Feb. 18, 2022: National Advocacy Update- AMA

The AMA asked the Biden administration to take additional steps to remove the prescription status of naloxone—the overdose-reversing drug—to make it more available over the counter.    
“As the overdose epidemic has worsened, given the FDA’s clear guidance there is no moral, medical, or safety-related reason for these life-saving overdose reversal agents to remain locked under prescription regulations,” the AMA wrote (PDF) the Office of National Drug Control Policy (ONDCP).    
If not for naloxone, tens of thousands of additional Americans likely would have died from overdoses. The AMA greatly appreciates ONDCP has made increasing access to naloxone a high priority and recommended steps that would make it more widely available to harm-reduction organizations and individuals regardless of their insurance status. The letter notes that naloxone manufacturers are dragging their feet on making it more available over the counter.

TO CONTINUE: ​https://www.ama-assn.org/health-care-advocacy/advocacy-update/feb-18-2022-national-advocacy-update?utm_source=SFMC&utm_medium=email&utm_term=2182022&utm_content=22-9997_Advocacy_Update_021822&utm_campaign=Advocacy_Email_Newsletter_AdvocacyUpdate&utm_uid=15829237&utm_effort=#ama-urges-administration-to-save-lives-by-moving-naloxone-from-behind-the-counter

(New York, NY, February 14, 2022) – A new, interactive, online memorial was launched today by the public health organization Vital Strategies to honor those who have lost their lives to a drug overdose—more than one million in the past two decades in the U.S.—far surpassing car crashes and firearm fatalities combined. Inspired by the AIDS quilt, the digital mosaic allows anyone to commemorate a loved one lost to overdose, and calls for urgent action in their name. 
The memorial’s launch is accompanied by the largest-ever national advertising campaign promoting harm reduction to raise awareness about common-sense ways to save lives, such as distributing the opioid overdose reversal drug naloxone to people who use drugs and their loved ones. Following the national launch, Vital Strategies will share the campaign in some of the states hardest-hit by the overdose crisis, including using technology that will allow the memorial to be projected onto buildings.
“The AIDS quilt turned grief into demand for change, forcing the country to confront the mounting HIV/AIDS epidemic with the urgency it required. With overdose deaths topping 100,000 a year, we are beyond the moment of reckoning with our failure to address drug use as a health issue,” said Dr. Daliah Heller, Vice President of Drug Use Initiatives at Vital Strategies. “We hope the overdose memorial offers an opportunity for those touched by this tragedy to share their stories and join in the call to support the public health solution to the overdose crisis: harm reduction.” 
The campaign is funded by Bloomberg Philanthropies as part of their initiative to tackle the overdose epidemic in the United States.
“At Bloomberg Philanthropies, we believe in promoting evidence-based interventions to ensure longer, better lives for the greatest number of people—harm reduction does just that,” said Dr. Kelly Henning,  who leads the public health program at Bloomberg Philanthropies. “The rising number of overdose deaths is devastating communities around the U.S. so it’s urgent that public health solutions such as harm reduction interventions are widely supported and implemented. Too often underfunded, such community-led, evidence-driven interventions like naloxone distribution and syringe service programs are critical and must receive increased support to help save lives.” 
Every 5-and-a-half minutes someone dies from a drug overdose in the U.S. More than 100,000 people died in the past year alone—the highest number on record. Many of these tragedies could have been prevented if harm reduction measures were in place and at scale. Although the Biden Administration began funding harm reduction last year, most federal- and state-directed overdose prevention efforts do not focus on these proven, life-saving measures. 
The goal of this public awareness initiative is to build support for harm reduction measures such as: fentanyl test strips and other drug checking tools so that people can test for harmful additives in drugs; sterile syringes and other safer drug use supplies to stop the spread of HIV and Hepatitis C; naloxone in community hands to reverse fatal overdoses; methadone and buprenorphine access for those struggling with opioid dependence; and overdose prevention centers, such as those recently opened in New York. 

TO CONTINUE: https://www.vitalstrategies.org/largest-ever-harm-reduction-ad-campaign-to-run-in-conjunction-with-memorial-to-generate-support-for-solutions-to-growing-crisis-including-full-page-new-york-times-ad-and-tv-spots/?fbclid=IwAR1HLUEoN23-qyz0hIogsa8Qkzn1ZZbK-GPgUNBMnlO2exw_B85RQI9qIYc

After New York City successfully opened the nations’s first legally operating overdose prevention centers, it’s time to open more of them across the state.

