​By Elizabeth Pratt | Fact-checked by Barbara Bekiesz | Published December 19, 2024
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• “It is said that medicine is a combination of art and science. [It’s] based on science, but the application of the science for the benefit of the patient, well, that's an art.” — William Schaffner, MD
  
• “They don’t want to interrupt your sleep or private time—they would much rather be in bed themselves. [Remember], it’s neither the emergency doctor’s nor the patient’s fault that some specialist’s expertise is critically needed at an uncivil hour.” — Michael Curry, MD
  

Find more of your peers' perspectives and insights below.
The new year is almost upon us, and there’s never been a better time to brush up on bedside manner.
Sir William Osler, one of the founding professors of Johns Hopkins Hospital, once stated, “The good physician treats the disease; the great physician treats the patient who has the disease.”[1]


Bedside manner is crucial to patient care, and there is always room for improvement. If you want to improve your bedside manner in 2025, here are eight helpful hints.

​TO LEARN MORE:https://www.mdlinx.com/article/want-to-be-a-better-doctor-in-2025-adopt-these-8-habits-for-better-bedside-manner/5G402HZgL10Zpn6FZEPGaW?sh

Summary: In a message to the substance use treatment and public health communities, CDC and SAMHSA leaders highlight the need for and opportunities to increase the provision of HIV and viral hepatitis testing as a part of substance use disorder treatment services.
In a new joint letter, the leaders of the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA) encourage the public health and substance use disorder (SUD) treatment communities to increase the number of people with SUD who are tested and treated for HIV and viral hepatitis.

In their message, “Advancing HIV and Viral Hepatitis Testing with Point-of-Care Diagnostics for People with Substance Use Disorder,” Miriam Delphin-Rittmon, PhD, Assistant Secretary for Mental Health and Substance Use, and Mandy Cohen, MD, MPH, Director, Centers for Disease Control and Prevention, discuss the connection between injection drug use and acquisition of hepatitis C, hepatitis B, and HIV, the prevalence of these diseases among people who inject drugs, and CDC’s recommendations for HIV, HCV, and HBV testing for people who inject drugs. While millions of Americans receive SUD treatment services each year, they observe, only a third of the nation’s 15,000 SUD treatment facilities offer HIV, HCV, or HBV testing. They encourage those facilities to integrate HIV and viral hepatitis testing into the services they offer clients and highlight recent advances in point-of-care diagnostics that support such integration, including FDA-approved POC tests for HIV and the recently FDA-cleared fingerstick POC HCV RNA test that enables same-day diagnosis.

​Providing these tests in SUD treatment settings can reduce barriers to accessing them and facilitate initiation of treatment.

https://www.hiv.gov/blog/cdc-and-samhsa-leaders-encourage-hiv-and-viral-hepatitis-testing-in-substance-use-disorder-treatment

Related HIV.gov Blogs

12 December 2024
By Sorcha Daly, Rebecca Bulmer, Vincent Condron, Gary Hind and Matthew Smith

Hepatitis C (HCV) is a blood-borne virus that is most commonly acquired by people who inject drugs. If left untreated, HCV can cause cirrhosis of the liver, liver failure and liver cancer. Unfortunately, due to its most common transmission routes (the sharing of unsterile injecting equipment), hepatitis C is also a stigmatised disease. As such, people who use drugs with a HCV diagnosis face multi-layered stigma, often seen as instruments of contagion, rather than those deserving of care.
It is unsurprising, then, that receiving a positive diagnosis of hepatitis C can have a negative effect on mental health. Diagnosis is associated with lower self-esteem, social isolation, and fears around disclosure and confidentiality breaches. There are also much higher levels of existing mental health difficulties in people diagnosed with HCV. As Dame Carol Black notes in her independent review of drugs in the UK, “trauma (physical, sexual or psychological) and mental ill-health are the drivers and accompaniment” of drug dependency.   
Despite the obvious need for mental and other health services for people with a HCV diagnosis, stigma related to HCV and its transmission routes affect how people interact with health services and can stop people from seeking health care. This not only excludes people from the testing and treatment that could quickly and simply cure HCV, but from accessing mental health and recovery services needed to support the cessation of practices that elevate the risk of acquiring HCV and other blood-borne viruses.

