By Jan Hoffman NEW YORK TIMES
​Sept. 10, 2018

BOSTON — To the medical students, the patient was a conundrum.
According to his chart, he had residual pain from a leg injury sustained while working on a train track. Now he wanted an opioid stronger than the Percocet he’d been prescribed. So why did his urine test positive for two other drugs — cocaine and hydromorphone, a powerful opioid that doctors had not ordered?
It was up to Clark Yin, 29, to figure out what was really going on with Chris McQ, 58 — as seven other third-year medical students and two instructors watched.
“How are you going to have a conversation around the patient’s positive tox screen results?” asked Dr. Lidya H. Wlasiuk, who teaches addiction awareness and interventions here at Boston University School of Medicine.
Mr. Yin threw up his hands. “I have no idea,” he admitted.
Chris McQ is a fictional case study created by Dr. Wlasiuk, brought to life for this class by Ric Mauré, a keyboard player who also works as a standardized patient — trained to represent a real patient, to help medical students practice diagnostic and communication skills. The assignment today: grappling with the delicate art and science of managing a chronic pain patient who might be tipping into a substance use disorder.

How can a doctor win over a patient who fears being judged? How to determine whether the patient’s demand for opioids is a response to dependence or pain?
Addressing these quandaries might seem fundamental in medical training — such patients appear in just about every field, from internal medicine to orthopedics to cardiology. The need for front-line intervention is dire: primary care providers like Dr. Wlasiuk, who practices family medicine in a Boston community clinic, routinely encounter these patients but often lack the expertise to prevent, diagnose and treat addiction.

According to the Centers for Disease Control and Prevention, addiction — whether to tobacco, alcohol or other drugs — is a disease that contributes to 632,000 deaths in the United States annually.
But comprehensive addiction training is rare in American medical education. A report by the National Center on Addiction and Substance Abuse at Columbia University called out “the failure of the medical profession at every level — in medical school, residency training, continuing education and in practice” to adequately address addiction.
Dr. Timothy Brennan, who directs an addiction medicine fellowship at Mt. Sinai, said that combating the crisis with this provider work force is “like trying to fight World War II with only the Coast Guard.”

Now, a decade-long push by doctors, medical students and patients to legitimize addiction medicine is resulting in blips of change around the country. A handful of students has begun to specialize in the nascent field, which concentrates on prevention and treatment of addictions and the effect of addictive substances on other medical conditions. In June, the House of Representatives authorized a bill to reimburse education costs for providers who work in areas particularly afflicted by addiction.
There are only 52 addiction medicine fellowships (addiction psychiatry is a separate discipline), minuscule compared to other subspecialties. In August, the first dozen finally received gold-standard board certification status from the Accreditation Council for Graduate Medical Education (by contrast, there are at least 235 accredited programs in sports medicine).
While most medical schools now offer some education about opioids, only about 15 of 180 American programs teach addiction as including alcohol, tobacco and other drugs, according to Dr. Kevin Kunz, executive vice president of the Addiction Medicine Foundation, which presses for professionalization of the subspecialty. And the content in all schools varies, he noted, ranging from one pharmacology lecture to several weeks during a third-year clinical rotation, usually in psychiatry or family medicine.
Programs rarely go deeper. But Boston University braids addiction training into all four years.
This 75-minute session to teach B.U. students the nuances of assessing a pain patient is already unusual. What also distinguishes it is the presence of an addiction medicine fellow, Dr. Bradley M. Buchheit of Boston Medical Center.

Dr. Lidya Wlasiuk, third from right, teaches medical students how to treat patients with addictions respectfully. “Language matters,” she said. “Avoid saying, ‘I found this out.’ Instead, say, ‘This was in your urine screen.’ You want to keep that conversation going, not shut it down.”CreditKayana Szymczak for The New York Times“What isn’t present in his tox screen?” Dr. Buchheit prompted students.
Fidgety silence.
“What we’ve prescribed him — Percocet,” Dr. Buchheit told them.
“So we have to figure out where that Percocet has been going.”
And suddenly the medical maze surrounding Mr. McQ became even more complex.

