypt hepatitis C elimination

Hep is an award-winning print and online brand for people living with and affected by viral hepatitis. Offering unparalleled editorial excellence since 2010, Hep and are the go-to source for educational and social support for people living with hepatitis.
Winter Issue 2018
Curing Hep C May Dial Back Liver Damage
Hep C Testing Slowly Rising Among Baby Boomers
People Who Inject Drugs Succeed With Hep C Treatment
and more....

The HCV Advocate newsletter is a valuable resource designed to provide the hepatitis C community with monthly updates on events, clinical research, and education.
In this month's newsletter coverage of the Liver Meeting continues; read easy to understand commentary on HCV-related topics that matter most to patients. In next month's issue notable research on liver cancer presented at the meeting will be featured as well.

On This Blog
After The Liver Meeting Summary: Viral Hepatitis & Fatty Liver Disease
For patients - An index of links provide an overview of the meeting with a focus on HCV; read expert analysis of key data, interviews with leading researchers and clinicians, or listen to live presentations, view slidesets and capsule summaries. Sit back and watch daily clips or a live symposium, finally review a webinar with all the notable Liver Meeting updates. 

HCV Action brings together hepatitis C health professionals from across the patient pathway with the pharmaceutical industry and patient representatives to share expertise and good practice.
Read the latest: HCV Action e-update

The World Hepatitis Alliance goal is to achieve a world free from viral hepatitis, World Hepatitis Alliance provides global leadership in awareness-raising, advocacy and in efforts to find the missing millions.
News & Headlines 
Click here to read our latest newsletter.

The New York City Hepatitis C Task Force is a city-wide network of service providers and advocates concerned with hepatitis C and related issues. The groups come together to learn, share information and resources, network, and identify hepatitis C related needs in the community. Committees form to
work on projects in order to meet needs identified by the community.
December Newsletter: Reminder: NYC Hep C Task Force Meeting. December 5 (3-5 PM) @ 132 West 32nd St.
NYC Hep C Task Force
All - Hep Free NYC Newsletters

Hepatitis NSW provides information, support, referral and advocacy for people affected by viral hepatitis in NSW. We also provide workforce development and education services both to prevent the transmission of viral hepatitis and to improve services for those affected by it.
News Updates

GI & Hepatology News covers the world of liver disease with breaking news, on-site medical meeting coverage, and expert perspectives both in print and online. 
View all updates here....

Hepatitis Victoria is the peak not-for-profit community organisation working across the state for people affected by or at risk of viral hepatitis.
View the Latest Newsletter, or relax and listen to a short podcasts interviewing health experts and practioners on topics related to viral hepatitis - have a listen!

The British Liver Trust is the leading UK liver disease charity for adults – we provide information and support; increase awareness of how liver disease can be prevented and promote early diagnosis; fund and champion research and campaign for better services. 
View Recent Newsletters, here.

The Hepatitis C Trust is run by patients with the goal of eliminating HCV in the United Kingdom. The Trust’s mission is to reverse the rapidly increasing death toll caused by hepatitis C in the UK until no-one dies from this preventable and treatable disease and, ultimately, it is all but eradicated in this country.

The National Viral Hepatitis Roundtable (NVHR) is national coalition working together to eliminate hepatitis B and C in the United States.
NVHR 2018 Year in Review
View all NVHR newsletters

Check out the latest National Institutes of Health Newsletter.
December Newsletter
Plan Your Plate - Shifting to a Healthy Eating Style

Blog Updates
Karen Hoyt is devoted to offering support and accurate information to people coping with the effects of hepatitis C.
Latest blog entry: Holiday and Health Problems
Find Karen on Facebook
YouTube Page

Lucinda K. Porter
Lucinda Porter is a nurse, speaker, advocate and patient devoted to increasing awareness about hepatitis C.
View all new blog updates, here....

Hep is an award-winning print and online brand for people living with and affected by viral hepatitis.
Latest blog updates: 
By Lucinda K. Porter, RN
By Connie M. Welch 
Hepatitis C Cure 
By Greg Jefferys
View all blog updates, here...

AGA Blog
Gastroenterology and Clinical Gastroenterology and Hepatology
View all blog updates, here...

Life Beyond Hep C is where faith, medical resources and patient support meet, helping Hep C patients and their families navigate through the entire journey of Hep C.
Latest blog entry: 5 Common Questions and Answers about Hepatitis C Treatment
View all updates, here...

Canadian Liver Foundation
We strive to improve prevention and the quality of life of those living with liver disease by advocating for better screening, access to treatment, and patient care.
Latest blog entry: Tips for a struggling caregiver
View all updates, here...

The Hepatitis B Foundation is a national nonprofit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.
Latest blog entry: My partner has been diagnosed with hepatitis B. Can transmission be prevented by vaccination?
 Ask An Expert: Managing Hepatitis Delta During Pregnancy
View all updates, here....

ADRLF (Al D. Rodriguez Liver Foundation)
Al D. Rodriguez Liver Foundation is a non-profit organization that provides resources, education and information related to screening, the prevention of and treatment for the Hepatitis Virus and Liver Cancer.
View all updates, here....

At we empower patients and caregivers to take control of Hepatitis C by providing a platform to learn, educate, and connect with peers and healthcare professionals.
Part 1: Doctors and Dragons: The Adventure Continues - By Rick Nash
View all updates, here....

Kevin Pho is a practicing physician and most known for his blog KevinMD. Thousands of authors contribute to his blog: primary care doctors, surgeons, specialist physicians, nurses, medical students, policy experts. And of course, patients, who need the medical profession to hear their voices.
View latest blog entry, here... 

Harvard Health Blog
The goal of our publications is to bring people around the world the most current health information that is authoritative, trustworthy, and accessible, drawing on the expertise of the 10,000+ faculty physicians at Harvard Medical School.
Latest blog entry: Alcohol use disorder: When is drinking a problem?
Benefits of a healthy diet — with or without weight loss
Safe and effective use of insulin requires proper storage

University of Michigan - Lab Blog
Providing physicians with virtual access to specialists can be lifesaving to liver disease patients.
View all updates: Lab Blog

In Case You Missed It
Dec 13, 2018
New HCV Clinical Advances
Sit back and watch a live symposium from the November 2018 Liver Meeting featuring table discussions with leading physicians discussing viral hepatitis, launched by Chronic Liver Disease Foundation (CLDF) on December 13, 2018.

December 21, 2018
During 2013 to 2016, what proportion of adults were living with hepatitis C virus (HCV) infection in each US state?
Regions with long-standing HCV epidemics, and those with newly emergent ones partly driven by the opioid crisis, face substantial HCV prevalence.
Prevalence of Hepatitis C Virus Infection in US States and the District of Columbia, 2013 to 2016
Prevalence of HCV infection varies widely in the United States. Highest rates are frequently in states deeply affected by the opioid crisis or with a history of increased levels of injection drug use and chronic HCV infection, particularly in the West. Progress toward hepatitis C elimination is theoretically possible with the right investments in prevention, diagnosis, and cure. The urgency for action and the resources necessary will vary by jurisdiction.

JAMA In The News: Hepatitis C Cases Cluster in States Hit Hard by Opioids
FRIDAY, Dec. 21, 2018 (HealthDay News) -- More than half of Americans with hepatitis C are living in just nine U.S. states -- five of those in a region hit hard by the opioid epidemic, a new study shows.

JAMA Patient Page
This JAMA Patient Page describes recent advancements in hepatitis C treatment.
December 4, 2018
Treating Hepatitis C
From a medical point of view, almost all patients with hepatitis C should be treated.

See you soon!