HHS.gov
July 17, 2018
By: Corinna Dan, R.N., M.P.H., Viral Hepatitis Policy Advisor, Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services and Adm. Brett P. Giroir, M.D., Assistant Secretary for Health
Summary: 
Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections.

The opioid crisis in the United States is devastating the lives of millions of Americans. Perhaps overshadowed by the alarming rise in overdoses and deaths is the accompanying numbers of injection-related infectious diseases. Opioid overdose deaths increased fivefold from 1999 to 2016, and new hepatitis C infections more than tripled from 2010 to 2016.
Some communities that have been hardest hit by the opioid crisis have also seen associated increases in hepatitis B and C and other infections, such as endocarditis, septic arthritis and abscesses, driven by increases in the numbers of people who inject opioids.
Earlier this year, the HHS Office of the Assistant Secretary for Health’s Office of HIV/AIDS and Infectious Disease Policy and the Office on Women’s Health sponsored a workshop at the National Academies of Sciences, Engineering and Medicine to explore the infectious disease consequences of the opioid crisis and consider opportunities to better integrate effective responses. A detailed summaryof the proceedings is newly available.
One of HHS’s top priorities is the implementation of a comprehensive national opioid strategy. The HHS five-point opioid strategy emphasizes the need to empower local communities to assess and respond to local needs, including both drivers and consequences of the opioid crisis.  
The National Academies’ workshop highlighted the importance of addressing infectious diseases as part of an improved, comprehensive opioid response.
The opioid crisis is part of a set of interconnected health problems, often called syndemics, because they have common root causes and interact synergistically, with one problem making the others worse. Because syndemics are interconnected, coordinated efforts are required across multiple programs and partners to successfully overcome the set of problems and their consequences.
The federal government can’t fight this battle alone. We recognize that some of the best and most effective solutions will come from healthcare providers, community leaders and law enforcement who are dealing with the opioids and infectious diseases crisis on the ground.

​TO CONTINUE READING: https://www.hhs.gov/hepatitis/blog/2018/07/17/integrating-infectious-disease-prevention-and-treatment-into-the-opioid-

By Maddie Bender, CNN
Updated 6:26 AM ET, Tue July 17, 2018



(CNN)Death rates from liver cancer increased 43% for American adults from 2000 to 2016, according to a report released Tuesday by the US Centers for Disease Control and Prevention's National Center for Health Statistics. The increase comes even as mortality for all cancers combined has declined.

Liver cancer death rates increased for both men and women 25 and older, as well as white, black and Hispanic people. Only Asians and Pacific Islanders saw a decrease in mortality from liver cancer.

HPV test more effective than Pap smear in cancer screening, study suggests
The rise in mortality doesn't mean that liver cancer is deadlier than before, according to Dr. Jiaquan Xu, the author of the report; the 10-year survival rate for liver cancer didn't change much. Rather, the increase in mortality means more people are developing liver cancer.More than 70% of liver cancers are caused by underlying liver disease, which has risk factors such as obesity, smoking, excess alcohol consumption, and hepatitis B and C infection, said Dr. Farhad Islami, the scientific director of cancer surveillance research at the American Cancer Society.
"I think the main reason for the increase in liver cancer incidence and death rate in the US is the increase in the prevalence of excess body weight and hepatitis C virus infection in baby boomers," said Islami, who authored a study on liver canceroccurrence between 1990 and 2014.
New hepatitis C infections triple due to opioid epidemic
Up until 1992, blood transfusions and organ transplants were not screened for hepatitis C, Xu said. According to the CDC, this was once a common means of hepatitis C transmission.
It is often years before a person living with hepatitis C develops liver cancer, which would account for an increase in incidence of the cancer among older individuals who received blood transfusions and organs before 1992. Liver cancer mortality was greatest in those 75 and older, followed by those 65 to 74 and 55 to 64, according to the new report.
The opioid epidemic might also be at fault, said Dr. Manish A. Shah, a medical oncologist at Weill Cornell Medicine and NewYork-Presbyterian. Hepatitis C, spread by sharing needles, drove elevated rates of liver cirrhosis, or scarring due to damage to the liver, in the 1990s and 2000s, Shah said. Cirrhosis increases the risk for liver cancer, although it is not clear why, he added.
Xu said he hopes people realize lifestyle changes can decrease their risk of developing liver cancer.
"Some of these liver cancer risk factors like obesity, diabetes and excess consumption of alcohol, those things can be prevented," he said.
TO CONTINUE READING: https://www.cnn.com/2018/07/17/health/liver-cancer-death-rate-study/index.html?no-st=1531863435.

Needle exchanges have been exhaustively studied — and proved to work. But stigma remains.
By German Lopez@germanrlopezgerman.lopez@vox.com  Jun 22, 2018, 1:20pm EDT,VOX

Needle exchange programs are an exhaustively studied, proven public health intervention in the fight against opioid addiction — making them a key component in efforts to haltthe opioid epidemic. But needle exchanges, it turns out, are also illegal in 15 states.
Take a look at this map by HIV/AIDS advocacy organization amfAR, recently resurfaced by University of Texas Austin clinical assistant professor Lucas Hill:

​As the map shows, the programs are banned in most of the South and much of the West.At the federal level, needle exchanges aren’t banned. But until as recently as 2016federal dollars were not allowed to go to such programs.
Now, legalization doesn’t necessarily mean that needle exchanges can be easily opened and remain in place. In California’s Orange County, for example, local officials shut down the district’s only needle exchange and have tried to prevent its reopening.
Needle exchanges not only provide a place where people can obtain syringes for drug use or dispose them. They also can help link people to other services, including addiction treatment, vaccinations, and infection testing. The driving idea behind the programs is this: Recognizing the reality that some people do use drugs, it’s better to provide them somewhere to pick up new, sterile syringes (without the risk of spreading, say, HIV or hepatitis C infection) than to turn them away from potential public health services and force them to reuse needles despite the hazards.
The decades of research about needle exchanges is clear: The programs combat the spread of blood-borne diseases like hepatitis C and HIV, cut down on the number of needles thrown out in public spaces, and connect more people to treatment — all without enabling more drug use. This is an exhaustive body of research, backed by independent academic researchers, the World Health Organization, and the Centers for Disease Control and Prevention.
Yet needle exchanges often face resistance due to stigma and concerns that the programs will attract drug users to an area and lead to more drug-related problems. In Orange County, officials in Santa Ana, the county seat, said that the needle exchange program there led to a massive increase in the amount of needle litter in public areas.
Advocates of such exchanges argue that the people using drugs already live in these areas. They are just using them without any place to reliably visit to pick up sterile syringes.
Supporters of needle exchanges also point to studies that show the programs actually reduce drug-related problems such as needle litter.
For example, a 2012 study published in Drug and Alcohol Dependence compared a city with needle exchanges, San Francisco, to one without exchanges, Miami. Through visual inspections, researchers found 44 syringes per 1,000 census blocks in San Francisco, compared with 371 syringes per 1,000 census blocks in Miami. Based on a survey of injection drug users in both cities, the researchers also concluded that users in Miami had more than 34 times the adjusted odds to improperly dispose of syringes in public than users in San Francisco.
“These results suggest that [needle exchanges] are a significant means of collecting used syringes and do not increase the amount of publically discarded used syringes,” the study concluded.
TO CONTINUE READING: https://www.vox.com/science-and-health/2018/6/22/17493030/needle-exchanges-ban-state-map