Asking about cocaine useWhen you are a twenty-something medical student, fists clenching nervously in the pockets of your white medical coat, learning to get gruff, grizzled Chris McQ to disclose uncomfortable truths is not readily gleaned from a textbook. Mr. McQ is crusty and defensive. As students resorted to the same chirpy rejoinder — “Awesome!”— he tried not to flinch. The man just wanted pain meds.
In each small-group session, a student had 15 minutes to assess Mr. McQ and make a plan. Mr. McQ once had a cocaine problem. His girlfriend was taking hydromorphone, known as Dilaudid, for back pain. Was he at risk for misusing opioids?
“Ask him about his pain first,” Dr. Wlasiuk told the students. “Language matters. Avoid saying, ‘I found this out.’ Instead, say, ‘This was in your urine screen.’ You want to keep that conversation going, not shut it down.”
The students had learned about “motivational interviewing,” a technique that encourages patients to articulate health goals. As medicine moves away from doctor-knows-best paternalism, students are being schooled in engaging the patient with a joint-decision-making, team approach.
Before Mr. McQ entered the classroom, the students debated: Was he selling Percocet to buy cocaine? Stealing his girlfriend’s Dilaudid?
Dr. Buchheit cautioned: “Substance use disorder is a chronic, relapsing disease. So is diabetes. Diabetics don’t follow a diabetic diet 100 percent of the time. If they were to have a slip-up, we would figure out what went wrong and say ‘Is there anything else we can do?’”
Despite the urgent need for addiction medicine education, there are considerable barriers to establishing it. Hours of training have already been meted out to conditions deemed critical. Making time in a jammed schedule can mean another subject has to be shrunk.

Because addiction medicine is young, most medical schools can’t rely for expertise on fellows — post-graduate students who steep themselves in a subspecialty. Fellows would typically consult on addiction-related cases in hospitals and clinics, educate medical students and supervise residents in primary care fields where these patients first appear: family medicine, emergency medicine, obstetrics.
And so the field of addiction medicine struggles to perpetuate itself.
Dr. Daniel Alford, a professor and associate dean at Boston University, is a driving force behind its curriculum. “The biggest challenge now is how do you sustain it?” he said. “Who keeps updating it? When faculty leave, who will replace them?”
There is not much incentive to specialize in addiction medicine. According to a 2017 study, insurance disparities can be striking. Insurance views addiction treatment as an afterthought to mental health therapy, which itself trails reimbursement for physical health care.
The reasons for resisting this career are also cultural. The stigma that attaches to patients also clings to doctors who treat them. The patients are often dismissed as manipulative and incurable; caring for them is seen as a thankless endeavor.


At a South Boston community health center, Chioma Anyikwa (left), a medical student, counsels a patient, Sharon, who is in recovery from opioids.CreditKayana Szymczak for The New York Times“I really enjoy working with these patients,” Dr. Buchheit told the students. “They have often been kicked to the curb by the formal medical system. They don’t trust us. So for them to walk into a room and have a doctor say, ‘It’s great to see you, thank you for coming in,’ is very powerful. And then you can see them get better with treatment. It can be very rewarding work.”
The students tried out approaches on Mr. McQ. “You called our office and wanted an early refill on your Percocet,” said one. “But it’s important that you come in. I’m glad you’re here and we can maintain our relationship.”

Mr. McQ told one student that his pain had worsened — that he ran through his prescription, tried to get more and took some of his girlfriend’s Dilaudid.
Mr. McQ suggested that the doctor switch him to Dilaudid.
“Time out!” Mr. Yin, the student, said, turning to the class.
“What are you struggling with?” Dr. Wlasiuk asked him.
Mr. Yin replied that he didn’t want to reward the patient’s behavior with a prescription for stronger medication, but also didn’t want to drive the patient away. “I trust the patient’s story about pain,” he said, “but I don’t want to be naïve.”
Another student asked: “By increasing his dose, are you protecting him from getting the drugs off the street?”
Dr. Wlasiuk said that although medical training typically urges students to come up with absolute answers, treating these patients often means getting comfortable with ambiguity.
The students brainstormed with her and Dr. Buchheit. Some offered to raise the Percocet dose if he agreed to frequent office visits; others urged him to try physical therapy and acupuncture.
A few remembered to caution Mr. McQ about opioids. (“Percocet is an opioid?” Mr. McQ responded. “I’m not one of those people!”)
In an evenhanded tone, Chioma Anyikwa, 25, marched through Mr. McQ’s history and pain, which he had previously listed as four of 10.
“A seven-plus,” he said.
“Wow, that’s pretty high,” she said. “Did you do anything else to treat it?” Hesitantly, he spoke about sharing his girlfriend’s Dilaudid.
“In your urine screen we also saw some cocaine,” she continued. “Do you know anything about that? I appreciate you being honest with me.”
Mr. McQ looked uneasy. “It’s not gonna mess me up if I tell you?”
She shook her head. “No, we just want to help you regroup and fix the problem,” she said.


