By KATHARINE Q. SEELYEOCT. 30, 2015 NEW YORK TIMES

NEWTON, N.H. — When Courtney Griffin was using heroin, she lied, disappeared, and stole from her parents to support her $400-a-day habit. Her family paid her debts, never filed a police report and kept her addiction secret — until she was found dead last year of an overdose.
At Courtney’s funeral, they decided to acknowledge the reality that redefined their lives: Their bright, beautiful daughter, just 20, who played the French horn in high school and dreamed of living in Hawaii, had been kicked out of the Marines for drugs. Eventually, she overdosed at her boyfriend’s grandmother’s house, where she died alone.
“When I was a kid, junkies were the worst,” Doug Griffin, 63, Courtney’s father, recalled in their comfortable home here in southeastern New Hampshire. “I used to have an office in New York City. I saw them.”
 Noting that “junkies” is a word he would never use now, he said that these days, “they’re working right next to you and you don’t even know it. They’re in my daughter’s bedroom — they are my daughter.”
      When the nation’s long-running war against drugs was defined by the crack epidemic and based in poor, predominantly black urban areas, the public response was defined by zero tolerance and stiff prison sentences. But today’s heroin crisis is different. While heroin use has climbed among all demographic groups, it has skyrocketed among whites; nearly 90 percent of those who tried heroin for the first time in the last decade were white                          ”
And the growing army of families of those lost to heroin — many of them in the suburbs and small towns — are now using their influence, anger and grief to cushion the country’s approach to drugs, from altering the language around addiction to prodding government to treat it not as a crime, but as a disease.
“Because the demographic of people affected are more white, more middle class, these are parents who are empowered,” said Michael Botticelli, director of the White House Office of National Drug Control Policy, better known as the nation’s drug czar. “They know how to call a legislator, they know how to get angry with their insurance company, they know how to advocate. They have been so instrumental in changing the conversation.”
Mr. Botticelli, a recovering alcoholic who has been sober for 26 years, speaks to some of these parents regularly.
Their efforts also include lobbying statehouses, holding rallies and starting nonprofit organizations, making these mothers and fathers part of a growing backlash against the harsh tactics of traditional drug enforcement. These days, in rare bipartisan or even nonpartisan agreement, punishment is out and compassion is in.
The presidential candidates of both parties are now talking about the drug epidemic, with Hillary Rodham Clinton hosting forums on the issue as Jeb Bush and Carly Fiorina tell their own stories of loss while calling for more care and empathy.
 
To continue reading: http://www.nytimes.com/2015/10/31/us/heroin-war-on-drugs-parents.html?emc=edit_th_20151031&nl=todaysheadlines&nlid=35747334&_r=0
 


Correction: October 30, 2015 Because of an editing error, an earlier version of this article erroneously included one drug among the prescription opioids contributing to 44 deaths each day from overdoses. While OxyContin is a prescription opioid, heroin is not.

Upwards of a million more people have been infected with the hepatitis C virus (HCV) than current estimates indicate, according to new research from Weill Cornell Medicine. The investigators say their finding exposes a critical flaw in the survey that calculates disease prevalence, and underscores the need for stronger public health policies to combat the viral infection. Dr. Brian Edlin
The study, published online Aug. 25 in Hepatology, examined the National Health and Nutrition Examination Survey (NHANES), a government survey designed to assess the health of a representative sample of the country's population. In a 2014 report, the most recent one available, the survey estimated that 3.6 million people have HCV antibodies (meaning they have been infected, but might have fought off the virus on their own), of whom 2.7 million are currently infected.
But a closer analysis revealed that the report excludes six populations, some of which are stigmatized and marginalized, yet critically in need of public health resources: people who are homeless or hospitalized, prisoners, military personnel, nursing home residents, and residents of Native American reservations. Including these groups, the researchers estimate that 4.6 million people have antibodies for HCV and that 3.5 million are infected — and even those figures likely underestimate the disease's prevalence. It is nearly impossible to assess disease prevalence in populations like the homeless with complete accuracy.
"The populations that are uncounted in the national numbers are very disadvantaged populations, so not only do we miss the magnitude of the problem, but we also don't see how much more concentrated these problems are in people affected by economic disadvantage, ethnic discrimination, and challenges accessing care," said first author Dr. Brian Edlin, an associate professor of medicine at Weill Cornell Medicine.
"We need to pay more attention to our research and surveillance of these populations, and find effective methods for reaching them and engaging them in the process of overcoming the health challenges that they face."
The scientists obtained their data from publicly available records from hospital and prison databases, among others. They then multiplied the number of people in the institutions by the prevalence of HCV reported in the literature. An accurate estimate of hepatitis C and other diseases is important for many reasons, such as assessing the mortality rate of the disease and its financial burden on the healthcare system, designing targeted public health interventions, allocating resources, and implementing treatment plans.
Interventions such as outreach, education, testing, counseling, and especially needle exchange and other syringe access programs are vital for helping people who use drugs that contain bloodborne viral disease epidemics, such as HIV and hepatitis C, in their communities, Dr. Edlin said. He noted that these initiatives have proven very successful at decreasing and managing HIV, for example. But more funding is needed to establish hepatitis C public health initiatives, such as disease tracking, prevention, treatment, and research.
"Now that we have effective treatment for hepatitis C," Dr. Edlin said, "antiviral treatment needs to be delivered to the populations most severely affected by the disease."
"With a more accurate estimate we'd be able to direct resources to create programs to address the needs," he said. "Knowing the numbers doesn't accomplish anything by itself. The numbers have to be used."


