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

By Benedict Carey,   June 8, 2018

​The deaths of the designer Kate Spade and the chef Anthony Bourdain, both of whom committed suicide this week, were not simply pop culture tragedies. They were the latest markers of an intractable public health crisis that has been unfolding in slow motion for a generation.Treatment for chronic depression and anxiety — often the precursors to suicide — has never been more available and more widespread. Yet the Centers for Disease Control and Prevention this week reported a steady, stubborn rise in the national suicide rate, up 25 percent since 1999.
The rates have been climbing each year across most age and ethnic groups. Suicide is now the 10th leading cause of death in the United States. Nearly 45,000 Americans killed themselves in 2016, twice the number who died by homicide.
After decades of research, effective prevention strategies are lacking. It remains difficult, perhaps impossible, to predict who will commit suicide, and the phenomenon is extremely difficult for researchers to study.
One of the few proven interventions is unpalatable to wide swaths of the American public: reduced access to guns. The C.D.C. report found that the states where rates rose most sharply were those, like Montana and Oklahoma, where gun ownership is more common.
It is predominantly men who use guns to commit suicide, and men are much less likely to seek help than women.
The escalating suicide rate is a profound indictment of the country’s mental health system. Most people who kill themselves have identifiable psychiatric symptoms, even if they never get an official diagnosis.
The rise in suicide rates has coincided over the past two decades with a vast increase in the number of Americans given a diagnosis of depression or anxiety, and treated with medication.
The number of people taking an open-ended prescription for an antidepressant is at a historic high. More than 15 million Americans have been on the drugs for more than five years, a rate that has more than tripled since 2000.
TO CONTINUE READING: 
https://www.nytimes.com/2018/06/08/health/suicide-spade-bordain-cdc.html?emc=edit_th_180609&nl=todaysheadlines&

Media Contacts:
                                                                                                         Stephanie Goldina, IDSA (312) 558-1770
                                                                                                         Nola Gruneisen, AASLD (571) 292-3068

(May 25, 2018) HCVguidelines.org — a website developed by the American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA) to provide up-to-date guidance on the management of hepatitis C (HCV) — has updated several sections of the website to reflect new testing and management recommendations for pregnant women, people who inject drugs, men who have sex with men and people who are incarcerated.
“Today, hepatitis C is curable for over 95 percent of people who undergo treatment,” explain HCV Guidance Co-Chairs, Marc G. Ghany, MD, MHSc; Arthur Y. Kim, MD; Kristen M. Marks, MD; and Hugo E. Vargas, MD. “With the success of HCV treatments, the medical community must now shift our focus toward eliminating HCV as a public health problem. As a first step, our Panel has made new recommendations to re-emphasize the importance of testing key populations and treating virtually all patients with the virus. We feel these recommendations are in alignment with the 2016 World Health Organization and National Academies of Sciences, Engineering and Medicine (NASEM) goals of eliminating HCV infection by 2030.”
Universal screening for pregnant women
Drawing from recent studies highlighting a sharp increase of HCV-infected women giving birth in the United States between 2011-2014, and a lack of evidence that risk-factor-based testing is effective in identifying chronic HCV infection, the updated HCV Guidance recommends all pregnant women be tested for HCV infection, ideally at the start of their prenatal care.
By screening all pregnant women at the beginning of prenatal care, physicians will increase opportunities for education and referral and allow early testing and treatment for exposed infants. Treatment of women post-pregnancy will improve the health of women and ultimately prevent future HCV transmission.
Men who have sex with men
Several outbreaks of sexually transmitted HCV infection among HIV-infected men who have sex with men have been reported since 2000. Additionally, HCV incidence is increasing among HIV infected men who have sex with men.
With these things in mind, the Panel has made new recommendations that focus on sexually active adult and adolescent men who have sex with men who are HIV-infected, who are initiating pre-exposure prophylaxis (PrEP) for HIV, or who have been successfully treated or spontaneously cleared HCV infection.
For these men, the Guidance recommends:

• At least annual (or more often, based on risk) testing for HCV antibody for those who have never been exposed to the virus.
• HCV RNA testing for those who were treated or spontaneously cleared HCV infection.