Dr. Wlasiuk with Ms. Anyikwa and a patient, Brooke Anglin, during a checkup. “I am amazed by your strength,” Dr. Wlasiuk said.CreditKayana Szymczak for The New York TimesHe admitted that a friend had been in town and they did a few lines for old times’ sake.
Afterward, Ms. Anyikwa braced for the group’s feedback.
“Did I talk too much?” she asked.
From classroom to clinicTwo days later, Ms. Anyikwa screened actual patients.
Supervised by Dr. Wlasiuk, she spent a day at South Boston Community Health Center.


The first patient, Brooke Anglin, 28, had had a rough ride. During a turbulent relationship when she was sagged down by depression and severe anxiety, she soothed herself with opioids. After the birth of her second child, she lost both her job as a supermarket cake decorator and custody of her two children. Under Dr. Wlasiuk’s care, she gradually weaned herself off the opioids.
As Dr. Wlasiuk looked on, Ms. Anyikwa began careful questioning. “How have things been going?” she asked the patient.
Not great, Ms. Anglin replied. Earlier that week she had been evicted.
“That’s a lot,” Ms. Anyikwa responded. “How are you coping?”
Ms. Anglin said she’d had a resurgence of anxiety.
That was enough for Dr. Wlasiuk to step in. “Is your heart racing? Are you feeling panicky?”
Ms. Anyikwa watched Dr. Wlasiuk closely.
“Have you felt you wanted something for it from your friends?” Dr. Wlasiuk gently pressed. “What’s stopped you?” Ms. Anglin whispered, “I want my kids back.”
Dr. Wlasiuk grasped Ms. Anglin’s hands. “I am amazed by your strength,” she said. “I want to treat your anxiety until things settle down. What are your thoughts?”
They agreed on temporary anti-anxiety medication. Dr. Wlasiuk also taught her breathing exercises.
After the patient left, Dr. Wlasiuk remarked, “Primary care is the right place for treating substance misuse. We have the privilege of getting to know our patients well. How can you treat addiction in a vacuum?”
The next up was Sharon, 61, who brought along a toddler grandchild. Both Sharon and her daughter, the child’s mother, take Suboxone, a medication that can ease opioid craving.
Dr. Wlasiuk entered and Ms. Anyikwa started her recitation.
“Sharon has been clean for years,” Ms. Anyikwa began.
Vigilant about language and stigma, Dr. Wlasiuk interrupted her. “Clean” is eschewed by many in the field, because it implies that those in the throes of addiction are, by extension, “dirty.”

TO CONTINUE READING: 
https://www.nytimes.com/2018/09/10/health/addiction-medical-schools-treatment.html?emc=edit_th_180911&nl=todaysheadlines&nlid=357473340911

August 31, 2018 — More than 3,000 kits ready to be distributed citywide- New York City Fire Department