​Posted October 20, 2015 3:49 PM | Permalink to this posthttp://weill.cornell.edu/news/news/2015/10/analysis-hepatitis-c-prevalence-far-higher-than-previously-estimated.html​

Doctors say up to 80 percent of patients are denied expensive but effective drugs like HarvoniOctober 16, 2015 5:00AM ET by Sony Salzman

​Amber Rojas was almost eight months pregnant when she learned she had hepatitis C. After her daughter was born on Dec. 23, 2014, Rojas had hoped to start treatment with a newly approved, highly effective drug called Harvoni.
After filing for prior authorization and waiting for months, the 34-year old mother received an unwelcome letter on August 27, 2015 — her treatment request had been denied because her liver was still too healthy. Rojas said that even though she felt very sick with flu-like symptoms, her insurance provider deemed her “not sick enough to qualify.”
Rojas is one of an estimated 3.2 million Americans with hepatitis C, an infection that attacks the liver. In the United States, hepatitis C kills more people every year than HIV. Drugs like Harvoni promise to cure more than 90 percent of patients, yet many insurance providers only authorize treatment if a patient has extensive liver damage, or a “fibrosis score” of three or four.
In the first six months of 2015, approximately 130,000 patients started treatment on Harvoni or Sovaldi, two of the most widely prescribed medications, according to the manufacturer.
Harvoni belongs to potent class of drugs called direct-acting antivirals, which block the virus’ ability to replicate, and to infect other people. These new drugs have very few side effects, and most patients can be cured after taking pills for 12 weeks.
With Harvoni’s $95,000 price tag, some insurance providers will go to great lengths to deny claims. Approved October 2014, Harvoni is the most expensive of these new medications, although they all cost more than $60,000 wholesale (prior to discounts and rebates) for a 12-week course of treatment.
Because of the high prices, three common policies are typically employed to restrict access — the first is to deny treatment for patients who are “not sick enough,” like Rojas. Another common policy is to deny treatment for people who use drugs or drink alcohol. To confirm their sobriety, patients are required to pass multiple urine sample drug tests. Finally, doctors themselves are limited — many providers will only accept prescriptions written by a liver specialist, and some states don’t have enough specialists to service the population.
To Rojas, these policies are discriminatory, and morally wrong. “I feel like I’ve been treated less than human sometimes,” she said. Rojas was covered by Florida state Medicaid during her pregnancy, and nine months after giving birth to her daughter. (Today, Rojas is uninsured, having lost her Medicaid coverage after battling postpartum depression and losing custody of her daughter, she said.)
Florida’s state Medicaid program rejected Rojas’ request for treatment based on a principle of rationing treatment to patients with the most severe liver disease. However, private insurance companies and state managed programs alike commonly employ similar coverage restrictions. In fact, a recent Yale University study found that one in four patients was denied Harvoni after the first request, regardless of insurance provider. Dr Joseph Lim, director, Yale Viral Hepatitis Program in New Haven, Connecticut, led this research. Lim said that even though his study is small (only 129 patients were included for analysis, and all patients were located in Connecticut), it offers a rough snapshot of the coverage rates across America. Lim said that to his knowledge, this is the first published report of rejection rates in the United States.
Some clinicians offered a more bleak assessment based on their personal experience. Of the 800 prescriptions Dieterich’s medical group requested in the past year, approximately 60 percent were denied. And Dr. Hillel Tobias, a hepatologist at NYU Langone Medical Center, has treated 250 patients with the new medications, of which 80 percent were denied treatment on the initial application. 
Coverage restrictions often run counter to medical consensus, and are purely cost-saving measures, agreed Dieterich and Lim. For example, demanding that patients have a clean urine toxicity test “has nothing to do with anything,” Dieterich said. The policy is not scientific or medically necessary, just “immoral,” he said.
The American Liver Foundation believes that people living with hepatitis C should have access to medications prescribed by their clinicians, said Tom Nealon, CEO of the foundation. Instead, a “curious” situation has developed in which insurance providers, rather than clinicians, are deciding which patients receive medication, Nealon said.
Some of these policies are on shaky legal ground, according to Robert Greenwald, director of Harvard Law School's Center for Health Law and Policy Innovation, Cambridge, Massachusetts. For example, Greenwald believes some state Medicaid programs are violating federal Medicaid law with excessive hepatitis C prior-authorization rules. In addition, private insurance companies are violating their own contracts, which promise to provide “medically necessary” services to covered patients. “They are completely abrogating their obligation to provide these services in hepatitis C solely based on cost,” Greenwald said.
However, Matt Salo, executive director of the National Association of Medicaid Directors, said state Medicaid restrictions do not violate federal law, because states have a lot of leeway in setting their own parameters around any drug. State Medicaid programs often have limited budgets, and because the drugs are so expensive, they must be able to set policies that triage care, he said.
Private insurance providers do base coverage decision on medical evidence, said Claire Krushing, press secretary for America’s Health Insurance Plans, a national trade association that represents 90 percent of the private health insurance industry. If a doctor and patient disagree with the decision, there is an appeal process, she said. The most significant challenge for private insurance is the “huge price tag” of these drugs, Krushing said, adding that drug makers set the price at the highest point the market can bear.

