​Alexander Lekhtman 2Days

The adulteration of many drug supplies with the potent synthetic opioid fentanyl poses a serious risk for people who use illicit drugs of all kinds. But those who use substances other than opioids are more likely to be unaware of the risk or how to mitigate it. Public health officials in New York City issued safety information to cocaine users through bars and nightclubs—and a review of their strategy indicates that it was effective.
Many people might be aware of fentanyl’s presence in heroin supplies. Unfortunately, there is much less awareness of how it is also found in stimulants like cocaine or methamphetamine. Since 2016, there has been a faster national increase in fentanyl-and-cocaine-related deaths than in fentanyl-and-heroin deaths.
In New York City, nearly four in 10 deaths related to cocaine also involve fentanyl. People who use only cocaine have not developed tolerance to opioids, and may not know about vital resources like fentanyl testing strips or naloxone. Knowledge, in this case, really can save lives.
In spring 2018, the NYC Department of Health and Mental Hygiene (DOHMH) contacted 47 bars, nightclubs and music venues in downtown Manhattan about participating in a public information campaign. The venues were not known sites of fentanyl-involved overdoses, just places where people regularly consumed alcohol and likely, cocaine. Twenty-three venues agreed to participate.
The health officials gave the nightlife venues posters and drink coasters displaying information about how to avoid fentanyl overdose. “Using cocaine tonight?” the posters read. “Fentanyl, a drug stronger than heroin, is being mixed into cocaine and is causing a spike in overdose deaths. You can’t see, taste, or smell fentanyl.”
The posters also offered simple safety tips: “Use with others. If you overdose, it’s important to have someone else around to help. Have [naloxone] on hand and tell others how to use it. It could save your life.”

TO CONTINUE: https://filtermag-org.cdn.ampproject.org/c/s/filtermag.org/bars-nightclubs-deaths-fentanyl/amp/

​As overdose deaths climb, advocates and activists fear the opioid crisis will run headlong into the Covid-19 crisis.
​By Sophie Pinkham

​In mid-March, as the Covid-19 pandemic was accelerating, Shantae Owens found a man unconscious in a public bathroom in Tompkins Square Park, in New York’s East Village. Owens wasn’t surprised at his discovery. He was on street outreach distributing naloxone, which helps reverse opioid overdoses, as well as syringes, condoms, and other health supplies. He administered naloxone and called 911. The ambulance took longer to arrive than usual.
Owens is an outreach worker with the Lower East Side Harm Reduction Center, which has temporarily stopped doing outreach due to Covid-19-related safety concerns. But he still covers the parks, public restrooms, and drug houses of the South Bronx, Washington Heights, and Lower Manhattan as a volunteer with VOCAL-NY, a grassroots organization that grew out of the AIDS epidemic and is staying open during the lockdown. Many harm reduction programs are still running as essential services, though others, such as those that operate out of county health departments, like Michigan’s, are now largely closed because of Covid-19. Owens is concerned about what the lockdown will mean for drug users—in particular, for people who use opioids and are at high risk of fatal overdose. “We fear that overdose is going to rise,” Owens told me, “because there’s not enough services. We’ve already lost so many people to the overdose crisis.”
Around the country, organizations that work to reduce drug-related harms such as overdose, HIV, and hepatitis C are now facing yet another devastating virus. And for active drug users, people in drug treatment, and people without stable housing, business closures and physical distancing mandates are causing a cascade of economic and practical difficulties that compound health dangers. “I worry for my community,” said Kelly Culbert, who works at NYHRE, an East Harlem harm reduction center that has closed temporarily. “They’re scared. They have very little access to equipment [for safer drug use]. And everything has become more problematic—from the ways people were making their money to locating a dealer and that person having an adequate supply. It’s all become riskier, less available.”

Among the harms that advocates like Culbert fear most are a spike in overdoses, increased syringe sharing, and a choice between self-isolation and excruciating drug withdrawal. There are already reports from across the country of increased overdose rates.
Project SAFE works with women and queer people who use drugs in Philadelphia’s Kensington neighborhood, delivering harm reduction supplies and offering a place to take a shower or a nap. Many program participants are precariously housed and stay up all night to avoid being assaulted; they need a place to help them escape the cycle of exhaustion.

TO CONTINUE READING:​https://www.thenation.com/article/society/harm-reduction-coronavirus/

Matthew J. Akiyama, M.D., Anne C. Spaulding, M.D., and Josiah D. Rich, M.D.T
​The New England Journal of Medicine
​

Matthew Akiyama is the Medical Advisor to HCMSG

​Because of policies of mass incarceration over the past four decades, the United States has incarcerated more people than any other country on Earth. As of the end of 2016, there were nearly 2.2 million people in U.S. prisons and jails.1 People entering jails are among the most vulnerable in our society, and during incarceration, that vulnerability is exacerbated by restricted movement, confined spaces, and limited medical care. People caught up in the U.S. justice system have already been affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and improved preparation is essential to minimizing the impact of this pandemic on incarcerated persons, correctional staff, and surrounding communities.
Populations involved with the criminal justice system have an increased prevalence of infectious diseases such as HIV and hepatitis C virus (HCV) infections and tuberculosis. Disparities in social determinants of health affecting groups that are disproportionately likely to be incarcerated — racial minorities, persons who are unstably housed, persons with substance use disorders or mental illness — lead to greater concentrations of these illnesses in incarcerated populations. Yet implementation of interventions to address these conditions is often challenging in correctional settings owing to resource limitations and policy constraints. Therefore, comprehensive responses that straddle correctional facilities and the community often need to be devised.