By ANNETTE GAUDINO, BRIANNA NORTON, CLIFTON GARMON
FEBRUARY 9, 2022  NYN Media

Usually, an A grade would be seen as a measure of a job well done. However, when it comes to progress toward hepatitis elimination, New York is only now getting back on track. The Empire State has work to do in order to regain our status as national leaders in this effort. As evaluated by Hep ElimiNATION, a joint project of the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, the National Viral Hepatitis Roundtable, and the Center for Health Law and Policy Innovation at Harvard Law School, New York’s A grade comes with caveats, specifically a lack of dedicated, sufficient funding for proactive case finding, linkage to care and harm reduction services for New Yorkers living with and at risk of developing viral hepatitis. 
Hepatitis C is one of the deadliest infectious diseases in the United States, killing more annually than all other infectious diseases combined, except COVID-19. Around 3.5 million people in the country suffer from chronic infection, including over 100,000 living in New York State. They are disproportionately poor, people of color, people who have been incarcerated and people who use drugs. Hepatitis C has been fully curable for nearly a decade, but far too many patients still face obstacles accessing lifesaving treatment: achieving just outcomes for them demands a multi-pronged approach.
The New York Hepatitis C Elimination Task Force has identified several such areas for policy improvement, outlining potential action steps within each. We need to broadly implement proven strategies to prevent hepatitis C (HCV) infection before it happens, including expanded access to syringe service program, peer outreach to people who inject drugs and people experiencing homelessness, and prevention and treatment measures within correctional facilities. Next, we must strengthen our testing and care infrastructure serving those already infected, through interventions such as ensuring pregnant people are screened for HCV during each pregnancy, testing and treatment in non-traditional healthcare settings, and enforcement of recent policy changes that removed prior authorization requirements for HCV medication among Medicaid patients. Finally, we must better serve all the needs of those most vulnerable to viral hepatitis through initiatives to address social determinants of health including unstable housing and employment. 
TO CONTINUE READING: ​https://www.nynmedia.com/content/opinion-new-york-state-ready-statewide-injection-sites

MedicalXpress Breaking News-and-Events|February 7, 2022  MDLinx

A recent study has found that so-called "drug checking" programs have unexpected benefits, allowing public health programs to reach and work with people who use drugs who would otherwise not access services such as HIV testing.
Drug checking refers to analyzing illegal drugs, or prescription drugs not acquired from a pharmacy, that people have used or are about to use. There are various technologies available for drug checking, but the ultimate goal is to reduce overdoses and other health risks associated with an increasingly contaminated illicit drug supply.
"We already knew that using fentanyl test strips reduces overdoses in the United States—these are used to identify whether fentanyl is present in other drugs," says Jennifer Carroll, an assistant professor of anthropology at North Carolina State University and first author of a paper on the study. "We also knew that drug checking with advanced technologies, such as spectrometers, has been very effective at preventing drug overdoses in other countries, such as Canada and the United Kingdom.
TO CONTINUE READING:​https://www.mdlinx.com/news/study-finds-unexpected-benefits-of-drug-checking-programs/1qpzigBobDP1s5JjD0mbQ0?show_order=8&article_t

A wave of diagnostics ushered in by Covid could help revive flagging efforts to eliminate the disease.

 ​By Ted Alcorn Feb. 4, 2022 NY TIMES 

​The day after Christmas, when Kellie Trent was scheduled to pick up medication to cure her hepatitis C, it seemed like a little miracle.
She was expected at the Pioneer Family Practice in western Washington State, seven months after screening positive for the blood-borne infection at a clinic that dispenses medication to treat her heroin addiction. All that time, as she underwent more tests and waited for results while in and out of residential drug treatment, addressing her hepatitis C remained out of reach.

​On the eve of her December appointment, her physician, Dr. Lucinda Grande, grew concerned when a storm brought four inches of snow to the region, snarling the roads.

But in the end, Ms. Trent did not show up because she landed in jail for a few days, arrested after missing court appearances for sentencing on a misdemeanor assault charge, according to court records.
Dr. Grande stowed away the first half of the unused prescription — a four-week course of pills priced at $13,000.
“She has had a bumpy road,” Dr. Grande said.
Ms. Trent is among an estimated 2.4 million Americans with hepatitis C, which killed more than 14,000 in 2019, the most recent data available, despite the availability of drugs offering a relatively straightforward cure. The U.S. government set a target of largely vanquishing the disease by 2030, but data from the Centers for Disease Control and Prevention show the number of treated patients has been falling and is less than half the rate necessary to meet that goal.