Fire Commissioner Daniel A. Nigro today announced the launch of the “Leave Behind” Naloxone Program, a strategy included in the expansion of HealingNYC, the citywide plan to combat the opioid epidemic. This new program increases naloxone distribution and training on how to use this lifesaving medication. Yearly, FDNY members treat approximately 5,000 suspected opioid overdose patients.
Starting today, FDNY EMS personnel are trained and equipped to leave a personal naloxone kit with patients revived with naloxone. This kit will be offered to a patient during transport to the hospital, or at a scene of the overdose for patients who refuse further medical attention (RMA). Naloxone kits will also be available to friends and family members, if requested.
“This Leave Behind Naloxone program provides patients and family members with an opportunity to access a naloxone kit during a suspected overdose, potentially preventing an opioid related death,” said Fire Commissioner Daniel A. Nigro. “Providing life-saving treatment, as well as education and instructions to prevent loss of life, is critical to the Department’s sworn mission of providing emergency pre-hospital care.”
“We know that surviving a non-fatal overdose is one of the top risk factors for dying of overdose,” said Health Commissioner Dr. Mary T. Bassett. “By leaving behind naloxone with the friends and family of someone who survived an opioid overdose, EMS providers will provide a critical intervention and deliver naloxone to the people who need it most. I thank Commissioner Nigro and his team for adopting this program to save the lives of even more New Yorkers.”
Each naloxone kit is stored within a blue pouch and contains naloxone intra-nasal spray, 4mg/0.1ml (2 doses), rubber gloves, face shield, alcohol wipes, literature about the risk of opioid overdose, recognition and rescue steps, naloxone use instructions, rehabilitation resources, and a blue prescription card.
TO CONTINUE READING: https://www1.nyc.gov/site/fdny/news/fa7218/fire-commissioner-nigro-leave-behind-naloxone-program/#/0

In fact, most addicts recover, often on their own. Here are some of their stories. 

​By Maia Szalavitz, Photographs by Ryan Christopher Jones
Aug. 31, 2018

Filthy hands gripping bloody needles, pregnant women shooting up, angelic toddlers in car seats with their parents slumped upfront, overdosed — media images of the opioid crisis are relentlessly dire.
Fortunately, this is not the whole story. Around two million Americans are addicted to opioids. Yet many more have overcome their opioid problems. A large national population study found that almost all of those who once met criteria for prescription opioid-use disorder achieved remission during their lifetimes — and half of those recovered within five years. Although heroin and street fentanyl are more dangerous, most of those who avoid fatal overdoses recover from addiction.
To improve the odds, we need to recognize and champion recovery — and the wide variety of forms it can take. In media and pop culture, when recovering people are seen at all, one type usually appears: someone who goes to rehab and then abstains from all drugs by relying on 12-step programs like Narcotics Anonymous.
In fact, other recovery journeys are more common. For example, nearly half of those with prescription opioid addiction are able to recover without formal treatment or self-help participation.
Moreover, many of those who recover do it through professional treatment with medications like methadone or buprenorphine, not through abstinence. Studies, including one of all patients in Britain treated for opioid addiction between 2005 and 2009, show that these two medications are the only treatments that reduce mortality by half or more when used long-term — and they cut relapse rates more than an abstinence approach.
Other people take their own routes entirely. We find new passions in relationships, parenting, culture, exercise, work, art, spirituality, activism and community service. Some recover primarily by learning better ways to manage the trauma and mental illness that underlie many addictions. Some even kick opioids by using marijuana or psychedelic drugs.

​TO CONTINUE READING: 
​https://www.nytimes.com/2018/08/31/opinion/addiction-recovery-survivors.html?action=click&module=Opinion&pgtype=Homepage

Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment.
By Margot Sanger-Katz     Aug. 15, 2018  New York Times

Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.
Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.
The picture is not equally bleak everywhere. In parts of New England, where a more dangerous drug supply arrived early, the number of overdoses has begun to fall. That was the case in Massachusetts, Vermont and Rhode Island; each state has had major public health campaigns and has increased addiction treatment. Preliminary 2018 numbers from Massachusetts suggest that the death rate there may be continuing to fall.
But nationwide, the crisis worsened in the first year of the Trump presidency, a continuation of a long-term trend. During 2017, the president declared the opioid crisis a national public health emergency, and states began tapping a $1 billion grant program to help fight the problem.