At the Hepatitis C Trust, a group of Peer Researchers have been discussing the use of stigmatising language in policy and research documents and service delivery. We reviewed words and phrases (too many to fit into this blog) used in service delivery, policy and academic papers. Phrases such as ‘drug of choice’ (‘it was never a choice, just a necessity’) and ‘substance use disorder’ (I didn’t use because I was disordered, I just couldn’t deal with the trauma’) were highlighted. As the quotes from our meeting demonstrate, language often misrepresents the reality, perspectives and experiences of people who take and/or are dependent on drugs, leading to policy and practice that fails to meet their needs.

TO CONTINUE READING:​https://www.centreformentalhealth.org.uk/hepatitis-c-and-mental-health-using-peer-support-to-fight-stigma/

​The United States is still in the throes of this devastating emergency. So why has all discussion of it faded from the campaign?

Years after it was declared a public health emergency, the overdose crisis continues to impact the nation in profoundly tragic ways. In 2023, more than 107,000 people in the United States died of a drug-related overdose. For people aged 18–45, the leading cause of death may be fentanyl-related drug overdose; each week, dozens of teens die of an overdose across the country. Overdose death rates have increased for Black, Hispanic, Asian, and Native Americans. Families from rural West Virginia to the streets of the Bronx have something sorrowful in common: They all find themselves grieving a loved one.

But if you’ve been paying attention to this year’s presidential campaign, you wouldn’t really think it’s that big an issue. The Republican Party platform has no section about tackling the overdose crisis, while the Democratic Party offers three small paragraphs that address the Biden administration’s work in expanding treatment—and increasing the use of naloxone—while promising this work will continue under a Harris administration.

And while you may not hear about overdose deaths themselves, both parties have extensively referenced the drug that is causing them—fentanyl. The Republican Party platform makes mention of the drug, and the Democrats reference it 16 times in their own platform. But instead of tying the synthetic opioid to the ongoing public health crisis, politicians have cynically entangled “fentanyl” in an entirely different issue: It’s being used to hype up the ongoing political culture war involving border security and immigration.
In multiple ads touting her border security chops, Kamala Harris promises that as president she will crack down on fentanyl, including by investing in fentanyl detection technology to block it from entering the country. The Republicans, meanwhile, directly implicate migrants, with Donald Trump frequently saying that migrants are responsible for an increase in fentanyl overdoses. All of this has damaging impacts on what people believe about asylum-seekers—a 2022 poll, for instance, found that many Americans, especially Republicans, believe that migrants are smuggling fentanyl across the U.S. border. This, of course, is a flat-out lie: Most fentanyl enters the country through ports of entry and is carried by U.S. citizens.
Predominately talking about overdoses as a border security issue not only falsely ties people seeking asylum to overdose deaths but also overshadows real solutions to this crisis, while inhibiting their potential effectiveness. Fentanyl is a dangerous drug, but it is talked about as if it was a “weapon of mass destruction” and treated like a threat to national security—like anthrax, rather than something that contributes to overdoses and substance use disorders. What this misses is how fentanyl impacts the drug supply and who uses drugs in the United States.

On the one hand, fentanyl is found in pressed pills and can sometimes be mixed into drugs like cocaine (usually inadvertently). For people who have no prior exposure to fentanyl, say a teenager buying pills, such a dose can be deadly. There are also people who regularly use fentanyl (heroin is almost impossible to get in the U.S. nowadays) and are used to the dosages. If they don’t use fentanyl, they can go into withdrawal. At the same time, the drug supply is constantly changing, and new, more potent drugs can emerge—putting regular users at risk of overdosing. This is a complex and multifaceted problem, and it affects different people in a range of ways.

TO CONTINUE READING:
https://newrepublic.com/article/185098/overdose-crisis-2024-harris-trump

By  CARLA K. JOHNSON
Updated 9:17 AM EDT, September 20, 2024 AP NEWS

The first big update to U.S. methadone regulations in 20 years is poised to expand access to the life-saving drug starting next month, but experts say the addiction treatment changes could fall flat if state governments and methadone clinics fail to act.
For decades, strict rules required most methadone patients to line up at special clinics every morning to sip their daily dose of the liquid medicine while being watched. The rules, built on distrust of people in the grip of opioid addiction, were meant to prevent overdoses and diversion — the illicit selling or sharing of methadone.
The COVID-19 pandemic changed the risk calculation. To prevent the spread of the coronavirus at crowded clinics, emergency rules allowed patients to take methadone unsupervised at home.
Research showed the looser practice was safe. Overdose deaths and drug diversion didn’t increase. And people stayed in treatment longer.
With evidence mounting, the U.S. government made the changes permanent early this year. Oct. 2 is the date when clinics must comply with the new rules — unless they’re in a state with more restrictive regulations.