 
 
People who inject drugs
To address the growing number of cases of HCV infection due to the opioid epidemic, the updated Guidance recommends annual HCV testing for people who inject drugs and have never been tested for the virus. The guidance also recommends annual testing for people who have previously tested negative for the virus but continue to use injection drugs and treatment for those who test positive.
Additionally, the Guidance recommends:

• Substance use disorder treatment programs and needle/syringe exchange programs should offer routine, opt-out HCV antibody testing with reflexive or immediate confirmatory RNA testing and connection to care for those who are infected.
• People who inject drugs should be counseled on measures to reduce risk of HCV transmission to others.
• People who inject drugs should be connected to harm reduction services when available, including needle/syringe service programs and substance use disorder treatment programs.

People in correctional institutions
Research has shown that HCV infection disproportionately affects people in correctional institutions. The updated Guidance recommends that jails and prisons should implement opt-out testing for incarcerated individuals.
The Guidance also recommends:

• Chronically infected people in jail settings should receive counseling about HCV infection and be connected to follow-up community health care for evaluation of liver disease and treatment upon release.
• Chronically infected people in prisons — and those whose jail sentences are sufficiently long enough to complete a total course of antiviral therapy — should receive antiviral therapy according to AASLD/IDSA Guidance while incarcerated. Upon release, these patients should be connected to community health care to monitor for HCV-related complications. 
• To prevent HCV re-infection and reduce the risk of progression of HCV-associated liver disease, prisons should provide harm reduction and evidence-based treatment for underlying substance use disorders.
• Jails and prisons should facilitate continuation of HCV therapy for individuals on treatment at the time of incarceration.

Visit HCVguidelines.org for more information about these recommendations and to view other sections of the HCV Guidance.
About AASLD
AASLD is the leading organization of clinicians and researchers committed to preventing and curing liver disease. The work of our members has laid the foundation for the development of drugs used to treat patients with viral hepatitis. Access to care and support of liver disease research are at the center of AASLD’s advocacy efforts.
Visit aasld.org to view AASLD’s evidence-based practice guidelines and guidances.
About IDSA
The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has over 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see www.idsociety.org.
Visit www.idsociety.org/HCV/ to access IDSA’s extensive collection of resources on hepatitis C, including the Society’s Core Curriculum for HCV at www.idsociety.org/HCV_Curriculum/#Introduction. 

PostEverything . Perspective -The Washington Post

”Opposing needle exchanges and insisting people with addiction must hit “rock bottom” flies in the face of reality.

​By Maia Szalavitz March 13 
Maia Szalavitz is a journalist and author, most recently of “Unbroken Brain: A Revolutionary New Way of Understanding Addictions.

In the face of an unabating overdose crisis that has already killed more than a half-million people, San Francisco, Philadelphia and Seattle have announced plans to do what was once unthinkable: open centers where people can inject illegal drugs under medical supervision. Many other cities are also debating so-called safe infection facilities (SIFs) — but unfortunately, a common misconception about addiction stands in the way.
SIFs, also known as Overdose Prevention Sites or Supervised Consumption Centers, have operated for years in at least 66 cities in Europe, Canada and Australia. They reduce overdose mortality, cut transmission of HIV and hepatitis C, decrease public injecting and the presence of dirty needles in streets and parks, and even reduce local crime and violence rates — all while improving health. Despite millions of injections carried out by thousands of people, no one has ever died of an overdose at an SIF, according to Brandon Marshall, an associate professor of epidemiology at Brown University, who has studied these programs.
Instead, opponents argue that SIFs “enable” addiction — and that by mitigating risk, they prolong drug use by preventing people with addiction from suffering the consequences needed to motivate them to recover. In 2017, anti-SIF residents and politicians in Seattle organized a ballot initiative to block the city’s SIF plans, which garnered more than 47,000 signatures and qualified it for a vote. (The referendum was later blocked by a judge for procedural reasons).
In an op-ed laying out his opposition, Redmond, Wash., city council member David Carson put it this way: “It’s difficult to see how enabling addicts to continue a terribly destructive lifestyle is compassionate. Every recovering addict will tell you that they had to hit rock bottom before they wanted to change and that desire must drive their recovery.” Similar comments have been heard from opponents in San Francisco, Philadelphia and elsewhere.
The concept of “enabling” comes from 12-step recovery, based on the self-help group Alcoholics Anonymous. The idea is that friends and family must not support loved ones while they continue to use drugs or help them avoid dangerous consequences — otherwise, they might delay “rock bottom.” The vast majority of addiction treatment providers in America teach this perspective, even though there’s no research to support the idea that “enabling” is harmful.
Gigabytes of real-world data show the opposite. In the 1990s, the “enabling” argument was used to fight clean needle programs to prevent the spread of disease — and it helped delay their implementation. Even today, states with growling levels of IV drug use, such as Indiana and Florida, continue to have fights over these programs. Officials in Indiana have shut down several because of moral fears about enabling.