TO CONTINUE READING: https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html

Fentanyl is a big culprit, but there are also encouraging signs from states that have prioritized public health campaigns and addiction treatment.
By Margot Sanger-Katz       Aug. 15, 2018  The New York Times

Drug overdoses killed about 72,000 Americans last year, a record number that reflects a rise of around 10 percent, according to new preliminary estimates from the Centers for Disease Control. The death toll is higher than the peak yearly death totals from H.I.V., car crashes or gun deaths.
Analysts pointed to two major reasons for the increase: A growing number of Americans are using opioids, and drugs are becoming more deadly. It is the second factor that most likely explains the bulk of the increased number of overdoses last year.
The picture is not equally bleak everywhere. In parts of New England, where a more dangerous drug supply arrived early, the number of overdoses has begun to fall. That was the case in Massachusetts, Vermont and Rhode Island; each state has had major public health campaigns and has increased addiction treatment. Preliminary 2018 numbers from Massachusetts suggest that the death rate there may be continuing to fall.
But nationwide, the crisis worsened in the first year of the Trump presidency, a continuation of a long-term trend. During 2017, the president declared the opioid crisis a national public health emergency, and states began tapping a $1 billion grant program to help fight the problem.

TO CONTINUE READING:​https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html

​STAT
By LEV FACHER @levfacher
AUGUST 6, 2018

The Food and Drug Administration on Monday announced a shift in the way it evaluates drugs to treat opioid addiction that the agency says will give it more flexibility to approve new treatments.
Now, rather than merely examining whether a potential treatment reduces opioid use, the agency will consider factors like whether a drug could reduce overdose rates or the transmission of infectious diseases.
“We must consider new ways to gauge success beyond simply whether a patient in recovery has stopped using opioids, such as reducing relapse overdoses and infectious disease transmission,” FDA Commissioner Scott Gottlieb said in a statement.



The announcement is the latest in a string of efforts to improve the federal government’s response to the growing opioid crisis, which also includes legislation on Capitol Hill that aims to ensure treatment is evidence-based and, separately, to ensure more federal programs will pay for methadone treatment.
The many outcomes Gottlieb cited included mortality (both overall and from drug overdoses) and disease transmission, given the many communities that have seen outbreaks of HIV/AIDS and hepatitis concurrent with increased rates of injection drug use.MAT, coupled with psychosocial counseling, is widely acknowledged to be the standard of care in treating opioid addiction.
Currently, just three drugs exist to treat opioid use disorder: buprenorphine, methadone, and naltrexone. Adherence to the drugs is typically low, and addiction treatment experts have long said MAT is vastly underutilized, calling for expanded access to existing options and the development of more drugs beyond the existing three.
In its guidance, the FDA said encouraging drug developers to consider outcomes beyond drug use could yield significant health benefits.

​TO CONTINUE READING: https://www.statnews.com/2018/08/06/fda-expands-medication-assisted-treatment/

HHS.gov
July 17, 2018
By: Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and Adm. Brett P. Giroir, M.D., Assistant Secretary for Health
Summary: 
Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections.

The opioid crisis in the United States is devastating the lives of millions of Americans. Perhaps overshadowed by the alarming rise in overdoses and deaths is the accompanying numbers of injection-related infectious diseases. Opioid overdose deaths increased fivefold from 1999 to 2016, and new hepatitis C infections more than tripled from 2010 to 2016.
Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections, such as endocarditis, septic arthritis and abscesses, driven by increases in the numbers of people who inject opioids.
Earlier this year, the HHS Office of the Assistant Secretary for Health’s Office of HIV/AIDS and Infectious Disease Policy and the Office on Women’s Health sponsored a workshop at the National Academies of Sciences, Engineering and Medicine to explore the infectious disease consequences of the opioid crisis and consider opportunities to better integrate effective responses. A detailed summaryof the proceedings is newly available.
One of HHS’s top priorities is the implementation of a comprehensive national opioid strategy. The HHS five-point opioid strategy emphasizes the need to empower local communities to assess and respond to local needs, including both drivers and consequences of the opioid crisis.  
The National Academies’ workshop highlighted the importance of addressing infectious diseases as part of an improved, comprehensive opioid response.
The opioid crisis is part of a set of interconnected health problems, often called syndemics, because they have common root causes and interact synergistically, with one problem making the others worse. Because syndemics are interconnected, coordinated efforts are required across multiple programs and partners to successfully overcome the set of problems and their consequences.
The federal government can’t fight this battle alone. We recognize that some of the best and most effective solutions will come from healthcare providers, community leaders and law enforcement who are dealing with the opioids and infectious diseases crisis on the ground.

