By Joe Hannan | Medically reviewed by Kristen Fuller, MD 
| Updated November 17, 2022    MDLinx

Key Takeaways

• Overdose deaths stemming from opioid addiction remain a leading cause of the death in the US.
  
• Clinicians find themselves awash with the third wave (as documented by the CDC) of opioid addiction, which is driven in large part by synthetic opioids such as fentanyl.
  
• Medication for opioid use disorder is an effective treatment modality, but access—as well as patient, public, and clinical attitudes—have a decisive impact on its utilization.
  

Opioid addiction has gone from a relic of bygone eras to an epidemic raging in American homes and communities. No spot on the US map is untouched by the addiction crisis, and it's common to know someone who has been struck by this tragedy.
But much has changed in the fight against opioid addiction. New diagnostic approaches and treatments, as well as shifting attitudes, are hopefully poised to lay this problem to rest.
How we got hereChart out the pattern of opioid overdose deaths in the US, beginning in 1999, and you get a hockey-stick graph.[1]
Between 1999 and 2020, an estimated 546,000 people died from opioid overdoses.
The CDC charts the rise of opioid addiction and its deadly wake in three distinct waves. Wave 1 began to crest in the 1990s with the wide distribution of prescription opioids. Wave 2 marked a shift toward fatal heroin overdoses beginning in 2010.
Clinicians find themselves struggling to stay afloat as Wave 3 pummels the US healthcare system. Driving this surge are synthetic opioids such as fentanyl. Increasingly, fentanyl and its synthetic analogs (acetylfentanyl, furanylfentanyl, and carfentanil) have made their way into combinations with heroin, cocaine, and counterfeit pills—all with deadly implications, including accidental overdose.
The CDC estimates that 187 people are dying each day from opioids.
TO CONTINUE: ​https://www.mdlinx.com/article/opioid-crisis-update-whats-changed-and-where-are-we/2iqSkO3VbVT9WwLQNq0Ae?show_order=2&article_type=selected&tag=Morning&utm_campaign=daily-alert_all-specialties_221118_malert_a90&ipost_environment=m3usainc&utm_medium=email&utm_source=iPost&iqs=9z2zrtc58f4bcnhgjr6g5vi8bpasbkbcjtrb1g1lomg

ROLLCALL POLICY -    By Sandhya Raman, Posted October 25, 2022 at 11:15am
The plan would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic
The Biden administration is preparing a comprehensive initiative to fight hepatitis C that would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic.
Francis Collins, special project adviser to President Joe Biden and former longtime director of the National Institutes of Health, said Monday the administration hopes to secure some funding this year for the yet to be formally unveiled initiative.
He said he has briefed Biden on the plan, and the Office of Management and Budget is “enthusiastic about figuring out how to fit this into the budgetary requests.”
The plan, he said, would include agencies including the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, the Indian Health Service, Food and Drug Administration and the Federal Bureau of Prisons.
“It would certainly involve virtually all of the government agencies that have a major role to play,” he said.

​TO CONTINUE: https://rollcall.com/2022/10/25/administration-eyes-national-hepatitis-c-treatment-plan/

​By Nicholas Florko Sept. 13, 2022

WASHINGTON — For nearly a decade, many experts assumed the biggest obstacle to eliminating hepatitis C was the sky-high cost of the new cures.
So when Washington state and Louisiana signed flashy, unprecedented deals with the pharmaceutical companies that make the medicines back in 2019, and dedicated personnel and money toward the lofty goal, many celebrated. Just last week, the White House held the states up as a potential model for a forthcoming multibillion-dollar national effort with the same aim.
But those states are nowhere near achieving the overarching goals they set, a new STAT investigation reveals. In Washington, the rate of treatment for the state’s Medicaid program now is actually lower than it was before the initiative began.

The rocky roads in each state underscore that eliminating hepatitis C will likely be far more difficult than it seems, as STAT’s interviews with more than two dozen experts, including current and formerly incarcerated people, drug industry officials, the intellectual architects of the Washington and Louisiana deals, and a U.S. senator show.
Though we have now had a miracle cure for the condition for nearly a decade — and though its cost is falling — there are more intractable problems than mere access. The condition often affects people who don’t see doctors regularly and might miss the infection, or who don’t even have a safe place to store medication. Big goals and a stockpile of pills, experts told STAT, aren’t enough.