TO CONTINUE READING: https://www.washingtonpost.com/news/posteverything/wp/2018/03/13/why-its-not-enabl

By WILLIAM NEUMAN MAY 3, 2018 NY Times

Mayor Bill de Blasio is championing a plan that would make New York City a pioneer in creating supervised injection sites for illegal drug users, part of a novel but contentious strategy to combat the epidemic of fatal overdoses caused by the use of heroin and other opioids.
Safe injection sites have been considered successful in cities in Canadaand Europe, but do not yet exist in the United States. Leaders in San Francisco, Philadelphia and Seattle have declared their intention to create supervised sites, although none have yet done so because of daunting obstacles. Among them: The sites would seem to violate federal law.
The endorsement of the strategy by New York, the largest city in the country, which last year saw 1,441 overdose deaths, may give the movement behind it impetus.
For the sites to open, New York City must still clear some significant hurdles. At minimum, the plan calls for the support of several district attorneys, and, more critically, the State Department of Health, which answers to Gov. Andrew M. Cuomo. The city sent a letter on Thursday to the state, asserting its intention to open four injection centers.
Although Mr. Cuomo and Mr. de Blasio are Democrats, they have engaged in a yearslong feud that has seen few examples of cooperation. Mr. Cuomo, who is facing an energetic primary challenge from Cynthia Nixon, has not said whether he supports injection sites, a popular cause among more left-leaning Democrats.

​Continue reading the main story:https://www.nytimes.com/2018/05/03/nyregion/nyc-safe-injection-sites-heroin.html

ESSAYMay/June 2018 Issue Foreign Affairs

​Stopping an American Epidemic From Going Global By Keith Humphreys, Jonathan P. Caulkins, and Vanda Felbab-Brown
​

In 2016, nearly 50,000 people died of opioid overdoses in the United States, and, per capita, almost as many died in Canada. From 2000 to 2016, more Americans died of overdoses than died in World War I and World War II combined. Yet even these grim numbers understate the impact of opioid abuse, because for every person who dies, many more live with addiction. The White House Council of Economic Advisers has estimated that the epidemic cost the U.S. economy $504 billion in 2015, or 2.8 percent of GDP.
This public health story is now common knowledge. Less well known is the growing risk that the epidemic will spread across the globe. Facing a backlash in the United States and Canada, drug companies are turning their attention to Asia and Europe and repeating the tactics that created the crisis in the first place. At the same time, the rise of fentanyl, a highly potent synthetic opioid, has made the outbreak even deadlier and begun to reshape the global drug market, a development with significant foreign policy implications. As a result, the world is on the cusp of a global opioid epidemic, driven by the overuse of legal painkillers and worsened by the spread of fentanyl, that could mark a public health disaster of historic proportions.
Yet in the face of this terrifying possibility, the world has remained largely complacent. Governments and international organizations urgently need to learn the lessons of the North American crisis. The first and most important of those is that the more opioids flood the market, the bigger the problem will be—and so governments must couple efforts to treat addicted individuals with efforts to curb supply. That will require them to crack down on pharmaceutical companies that abuse their positions and to take aggressive steps to regulate the sale and marketing of opioids. And the rise of synthetic opioids means that governments must rethink the role that fighting drug trafficking plays in their foreign policies.
THE PRESCRIPTION AND THE DAMAGE DONE