​To continue:http://america.aljazeera.com/articles/2015/10/16/insurance-providers-deny-hepatitis-drugs.html

http://blog.aids.gov/

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September 29, 2015 • 0 comments • By Dominique Saunders, Viral Hepatitis Prevention Coordinator, Kansas Department of Health and Environment and Sarah Knopf-Amelung, Project Manager, Mid-America ATTC, University of Missouri-Kansas City School of Nursing and Health Studies 
Recently, there has been a spotlight on America’s prescription opioid misuse and overdose epidemics.  However, too often, people remain unaware of the related hepatitis C virus (HCV) epidemic. The Centers for Disease Control and Prevention (CDC) reported an estimated 150% increase in new HCV infections from 2010 to 2013 and, further, that most of the new infections were associated with injection drug use. An analysis of state and national data indicate that a large proportion of new HCV infections are occurring in young people (<30 years of age) in rural and suburban areas who use oral prescription opioid analgesics before transitioning to injecting.

At the same time, recent years have seen advances that have revolutionized the field of hepatitis C.  Groundbreaking treatments with cure rates as high as 90-100% are now available.  Preventive screenings without cost-sharing under the Affordable Care Act make HCV screening more accessible for many people.  And the national Viral Hepatitis Action Plan increases coordination across federal programs and includes among its priorities the urgent need to reduce viral hepatitis associated with drug use behaviors.

However, reaching health professionals with information about these important changes in the evolving hepatitis C arena can be challenging. Because of the prevalence of HCV among people who inject drugs, addictions treatment and recovery professionals are a key group to engage in efforts to address HCV. Additionally, both primary care and behavioral health settings are becoming increasingly important providers of HCV screening and care, creating the need for more effective means for timely HCV information dissemination.

Launched in 1993, the Addiction Technology Transfer Center  (ATTC) network is a Substance Abuse and Mental Health Services Administration (SAMHSA)-funded, nationwide resource for professionals in the addictions treatment and recovery services fields.  In 2011, SAMHSA tasked the ATTC Regional Centers with developing a national HCV educational initiative targeting behavioral health and medical providers. Since over half of new HCV infections are associated with injection drug use, the ATTCs were uniquely positioned to address the hepatitis C epidemic through existing expertise and connections with the behavioral health workforce. The timing was perfect to bridge the gap in the behavioral health workforce’s knowledge about HCV as well as provide cross-training in behavioral health for medical providers.