​TO CONTINUE READING: https://www.hhs.gov/hepatitis/blog/2018/07/17/integrating-infectious-disease-prevention-and-treatment-into-the-opioid-

By Maddie Bender, CNN
Updated 6:26 AM ET, Tue July 17, 2018



(CNN)Death rates from liver cancer increased 43% for American adults from 2000 to 2016, according to a report released Tuesday by the US Centers for Disease Control and Prevention's National Center for Health Statistics. The increase comes even as mortality for all cancers combined has declined.

Liver cancer death rates increased for both men and women 25 and older, as well as white, black and Hispanic people. Only Asians and Pacific Islanders saw a decrease in mortality from liver cancer.

HPV test more effective than Pap smear in cancer screening, study suggests
The rise in mortality doesn't mean that liver cancer is deadlier than before, according to Dr. Jiaquan Xu, the author of the report; the 10-year survival rate for liver cancer didn't change much. Rather, the increase in mortality means more people are developing liver cancer.More than 70% of liver cancers are caused by underlying liver disease, which has risk factors such as obesity, smoking, excess alcohol consumption, and hepatitis B and C infection, said Dr. Farhad Islami, the scientific director of cancer surveillance research at the American Cancer Society.
"I think the main reason for the increase in liver cancer incidence and death rate in the US is the increase in the prevalence of excess body weight and hepatitis C virus infection in baby boomers," said Islami, who authored a study on liver canceroccurrence between 1990 and 2014.
New hepatitis C infections triple due to opioid epidemic
Up until 1992, blood transfusions and organ transplants were not screened for hepatitis C, Xu said. According to the CDC, this was once a common means of hepatitis C transmission.
It is often years before a person living with hepatitis C develops liver cancer, which would account for an increase in incidence of the cancer among older individuals who received blood transfusions and organs before 1992. Liver cancer mortality was greatest in those 75 and older, followed by those 65 to 74 and 55 to 64, according to the new report.
The opioid epidemic might also be at fault, said Dr. Manish A. Shah, a medical oncologist at Weill Cornell Medicine and NewYork-Presbyterian. Hepatitis C, spread by sharing needles, drove elevated rates of liver cirrhosis, or scarring due to damage to the liver, in the 1990s and 2000s, Shah said. Cirrhosis increases the risk for liver cancer, although it is not clear why, he added.
Xu said he hopes people realize lifestyle changes can decrease their risk of developing liver cancer.
"Some of these liver cancer risk factors like obesity, diabetes and excess consumption of alcohol, those things can be prevented," he said.
TO CONTINUE READING: https://www.cnn.com/2018/07/17/health/liver-cancer-death-rate-study/index.html?no-st=1531863435.

Needle exchanges have been exhaustively studied — and proved to work. But stigma remains.
By German Lopez@germanrlopezgerman.lopez@vox.com  Jun 22, 2018, 1:20pm EDT,VOX

Needle exchange programs are an exhaustively studied, proven public health intervention in the fight against opioid addiction — making them a key component in efforts to haltthe opioid epidemic. But needle exchanges, it turns out, are also illegal in 15 states.
Take a look at this map by HIV/AIDS advocacy organization amfAR, recently resurfaced by University of Texas Austin clinical assistant professor Lucas Hill:

​As the map shows, the programs are banned in most of the South and much of the West.At the federal level, needle exchanges aren’t banned. But until as recently as 2016federal dollars were not allowed to go to such programs.
Now, legalization doesn’t necessarily mean that needle exchanges can be easily opened and remain in place. In California’s Orange County, for example, local officials shut down the district’s only needle exchange and have tried to prevent its reopening.
Needle exchanges not only provide a place where people can obtain syringes for drug use or dispose them. They also can help link people to other services, including addiction treatment, vaccinations, and infection testing. The driving idea behind the programs is this: Recognizing the reality that some people do use drugs, it’s better to provide them somewhere to pick up new, sterile syringes (without the risk of spreading, say, HIV or hepatitis C infection) than to turn them away from potential public health services and force them to reuse needles despite the hazards.
The decades of research about needle exchanges is clear: The programs combat the spread of blood-borne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and connect more people to treatment — all without enabling more drug use. This is an exhaustive body of research, backed by independent academic researchers, the World Health Organization, and the Centers for Disease Control and Prevention.
Yet needle exchanges often face resistance due to stigma and concerns that the programs will attract drug users to an area and lead to more drug-related problems. In Orange County, officials in Santa Ana, the county seat, said that the needle exchange program there led to a massive increase in the amount of needle litter in public areas.
Advocates of such exchanges argue that the people using drugs already live in these areas. They are just using them without any place to reliably visit to pick up sterile syringes.
Supporters of needle exchanges also point to studies that show the programs actually reduce drug-related problems such as needle litter.
For example, a 2012 study published in Drug and Alcohol Dependence compared a city with needle exchanges, San Francisco, to one without exchanges, Miami. Through visual inspections, researchers found 44 syringes per 1,000 census blocks in San Francisco, compared with 371 syringes per 1,000 census blocks in Miami. Based on a survey of injection drug users in both cities, the researchers also concluded that users in Miami had more than 34 times the adjusted odds to improperly dispose of syringes in public than users in San Francisco.
“These results suggest that [needle exchanges] are a significant means of collecting used syringes and do not increase the amount of publically discarded used syringes,” the study concluded.
TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/22/17493030/needle-exchanges-ban-state-map