TO CONTINUE READING: ​https://www.statnews.com/2022/09/13/louisiana-washington-hep-c-investigation/?utm_source=STAT+Newsletters&utm_campaign=a418d40f4b-Pharmalot&utm_medium=email&utm_term=0_8cab1d7961-a418d40f4b-151392865
​

Team Takes on Virus Behind Liver Disease in Tens of Millions Globally

By Nicole Tenly Aug 24, 2022

The National Institute of Allergy and Infectious Disease (NIAID) awarded $6.9 million to researchers at the Institute for Bioscience and Biotechnology Research (IBBR) to design a vaccine to combat the virus that causes Hepatitis C (HCV), which affects an estimated 71 million people worldwide and puts them at risk for severe liver disease, including cancer.
This five-year award will support a multidisciplinary research team based at IBBR, a joint research enterprise of the University of Maryland, College Park (UMCP), the University of Maryland, Baltimore (UMB) and the National Institute of Standards and Technology (NIST). The researchers aim to develop a vaccine to induce broadly neutralizing antibodies and long-term memory T cell responses to help prevent HCV infection. This recent award follows a $6 million grant awarded to the IBBR research team in 2017 based on its significant progress in the field.

​TO CONTINUE: https://today.umd.edu/6-9m-niaid-award-to-fund-design-testing-of-hepatitis-c-vaccine

Key Takeaways

• The Supreme Court of the United States has ruled that doctors must show intent to mis-prescribe opioids in order to face criminal charges.
  
• Despite the drop in opioid prescriptions in recent years, opioid overdoses and deaths are on the rise, largely because of street drugs.
  
• The CDC’s position is that physicians can better serve patients by focusing on when to initiate and continue opioid treatment, what type and dosage of opioid to use, and how to address risk of drug abuse when prescribing opioids.
  
  TO CONTINUE:  https://www.mdlinx.com/article/scotus-ruled-on-opioid-prescriptions-here-and-8217-s-what-you-need-to-know/x1FOFNp2YHlJFJNM75UF3?show_
  
  

By Jules Murtha | Medically reviewed by Kristen Fuller, MD 
 Updated August 24, 2022   MDLinx

Key Takeaways

• The rise of anti-trans legislation, which limits access to or criminalizes gender-affirming care, may contribute to poorer mental and physical health outcomes and increased suicidality in trans youth, according to studies and medical experts.
• Prominent medical societies including the American Medical Association (AMA), American Psychiatric Association (APA), and the American Academy of Pediatrics (AAP) have issued public statements recognizing the importance and necessity of evidence-based, gender-affirming care for trans and gender-diverse youth.
• Physicians may feel caught in the middle of this controversy. They can care for trans youth by studying the evidence, educating themselves on the debate, and offering gender-affirming care as indicated. A collaborative approach between clinicians, mental health professionals, and families is advised.

A wave of federal and state legislation that bans or criminalizes gender-affirming services for transgender youth has spilled over into the exam room, leaving doctors to wonder how to care for these patients without landing in hot water—or even prison.
Their fear is real.
On Aug. 19, Rep. Marjorie Taylor Green (R-Ga) introduced a bill that would make it a class C felony to provide gender-affirming medical care such as puberty blockers or gender confirmation surgery to trans youth—punishable by up to 25 years in prison. She referred to this type of care as “child abuse.”
A number of states including Texas, Alabama, Arkansas, and Arizona, recently enacted laws or policies restricting youth access to gender-affirming care and, in some cases, imposing harsh penalties on doctors and parents who facilitate access (several of these laws have been temporarily blocked by court rulings). Similar policies have been proposed in dozens of other states.[1][2]
Restrictions like these may contribute to the mental health issues so many trans kids are experiencing, according to many medical experts, trans youth advocates, and many of the nation's most prominent medical societies, including the AMA, APA, AAP, and others.[3]
Mental illness among trans and questioning youthIt's becoming increasingly common for children to openly express gender identities that are incompatible with their assigned gender at birth—to come out as transgender.
Being transgender does not make one mentally ill, the Cleveland Clinic noted.[4] But transgender individuals face unique challenges like discrimination, bullying, and gender dysphoria, which can set the stage for mental illness or suicidal thoughts.
In 2021, 52% of transgender and non-binary youth reportedly considered taking their own lives, according to the Trevor Project’s 2022 national survey on LGBTQ+ youth mental health.[5]
Moreover, 60% of LGBTQ+ kids weren’t able to attain the mental healthcare they wanted, and less than one-third of trans children reported living in gender-affirming homes.
Trans youth have struggled to attain quality healthcare for years. A study published by Pediatrics stated that 62.1% of trans and gender-nonconforming students reported having “poor,” “fair,” or “good” health, as opposed to “very good” or “excellent health.”[6]
Only 33.1% of cisgender youth showed similar results (cisgender refers to individuals whose gender identity aligns with the sex they were assigned at birth).
While clinicians agree that further studies and a wider range of treatment options are needed to better support transgender youth, they are concerned that politicization of this issue harms trans youth and medical professionals.
Response from major medical associationsIn the heat of this controversy, a wide consensus is growing among major medical associations, which are speaking out against efforts to ban or make it a crime to provide these services.
The AMA, the APA, the AAP, the American Academy of Child and Adolescent Psychiatry, the American Psychological Association and the Endocrine Society, among others, have issued public statements that recognize the medical necessity of gender-affirming care for youth and outline the negative impacts of denying access to these services. They also decry the intrusion of government into medical practice.
“Evidence has demonstrated that forgoing gender-affirming care can have tragic consequences,” the AMA wrote in an April 2021 letter to the National Governors Association.
“Transgender individuals are up to three times more likely than the general population to report or be diagnosed with mental health disorders, with as many as 41.5 percent reporting at least one diagnosis of a mental health or substance use disorder,” the letter said, pointing to stigma and discrimination as linked causes.
“Because of this stress, transgender minors also face a significantly heightened risk of suicide.”
— AMA