TOCONTINUE: https://apnews.com/article/methadone-opioids-addiction-treatment-6dc1634de4cdac06410149e6a1372e18#

​Published August 27, 2024 | Originally published on Pennsylvania State University Health and Medicine News

According to the Centers for Disease Control and Prevention, nearly 108,000 people died from drug overdoses in 2022, 76% of which involved an opioid. However, there is limited research that examines the risk factors for overdose particularly among women who may face different challenges compared to men.
“Women who use drugs are heavily stigmatized because many are also mothers. This stigma may prohibit women from seeking harm reduction programs and substance use treatment,” said Abenaa Jones, the Ann Atherton Hertzler Early Career Professor in Health and Human Development, assistant professor of human development and family studies and senior author of the paper.

CME Activity: Optimizing Care for Prurigo Nodularis - Evidence-Based Treatment Approaches and Personalized Strategies RealCME
Women who use drugs and are involved in the criminal legal system are in a particularly vulnerable state, the researchers said. Not only do they face a high chance of overdose immediately following release but involvement in the criminal legal system also imposes longer-term challenges to recovery.
“These stigmas and barriers can make it hard to attain the forms of ‘recovery capital’ that are so needed to sustain recovery,” said Kristina Brant, assistant professor of rural sociology and co-author of the study. “Finding unique ways to support this group facing so many intersecting vulnerabilities is essential to promoting well-being.”

TO CONTINUE: https://www.mdlinx.com/news/harm-reduction-education-tools-access-may-help-women-prevent-opioid-overdose/23n71EiP8I3JNQBTlKbeMK?show_order=7&utm_campaign=reg_daily-alert_240828_daily-nl-am-v4_registered-users-a180&utm_source=iterable&utm_medium=email

Findings reveal shortfalls in hepatitis C elimination efforts in the United States and Mexico
UC San Diego Today July 30,2024

An international team of researchers from University of California San Diego and el Colegio de la Frontera Norte in Mexico have revealed a significant association between the use of illicit fentanyl and the transmission of hepatitis C virus (HCV) among people who inject drugs in San Diego, California and Tijuana, Mexico. The findings, published in Clinical Infectious Diseases, suggest that illicit fentanyl use could be driving recent increases in HCV incidence.
"
Our study provides the first evidence that illicit fentanyl use is linked to an increased risk of acquiring hepatitis C infection, which disproportionately affects people who inject drugs," said Steffanie Strathdee, Ph.D., senior author and professor of medicine at UC San Diego School of Medicine. "This underscores the importance of making point-of-care HCV viral load testing more widely available in the U.S., so those needing treatment can access it immediately."

HCV is one of several types of hepatitis, inflammation of the liver most often caused by a viral infection. HCV is most often transmitted through blood, which means that people who inject drugs are at particularly high risk of acquiring the disease.

Once acquired, the virus is easy to transmit unknowingly, because symptoms of HCV often don’t emerge until months or years after the initial infection. According to the U.S. Department of Health and Human Services (HHS), about half of people with HCV do not know they have it.
HCV prevalence is also on the rise in recent years; according to the Centers for Disease Control and Prevention (CDC), the number of reported cases of acute hepatitis C has doubled since 2014 and, during 2021, increased by 5 percent from 2020.
The new study, which followed a cohort of 398 people who inject drugs over two years, found that illicit fentanyl use was associated with a 64 percent increased risk of acquiring HCV.
TO CONTINUE READING:​https://today.ucsd.edu/story/illicit-fentanyl-use-linked-to-increased-risk-of-hepatitis-c-among-people-who-use-drugs

Published July 18, 2024 | Originally published on MedicalXpress Breaking News-and-Events