​TO CONTINUE READING: https://www.foreignaffairs.com/articles/world/2018-04-16/opioids-masses?cid=soc-tw-rdr

Liz Highleyman Published:13 April 2018
INFOHEP

​

​

The European Association for the Study of the Liver (EASL) presented updated clinical practice guidelines for the management of hepatocellular carcinoma (HCC) during a special session at the 2018 International Liver Congress yesterday in Paris. The full guidelines are now available online.
An expert panel made up of hepatologists, oncologists and other specialists developed the recommendations based on an extensive review of relevant studies – the guidelines include more than 600 references – focusing on advances since the guidelines were last updated in 2012. Of note, the number of systemic medications for HCC has risen from just one to half a dozen.
"The rising incidence of HCC in most European countries suggests an insufficient awareness of liver disease in general, calling for public health policies aiming to prevent, detect and treat liver disease—not only for HCC prevention," the panel wrote. "It is particularly frustrating to see most patients with HCC diagnosed at a stage no longer amenable to curative treatment, demonstrating again a neglect of liver disease and appropriate cancer surveillance."
Glossaryhepatocellular carcinoma (HCC)
MORE FROM THE GLOSSARYLiver cancer is the fifth most common cancer and the second leading cause of cancer-related death, with about 854,000 new cases and 810,000 deaths per year, according to the guidelines. About 85% of all cases occur in East Asia and sub-Saharan Africa. HCC accounts for around 90% of primary liver cancers, meaning they originate in the liver. (Cancers that arise elsewhere in the body and spread to the liver are not properly considered liver cancer.)
Over years or decades, chronic hepatitis B or C virus infection, heavy alcohol consumption, fat accumulation in the liver and other causes of liver injury can lead to development of liver cirrhosis and HCC. A majority of liver cancer cases in Asia and Africa are attributable to hepatitis B, while chronic hepatitis C appears to be the major risk factor in Western countries, according to the guidelines. Non-alcoholic fatty liver disease (NAFLD) associated with metabolic syndrome, diabetes and obesity seems to be a growing cause.
Liver cancer is often detected late, when it is difficult to treat. Depending on its stage, HCC may be treated with surgery to remove part of the liver (known as resection), liver transplantation, local therapies to destroy tumours, or systemic drugs – or a combination of these. But many people experience continued disease progression or recurrence and survival is typically measured in months.
The panel made recommendations in several areas:

• Epidemiology, risk factors and prevention
• Surveillance
• Diagnosis and recall policy
• Staging systems and treatment allocation
• Response assessment
• Liver resection
• Liver transplantation
• Local ablation and external radiation
• Transarterial therapies
• Systemic therapies
• Palliative and best supportive care. TO CONTINUE READING:​http://www.infohep.org/page/3256817/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English

By ANNIE CORREAL APRIL 12, 2018   NEW YORK TIMES

In 2015, when they unveiled the city’s plan to battle opioid-related deaths, Mayor Bill de Blasio and his wife, Chirlane McCray, said that from that day on, New Yorkers would be able to get the overdose-reversing drug naloxone at participating pharmacies without a prescription.
“Anyone who fears they will one day find their child, spouse or sibling collapsed on the floor and not breathing now has the power to walk into a neighborhood pharmacy and purchase the medication that can reverse that nightmare,” Ms. McCray said, with the mayor by her side.
But three years later, an examination by The New York Times has found that of the 720 pharmacies on the city’s list of locations that provide the drug, only about a third actually had it and would dispense it without a prescription. The list is used on the city’s website, the NYC Health Map, the Stop OD NYC app and when someone calls 311.
Phone calls placed to every pharmacy on the list last month found compliance with the program to be spotty, at best.
In the Bronx, which is battling a surge in heroin use and where more people died of opioid-related overdoses than in any other borough in 2016, only about a quarter of the more than 100 pharmacies on the list had the drug and followed the protocol. Requests for it were often met with bewilderment.