As a result, the HCV Current  initiative was launched in March 2015. HCV Current provides free HCV informational resources for health professionals, including online  and in-person  curriculum and training, downloadable provider tools , and region-specific resources . As new HCV research emerges, these products are updated. The tools available on HCV Current can help empower health care professionals to better educate patients about what to expect along each stage of the HCV continuum of care, including screening and understanding treatment options.  Providers can also download patient education resources, including fact sheets.

Engaging Regional ExpertsTo augment the HCV Current initiative, one ATTC Regional Center took a novel approach to enhance the effort by engaging regional expertise. The Mid-America ATTC   (which serves HHS Region 7) formed an HCV Stakeholder Group of experts from Iowa, Kansas, Missouri, and Nebraska. Composed of CDC-funded Viral Hepatitis Prevention Coordinators from those states and other stakeholders, the group provided expertise in the development of a free, 1.5-hour self-paced online course, HCV Snapshot: An Introduction to Hepatitis C for Health Care Professionals . Continuing education for this course is available for nurses, social workers, addiction professionals, Certified Health Education Specialists, and others. The HCV Stakeholder Group members also serve as regional trainers on behalf of Mid-America ATTC and welcome additional collaborations. Stakeholders provide 3- and 6-hour trainings in their respective jurisdictions for free in collaboration with Mid-America ATTC.

Strategic Partnerships for Integrated CareThe partnership between the Viral Hepatitis Prevention Coordinators and the Mid-America ATTC supports collaboration and integration between behavioral health and medical providers.  The HCV Current initiative illustrates important progress in community stakeholder efforts toward achieving the goals of the national Viral Hepatitis Action Plan.  The Initiative creates new partnerships to leverage existing resources, increases provider and system capacity to deliver HCV services, and builds momentum in our national response to this now-curable infectious disease. Viral Hepatitis Prevention Coordinators are key resources within their states and those involved in the Initiative have already experienced a shift in improved provider perceptions, engagement, and knowledge.  This is an exciting time both nationally and locally, as we develop better tools and resources to empower providers in every community and improve the quality of lives in our communities by preventing and curing HCV.

To locate training opportunities near you, check the HCV Current’s Training and Events calendar  or contact your region’s ATTC .

Related posts:

1. Addressing Viral Hepatitis in People With Substance Use Disorders
2. National Hepatitis Testing Day: Ask the Expert, Corinna Dan
3. Ryan White Program Addressing Coinfection with Viral Hepatitis
4. NIH Funding Opportunity for Drug Abuse Prevention Research Holds Potential for Addressing Viral Hepatitis
5. How Health Departments Are Addressing the Viral Hepatitis Epidemic in the U.S.

- See more at: https://blog.aids.gov/2015/09/hcv-current-initiative-addressing-the-national-epidemics-of-prescription-opioid-misuse-and-hepatitis-c-through-unique-partnerships.html#sthash.KbE5aXUh.dpuf

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​Leslie Mann Chicago Tribune

Like many hepatitis C patients, Anthony Lo Russo, 64, lived with the virus for years before he knew he had it. Even after a routine blood test flagged it in 1995, he eschewed hep C drugs because of their side effects. "I felt fine, so I waited," Lo Russo said.

After the 2013 introduction of kinder drugs, Lo Russo agreed to a standard 16-week treatment. Two weeks into it, he heard the word that's music to hep C patients' ears; his blood was "clear" of hep C. He was cured.

"I'm happy to be alive," said Lo Russo, of Lake Worth, Fla. He bowls in three leagues, swims and chats with fellow patients on Facebook.

About 2.7 million Americans have hep C (or "hep C virus" or "HCV"), according to the U.S. Centers for Disease Control and Prevention. So high is the rate among baby boomers that doctors urge that everyone born between 1945 and 1965 be tested.

If you test positive for hep C, you learn your genotype (genetic strain), No. 1 being the most common in the U.S. Your genotype affects your ability to clear hep C without drugs and the effectiveness of the drugs.

About one-third of hep C victims rid themselves of the virus within six months without treatment. The remainder develop chronic hep C. Untreated, it can lead to cirrhosis (scarring of the liver) or liver cancer.

Hep C is more likely to become chronic if you have HIV or hep B (see sidebar), are male, drink alcohol or are Native American or African-American.

People get hep C from infected blood, so injection-drug users who share needles are at high risk. Lo Russo assumes he got the virus while using heroin in the 1960s.

Also risky is getting a tattoo by an artist who doesn't use clean needles or dips into ink he used for his last customer.

You're not likely to get hep C by having sex with someone who has it, but you can get a trace of contaminated blood from a shared toothbrush, manicure scissors or a razor.