TO CONTINUE READING: ​ww.mdlinx.com/article/caring-for-trans-youth-in-a-contentious-political-climate/6fWtDWxxXcPrORNc6bA832?show_order=1&article_type=selected&utm_campaign=malert_082522_misc_specialties&tag=Morning&ipost_environment=m3usainc&utm_source=iPost&utm_medium=email&iqs=9z2zqdnk0hdkjqkpnhaq9eakln5kplhfa0tb9cfse9g

August 9, 2022 – Large gaps in hep C treatment persist nearly a decade after a highly effective cure for this deadly infection was approved

A new CDC Vital Signs report finds that too few people diagnosed with hepatitis C are being treated, even though hepatitis C is largely curable. According to CDC’s estimates, overall, less than 1 in 3 people with health insurance receive direct-acting antiviral treatment for hepatitis C within a year of diagnosis. Treatment is even lower among people who are Medicaid recipients, those living in states with Medicaid treatment restrictions, and among adults under the age of 40.

TO CONTINUE: https://www.cdc.gov/nchhstp/newsroom/2022/2022-Hep-C-Vital-Signs.html?ACSTrackingID=USCDC_243-DM82556&ACSTrackingLabel=New%20CD​

The Editors at Hepatitis Central
July 11, 2022

WHO publishes updated guidance on hepatitis C infection – with new recommendations on treatment of adolescents and children, simplified service delivery and diagnostics
Updated WHO Guidance on hepatitis C (HCV) infection was released today during a joint WHO-EASL-CDC symposium at the EASL International Liver Congress 2022 in London. These guidelines recommend a radical simplification of the care pathway to overcome barriers in access to HCV testing and treatment.
Continue reading this entire article:
https://www.who.int/news/item/24-06-2022-WHO-publishes-updated-guidance-on-hepatitis-C-infection

By Kristen Fuller, MD | Fact-checked by MDLinx Staff 
| Updated July 5, 2022

There’s a lot we don’t know about doctors who identify as LGBTQ.
LGBTQ is an acronym for lesbian, gay, bisexual, transgender and queer.

We don't know how many LGBTQ doctors there are, what specialties they're in, or where they practice.
As physicians, we’re often so focused on the inclusion of our LGBTQ patient population, but we’re behind in discussing LGBTQ medical students and physicians.
It’s time to have that discussion, and consider how we can better support our LGBTQ colleagues in the medical workplace.

The numbers
The Association of American Medical Colleges (AAMC) has only recently started to collect information pertaining to sexual orientation and gender identity from medical students.[1] Since 2016, the organization has included two sexual orientation and gender identity (SOGI) questions in its annual Matriculating Student Questionnaire and Medical School Graduation Questionnaire.
From 2017 to 2019, the percentage of graduating medical students identifying as bisexual increased from 4.2% to 5%, and those who identified as gay or lesbian increased from 3.6% to 3.8%.
TO CONTINUE READING:​ https://www.mdlinx.com/article/real-talk-the-challenges-of-being-an-lgbtq-doctor/3Qce6426b4MmPThCfmDhp?utm_campaign=Realtalk__070522

CORRESPONDENCE| VOLUME 7, ISSUE 7, P598-599, JULY 01, 2022PDF [71
Neil Gupta,Lindsey Hiebert,Paige A Armstrong,Carolyn Wester,John W Ward
Published:July, 2022DOI:https://doi.org/10.1016/S2468-1253(22)00168-6

Over a fifth of hepatitis C virus (HCV) infections occur in women of childbearing age.
 At least 19 countries, including the USA, have policies or guidelines recommending universal HCV screening during pregnancy.
2However, options for management and treatment of HCV infection during pregnancy are not well defined. Typical clinical practice is to refer and link pregnant individuals for treatment after pregnancy and the breastfeeding period; however, in practice, very few are successfully treated.
3Despite an excellent safety profile, direct-acting antivirals (DAAs) are not recommended for use in pregnancy. To date, only one prospective clinical trial has been published assessing HCV treatment in pregnancy.4

To Continue:https://www.thelancet.com/journals/langas/article/PIIS2468-1253(22)00168-6/fulltext​