“Can you spell that?” said a pharmacy worker at a Rite Aid on Featherbed Lane in Mount Eden, in one of the areas with the highest opioid-related overdose rates in the city.
“We don’t carry it,” said a pharmacy worker at a Rite Aid on Westchester Avenue in Mott Haven, another such neighborhood.
Some pharmacy workers inaccurately said that only the person in need of the drug could buy it, and then only with a prescription. “Are you having an overdose? You can’t buy it for someone else,” a pharmacy worker said at a Walgreens in Bronx Park, another area with a high overdose death rate. “If it’s for someone else, they would need to get a prescription.”
TO CONTINUE READING:  https://www.nytimes.com/2018/04/12/nyregion/overdose-antidote-naloxone-investigation-hard-to-buy.html

​Laura Ungar, Louisville Courier JournalPublished 8:42 a.m. ET April 6, 2018 | Updated 8:48 a.m. ET April 6, 2018

ATLANTA — First came the opioid epidemic. Then, a wave of drug-fueled infections.
Now, after years of quietly spreading across the nation, diseases like hepatitis and HIV are prompting action by a critical mass of top doctors, health officials and policymakers.
Such infections were among the many issues tackled at the recent National Rx Drug Abuse & Heroin Summit in Atlanta. Experts said disease threatens not only drug users but the entire population, hitting especially hard in Kentucky, Indiana and other rural states awash in addiction.
“If you don’t do anything, it’s a ticking time bomb,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “I think we can contain it, but we need to move rapidly.”
The fight is being waged on several fronts: Lawmakers at the state and national levels are introducing legislation. Federal health officials are issuing guidance on detecting and responding to outbreaks. And doctors are calling for more disease testing, treatment and education, as well as preventive measures such as needle exchanges.
The stakes are high – and getting higher.
With more people shooting up, new hepatitis C infections reported to the U.S. Centers for Disease Control and Prevention tripled over five years, from 850 in 2010 to 2,436 in 2015 – and officials acknowledge the insidious liver disease is vastly under-reported. Hep C kills 20,000 Americans each year, more than any other infectious disease reported to CDC.

TO CONTINUE READING: https://www.courier-journal.com/story/life/wellness/health/2018/04/06/drug-diseases-injections-ticking-bomb-hepatitis-hiv-epidemic/459182002/

THE NEW YORK TIMES 
HEALTH
By ABBY GOODNOUGH APRIL 5, 2018

WASHINGTON — The United States Surgeon General, Dr. Jerome M. Adams, issued a national advisory Thursday urging more Americans to keep on hand and learn how to use the drug, naloxone, which can save the lives of people overdosing on opioids. Naloxone has already revived thousands of overdose victims as the opioid epidemic has intensified, but rescue workers have usually been the ones to administer it.
It was the first advisory issued by a surgeon general since 2005, and it underscored the urgency of addressing an opioid epidemic that has killed more than 250,000 people over the past decade, including more than 42,000 people in 2016.
Dr. Adams said making naloxone more available in communities across the country is critical to reducing overdose deaths among people prescribed high doses of opioids for pain, as well as those who abuse painkillers or illicit opioids like fentanyl and heroin.
“Each day we lose 115 Americans to an opioid overdose — that’s one person every 12.5 minutes,” Dr. Adams said in a statement. “It is time to make sure more people have access to this lifesaving medication, because 77 percent of opioid overdose deaths occur outside of a medical setting and more than half occur at home.”
Naloxone can be administered through a nasal mist or an injection, suspending the effects of an overdose and resuscitating the victim. Many police officers and emergency medical technicians already carry the drug, and most states and many cities have issued standing orders allowing anyone to get naloxone at a pharmacy without a prescription. Most insurance plans cover it, and people can sometimes get it for free or low cost through public health programs or manufacturer discounts.

TO CONTINUE READING: https://www.nytimes.com/2018/04/05/health/opioids-naloxone-surgeon-general.html?emc=edit_th_180406&nl=todaysheadlines&nlid=357473340406​