TO CONTINUE READING:https://www.nytimes.com/2022/02/04/health/hepatitis-c-test.html

In the United States, mortality is rising, with more deaths than ever attributable to alcohol and drug poisoning and to suicide, in conjunction with increasing rates of obesity and type 2 diabetes. Yet many other wealthy nations have seen rates of these so-called “deaths of despair” decreasing.
“In Europe, Canada, Japan, Australia, they’re not having a problem or they’re having it to a much smaller degree,” says Penn neuroscientist Peter Sterling. “Here, we’re having a massive problem.” He and colleague Michael Platt wanted to understand the disparity and what the U.S. might learn.
“They have not seen this meteoric rise in people dying from drugs, smoking, eating badly, deaths through dislocation, suicide,” says Platt, the James S. Riepe Penn Integrates Knowledge University Professor. “We wanted to isolate what’s different between those countries and ours.”
In a new JAMA Psychiatry paper, the researchers look at the matter through the lens of neuroscience, anthropology, and primatology, finding that, unlike in the U.S., the countries they analyzed offer communal assistance at every life stage, from universal child care to affordable college. Such support, the researchers conclude, protects individuals and families in the long term.
Countering conclusions
Platt and Sterling have known each other for decades, and since Platt arrived at Penn in 2015 have corresponded frequently. “We seem to share similar concerns,” Platt says. “We’d been looking at the epidemic in deaths of despair the past few years. It hit home personally for me because where I grew up in a gritty part of Cleveland has been pretty devastated.”
Then, in March 2021, the National Academy of Sciences (NAS) published a report on the subject, comparing the U.S. to 16 wealthy nations, including Canada, Australia, Japan, and countries in Western Europe. “It was this 476-page document,” Sterling says. “They don’t ask in the whole 476 pages, what are these other places doing? How come they don’t have this problem?”
The NAS report drew a twofold conclusion, Platt says. “Basically, it acknowledged that this is an epidemic, but the prescription is very mild. ‘We need more research, and we can’t define despair.’ But how do you create an animal model of despair? I was dismayed.”
Platt and Sterling decided to take a closer look themselves. First, they asked, from a neurological perspective, what do humans need to thrive? Second, they wondered whether understanding that could explain why deaths of despair were rising in the U.S. but not in these culturally, politically, and economically equivalent countries. They turned to the neurological question first.

​TO CONTINUE: https://www.mdlinx.com/physiciansense/what-can-be-done-to-fix-ehrs/?mdl_cp_loc=top_extender&mdl_cp_imp=1vvaMk6PzOtcOEbfFmHVh5%7C3wemZS8dB

During her third pregnancy, Jamie Smith was itchy. Crazy itchy. Her obstetrician diagnosed her with cholestasis of pregnancy, a serious complication associated with liver disease. Her baby was at risk for being premature or even stillborn, so she was induced at 38 weeks.
Smith’s baby was healthy, but her own problems continued. She had muscle pain, brain fog and icy white hands and feet. Maybe at age 39, she figured, she was just getting older. Her new primary care doctor suggested some tests, including for hepatitis C. It was just a precaution. Her obstetrician had said her liver enzymes were normal and the regular screening tests were negative. While walking her dog near her home in Ohio, Smith casually scanned the electronic results on her phone.
“It said, ‘positive,’ ” she recalled, “And I’m like, ‘I don’t even know what hep C means.’ Wait, positive is a bad thing, right?”
At home, she searched “What is hep C?” online, which sent her down an Internet rabbit hole of common risk factors, including IV drug use, tattoos or piercings, having HIV or spending time in prison. She cried.
“I have lived the most boring life,” Smith said. “So it was a shock that I had this virus that comes with this stigma.”
Only later did her doctor connect the hepatitis C diagnosis to lifesaving blood transfusions she received in 1981, when she was a premature baby. Smith had lived with hepatitis C her entire life and exposed each of her three children. Women with hepatitis C have a higher risk of cholestasis of pregnancy, the liver problem that caused her severe itching.
Hepatitis C is the leading blood-borne disease in the United States, affecting at least an estimated 2.5 million Americans. Half of them don’t know they have it. The disease used to occur mostly among baby boomers. After World War II, a combination of increased medical procedures and recreational drug use drove the spread of the disease before widespread screening was available in the 1990s. But now people ages 20 to 39 are most likely to get infected, according to the Centers for Disease Control and Prevention, a shift experts attribute to the opioid crisis and needle-sharing. The CDC says adults with hepatitis C are at higher risk for severe illness from covid-19.

​TO CONTINUE READING: https://www.washingtonpost.com/health/hepatitis-c-pregnancy/2022/01/28/3e5f6e24-7d32-11ec-8d71-0e9ca350d4b1_story.html