A new study has identified the top reasons why some physicians may be reluctant to intervene in addiction. The comprehensive review, pulling 283 studies published on this topic within the last 61 years, showed that "institutional environment" was the reason most frequently reported in these studies.
"Institutional environment" refers to factors like lack of support from a physician's institution or employer; insufficient resources, such as staff and training; challenges in organizational culture; and competing demands. This reason was cited in 81% of the studies reviewed, followed by insufficient skill (74%), lack of cognitive capacity to manage a certain level of care (74%), and inadequate knowledge (72%).
Around 66% of studies cited negative social influences—or beliefs about public and community acceptance of addiction care—while 56% of studies cited fear of harming the patient-physician relationship as deterrents for physicians to intervene in addiction.
These may represent the manifestation of stigma associated with substance use disorder, the authors say. Reimbursement concerns for the cost of delivering addiction interventions were also observed.
The study's findings point to the need for institution-wide changes to improve the adoption of evidence-based substance use disorder treatment practices among physicians. These changes include increasing organizational support, leadership and staff buy-in, and education and training.
The study, titled "Physician Reluctance to Intervene in Addiction: A Systematic Review" and published in JAMA Network Open, was led by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health.
"People with substance use disorders must be able to access compassionate and evidence-based care at any touchpoint they have with a health care provider," said Nora D. Volkow, M.D., Director of NIDA.

​TO CONTINUE: https://www.mdlinx.com/news/doctors-reluctant-to-treat-addiction-most-commonly-report-lack-of-institutional-support-as-barrier/3lEMhZeaywZL8F0cVcQGgJ

By Sara Lorenz Taki and Lipi Roy July 16, 2024

Hepatitis C and opioid use disorder are both chronic but treatable conditions. Yet many Americans living with this deadly combination aren’t offered treatment. Imagine going to your doctor with strep throat and instead of being prescribed an antibiotic you are told it isn’t urgent and you can wait to treat it.
A solution is within reach: It starts with recognizing the power of integrating hepatitis C treatment with addiction care.

People with hepatitis C (HCV) and substance use disorders are often marginalized in traditional medical settings. These individuals are at much higher risk for liver cancer, liver cirrhosis, liver failure, and premature death, as well as diabetes, kidney disease, thyroid disease, and autoimmune disorders. All of which beg the question: In a country with more than 2,000 opioid treatment programs and more than 17,000 addiction treatment centers, why aren’t these health facilities providing broader access to a cure for the nation’s most common blood-borne infection?

As addiction and internal medicine doctors at the Greenwich House Center for Healing, a New York City-based opioid treatment program, we believe that addiction treatment facilities are the perfect delivery system for hepatitis C treatment. Utilizing all types of addiction treatment programs, withdrawal management and stabilization programs, outpatient programs, opioid treatment programs, sober houses, residential programs, harm reduction centers, etc. could be one of many effective interventions in the nation’s effort to eliminate hepatitis C for the nearly 4.7 million people infected with HCV nationwide. Most new hepatitis C infections in the U.S. occur in people who inject drugs, making addiction treatment centers an increasingly important place for people to access hepatitis C treatment.

TO CONTINUE: https://www.statnews.com/2024/07/16/dual-epidemic-hepatitis-c-opioid-overdose-new-role-for-addiction-treatment-centers/

New York aims for a 90% reduction in people living with HCV and an 80% increase in people being treated and cured by 2030.
July 8, 2024 • By Laura Schmidt  hep

​New York state is ramping up efforts to eliminate hepatitis C by 2030 by increasing screening, treatment and more, according to Spectrum News.

Hepatitis C (HCV) is a contagious but curable disease caused by a virus that infects the liver. HCV is a blood-borne virus that can cause lifelong infection, liver fibrosis, cirrhosis, liver cancer, liver failure and death.

About 2.4 million Americans are living with HCV, and nearly 2.2 million people could be living with hepatitis B, according to the Centers for Disease Control and Prevention.  

By 2030, New York aims for a 90% reduction in people living with HCV and an 80% increase in people being treated and cured.

Knowing your HCV status is the first step toward treatment and a cure. While current guidelines recommend that all adults should be tested for HCV at least once, New York state recently implemented a new testing law requiring universal screening for all adults over 18 and pregnant individuals.
TO CONTINUE: ​https://www.hepmag.com/article/new-york-implements-strategies-reach-hep-c-elimination-goal