ESSAYMay/June 2018 Issue Foreign Affairs

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

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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​