VOX-By German Lopez@germanrlopezgerman.lopez@vox.com  Jun 7, 2018, 12:00pm EDT

When it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.
For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.
The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.
The researchers concluded: “Individuals with higher stigma toward people who use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”
Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.
Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.
Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.
John Brooklyn, a chief architect of the hub-and-spoke system, referred to perceptions of evidence-based anti-addiction medications like buprenorphine as an example: “It’s now 14 years after buprenorphine’s been approved [by the Food and Drug Administration], and you still have an awful lot of docs — you even have our [former] secretary of health and human services — who [say] medication-assisted treatment is just a crutch.”
Or consider one of the emails I received in response to a story on opioids: “Darwin’s Theory says ‘survival of the fittest.’ Let these lost souls pay the price of their criminal choices and criminal actions. Society does not owe them multiple medical resuscitations from their own bad judgment, criminal activity, and self-inflicted wounds.”
TO CONTINUE READING:
hen it comes to combating opioid misuse and addiction, needle exchanges and safe injection sites have decades of evidence behind them. Yet a new study published in Preventive Medicine found that a majority of Americans oppose both — and stigmatizing attitudes toward people with addiction appear to be to blame.
For the study, researchers conducted a survey of more than 1,000 Americans asking about their attitudes on needle exchanges, safe injection sites, and addiction more broadly. They found that about 39 percent of Americans support needle exchanges, while around 29 percent back safe injection sites.
The survey also measured respondents’ stigmatizing attitudes toward addiction, putting together a composite of questions — whether they’d be willing to have a person who is using opioids marry into their family or start working closely with them on a job, and their overall feelings of people who use opioids.
The researchers concluded: “Individuals with higher stigma toward people who use opioids were less likely to support legalization of safe consumption sites … or syringe services programs.”
Needle exchanges are places where someone can dispose of used syringes, which are used to inject drugs, and obtain sterile syringes. The idea is that although you can’t stop everyone from using drugs, you can at least minimize the harms of drug use. The decades of research into such programs is clear: They combat the spread of bloodborne diseaseslike hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and link more people to treatment — all without enabling more drug use.
Safe injection sites, meanwhile, provide a place for people to use drugs under medical supervision in case anything goes wrong — like, say, an overdose. Drawing on more than a decade of studies, the European Monitoring Centre for Drugs and Drug Addiction in 2017 concluded that safe injection sites led to “safer use for clients” and “wider health and public order benefits.” Among those benefits: reductions in risky behavior that can lead to HIV or hepatitis C transmission, drops in drug-related deaths and emergency service call-outs related to overdoses, and greater uptake in drug addiction treatment, including highly effective medications for opioid addiction.
Yet despite the preponderance of empirical evidence supporting needle exchanges and safe injection sites, stigma holds back these policies. This is something I’ve seen time and time again in my reporting on the opioid epidemic. For example, when I asked the architects of Vermont’s “hub and spoke” system — which integrates addiction treatment into the rest of health care — what the biggest hurdles were to implementation, the barriers were not so much money or lack of evidence, but stigma.
TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/7/17434480/needle-exchange-safe-injection-site-stigma-study