 For example, HCV, which is the most prevalent infectious disease in incarcerated populations, is most commonly spread through injection drug use. Transmission can be reduced using measures known to reduce high-risk behaviors, such as opioid agonist therapy and syringe exchange. Although much of the country has yet to implement these strategies in correctional settings, managing transitions in care to and from the community and providing such services to people after incarceration has a large impact. Similarly, we have learned that controlling infections such as HIV and HCV in correctional settings can have positive effects both in these settings and on surrounding communities, as a form of treatment as prevention.
TO CONTINUE READING: https://www.nejm.org/doi/full/10.1056/NEJMp2005687

By Jacqueline Howard, CNN​Updated 5:13 AM ET, Fri April 10, 2020

​(CNN)The annual rate of newly reported hepatitis C infections in the United States has increased threefold, according to the US Centers for Disease Control and Prevention.

A new CDC report finds that the annual rate rose from a rate of 0.3 cases per 100,000 people in 2009 to a rate of 1.2 per 100,000 people in 2018. That report also makes new recommendations for all adults to get screened for hepatitis C at least once in their lifetimes.
The new Vital Signs report included data on confirmed acute hepatitis C cases between 2009 and 2018 from the CDC's National Notifiable Diseases Surveillance System. Hepatitis C is the most commonly reported bloodborne infection in the United States.
The report, published in the CDC's Morbidity and Mortality Weekly Report on Thursday, finds that the highest rate of new hepatitis C cases in 2018 was among younger adults ages 20 to 39.


Among adults ages 20 to 29, rates increased about 300% from 0.7 per 100,000 in 2009 to 3.1 per 100,000 in 2018. Among adults ages 30 to 39, rates increased about 400%, from 0.5 per 100,000 in 2009 to 2.6 per 100,000 in 2018, according to the report.
According to the CDC, hepatitis C previously was seen as a concern primarily for baby boomers and people with risk factors, such as injection drug use, but the new data finds that in 2018:

• Millennials, or those born during 1981 to 1996, accounted for 36.5% of newly reported chronic hepatitis C infections.
• Baby boomers accounted for 36.3% of newly reported chronic infections.
• Generation X, born during 1966 to 1980, accounted for 23.1% of newly reported chronic infections.

 TO CONTINUE READING:https://www.cnn.com/2020/04/10/health/hepatitis-c-infection-rate-rises/index.html

​Recommendations and Reports / April 10, 2020 / 69(2);1–17
Sarah Schillie, MD1; Carolyn Wester, MD1; Melissa Osborne, PhD1; Laura Wesolowski, PhD1; A. Blythe Ryerson, PhD1 

Recommendations
​
The following recommendations for hepatitis C screening augment those issued by CDC in 2012 (5). The recommendations issued by CDC in 1998 remain in effect (6). CDC recommends (Box 1):

• Universal hepatitis C screening (new recommendations):
  • Hepatitis C screening at least once in a lifetime for all adults aged ≥18 years, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%
  • Hepatitis C screening for all pregnant women during each pregnancy, except in settings where the prevalence of HCV infection (HCV RNA-positivity) is <0.1%
• One-time hepatitis C testing regardless of age or setting prevalence among persons with recognized conditions or exposures (existing recommendations):
  • Persons with HIV
  • Persons who ever injected drugs and shared needles, syringes, or other drug preparation equipment, including those who injected once or a few times many years ago
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis and persons with persistently abnormal ALT levels
  • Prior recipients of transfusions or organ transplants, including persons who received clotting factor concentrates produced before 1987, persons who received a transfusion of blood or blood components before July 1992, persons who received an organ transplant before July 1992, and persons who were notified that they received blood from a donor who later tested positive for HCV infection
  • Health care, emergency medical, and public safety personnel after needle sticks, sharps, or mucosal exposures to HCV-positive blood
  • Children born to mothers with HCV infection
• Routine periodic testing for persons with ongoing risk factors, while risk factors persist:
  • Persons who inject drugs and share needles, syringes, or other drug preparation equipment
  • Persons with selected medical conditions, including persons who ever received maintenance hemodialysis
• Any person who requests hepatitis C testing should receive it, regardless of disclosure of risk, because many persons might be reluctant to disclose stigmatizing risk.  
  
• https://www.cdc.gov/mmwr/volumes/69/rr/rr6902a1.htm?s_cid=rr6902a1_w&deliveryName=USCDCNPIN_171-DM25236