One of the best ways to catch hep C is to frequent hospitals and clinics, where the virus can linger on equipment for weeks. "That's why people on dialysis have higher rates; they have an increased exposure," explained Dr. Kris Kowdley, hep C researcher and hepatologist at Swedish Medical Center in Seattle.

Hep C also can transfer from mother to baby at birth, but it's rare. It's not transferred through breast milk.

If you received a blood transfusion before 1992, it may have infected you with hep C because that's when blood banks started screening for it. "It was also when we went from paid blood donors — more likely to be young people in high-risk lifestyles — to volunteer donors," said Dr. Stuart Ray, a professor at Johns Hopkins School of Medicine in Baltimore.

Many victims — one in 10 hep C patients — never learn where they got the virus, however.

For example, Ronni Marks director of the New York City-based Hepatitis C Mentor & Support Group Inc. (www.hepatitiscmsg.org), figures she got hep C from a transfusion during one of her many childhood surgeries.

Also tending to mask origin is that fact that early hep C symptoms, such as fatigue or nausea, mimic other illnesses and may be dismissed as flu because they're mild and intermittent. If your hep C advances, however, you may have dark urine, jaundice or fluid retention.

Diagnosis includes two blood tests: one for hep C antibodies and one for the virus. If you test positive for the antibodies (the body's disease-fighting warriors), you have had the disease. Your body fought it and won — for now. You do not become immune to it.

Subsequent tests — ultrasound, magnetic resonance imaging (MRI) and liver biopsy — measure hep C's damage to the liver.

You may be a candidate for hep C drugs, which took a giant step forward in 2013. Before that, the side effects were so debilitating that many patients, including Lo Russo, said no thanks. For Marks, they were "painful and horrific," caused nerve damage and did not kill the virus.

The new concoctions, which include sofosbuvir and simeprevir, yield better results and are easier to endure. "They just made me tired and irritable," Lo Russo reported.

Today's hep C meds are a godsend for most patients but fail to help some patients with genotype 3 and people who also have chronic kidney disease, Kowdley said. "But, in both cases, we're working on it," he added.

Unfortunately, the new drugs come with hefty price tags, up to $100,000 per person. It is not always covered by insurance or Medicaid.

"Every day, we hear from patients who are denied coverage because of insurers' restrictions," said Ivonne Perlaza Fuller, CEO of Hepatitis Foundation International (www.hepfi.org), based in Silver Spring, Md. "They're told they're not sick enough to qualify, they must pass alcohol screening or must be seen by certain specialists."

Lo Russo qualified for free drugs from a manufacturer, but not everyone can take advantage of these "manufacturer-assistance programs."

"Our goal is to put ourselves out of business," said Ryan Clary from the National Viral Hepatitis Roundtable (www.nvhr.org), which helps patients find funds for hep C drugs while supporting pending legislation that will lift restrictions that bar some people from the drugs, such as those whose disease is not advanced enough.

Meanwhile, back at the lab, scientists are studying why some people's immune systems fend off hep C. "This will help us develop a hep C vaccine," Ray said. And, they are developing drugs that require shorter time frames.

Hindering fundraising for hep C research is the virus's reputation as a "drug user's disease."

The first time she staffed the HEPFI hotline, Fuller fielded a call from a young woman hiding in her bedroom closet. "She didn't want anyone in her family or in her small town to know she had hep C," she said. "We need to get past this stigma."

"My crystal ball says we'll still have hep C in 10 years," Kowdley said. "But, drug prices are falling. Testing is more widespread. We do have a cure — for most patients. We're making progress."




The ABCDE's of hepatitis




Hep C gets more ink than its alphabetical cousins for good reason; it's the most serious. Here are the others:

Hep A (infectious hepatitis) is spread by eating contaminated food or having sex with an infected person. Many people have been exposed to it and have become immune to it but don't know it. There is a hep A vaccine; the CDC recommends children take it at age 1.

Hep B (serum hepatitis) spreads through body fluids such as saliva, semen and blood. You can get it from unprotected sex, injected drug use or sharing a razor or toothbrush with an infected person. Children should get the hep B vaccine at birth and between 6 and 18 months, the CDC says.

Hep D piggybacks hep B. If you get B, you may get D too. But the B vaccine protects you from D.

Hep E is transmitted by feces of infected people, so it is more prevalent in countries with contaminated water.
http://www.chicagotribune.com/lifestyles/health/sc-hepatitis-c-outlook-health-1007-20151001-story.htm

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