truth-out

Saturday, November 18, 2017
By Janine Jackson, FAIR | Interview

Janine Jackson: Donald Trump called on the Department of Health and Human Services to declare a "public health emergency," stating, in what the New York Times called "an elaborate and emotional ceremony," that opioids represent "the worst drug crisis in American history and even, if you really think about it, world history."
As is often the case, it wasn't exactly clear what he was talking about, but media aren't always much clearer. Is the crisis overdose deaths? Opiates themselves? Their overprescription? Their use? Addiction? The issues that lead to addiction? You don't need to be in denial about a problem to recognize that the definition of the problem will affect the response. And when it comes to the "war on drugs" in this country, it's not as though there is no record to check.
So what does Trump's recent declaration mean, and what possible responses to problems associated with opioids are existing, but maybe not mentioned? We're joined now by Maria McFarland Sánchez-Moreno, executive director of Drug Policy Alliance. Welcome to CounterSpin, Maria McFarland Sánchez-Moreno.
Maria McFarland Sánchez-Moreno: Thanks so much for having me.
JJ: I've heard Trump's declaration of a public health emergency around opioids described as "good but not enough," "good but it needs money attached." We can be grateful for official attention, which we know is meaningful, but if a policy is wrongheaded or misdirected, it's hard to wish that it had more fuel behind it. I wonder if you can just walk us through some of the things that you found problematic or that concerned you about Trump's declaration.
MMSM: Yeah, so, I wouldn't call his declaration "good." I would say that there were a couple of good proposals buried in there that might mitigate some of the harm of the overdose crisis. But overwhelmingly, his speech just betrayed ignorance, and perhaps deliberate indifference to the realities underlying drugs and drug use in the United States. And if the US really pursues the path that he has charted in his rhetoric, it's a recipe for more overdose deaths, continued harsh war on drugs, and no real meaningful progress.
JJ: You have said that the war on drugs is a factor in the overdose crisis. What do you mean by that?
MMSM: A big part of the problem here is the war on drugs itself, the fact that for over 50 years, the US has been focusing on strictly prohibiting access to certain types of drugs, and using criminal justice responses to deal with them. As a result, people who use drugs are often doing so underground, in ways that make it much more likely that they will overdose; much more likely that they will encounter substances that have been adulterated, for example with fentanyl, and have no way to check them; much more likely that they will not have basic information about how to mitigate risk.
For example, a huge number of the overdoses that we're seeing right now have to do with mixing substances, with mixing opioids and alcohol or mixing opioids and benzodiazepine. Those deaths perhaps could be prevented if people knew that mixing was a major factor in overdose. But right now, public education on drugs doesn't really get into those issues.
And what Trump was proposing in his speech was a return to "just say no"–style ad campaigns and education campaigns from the 1980s, which are what the Reagans pushed, and were proven to be utterly ineffective, because young people tend to dismiss them as patronizing and not based on reality.
Yeah. I mean, "just say no," I think many people thought that that was kind of a punchline at this point. But now it's being reintroduced as actual policy, and Donald Trump has said of opioids, and of drugs in general, "It's really, really easy not to take them." And it seems sort of emblematic of a bifurcation, of a difference, where some people think if you talk about drugs -- the same as sex -- if you talk about it, that's going to make people do it. And so what we really need to say is, no, that's not acceptable, you won't do that, that's not going to happen. And then you don't get any clarity about what happens if it happens.
Yeah. I think we need to talk about a fundamental shift in the way we frame drug issues. I think we need to as a society, and certainly the government needs to, recognize that drug use is a fact, that there are always going to be some people in society who use drugs, whether they're legal or not. Then you have to look at, OK, some people are going to use drugs, some people will misuse drugs. How can you reduce the likelihood that people will misuse drugs, and that they will have the whole host of problems that are associated with misuse? And how can you mitigate the risks that the worst things will happen, like overdose?
TO CONTINUE READING: http://www.truth-out.org/news/item/42611-we-need-a-fundamental-shift-in-the-way-we-frame-drug-issues

​
Gail Connor Roche
Publish Date: Tuesday, November 14, 2017

Nine countries are on track to eliminate the hepatitis C virus (HCV) by 2030, current estimates from the Polaris Observatory show.
           
Australia, Egypt, France, Georgia, Germany, Iceland, Japan, the Netherlands, and Qatar are all set to wipe out the liver-attacking disease by the World Health Organization’s target date, according to the Lafayette, Colorado-based Polaris.
           
“Countries like Australia, Egypt and the Republic of Georgia have made the elimination of HCV a political priority and have allocated the resources to make it happen,” Michael Ninburg, MPA, president-elect of the World Hepatitis Alliance, told MD Magazine.
           
Based on current policies, the US is 1 of 22 nations including Spain, the UK, Canada and Iran that are "working towards" HCV elimination.           

For China, Russia, India, and some 5 dozen other countries, the 2030 goal is unachievable given existing policies, Homie Razavi, PhD, MBA, told MD Magazine. Razavi is managing director of the CDA Foundation, which oversees Polaris’s mission of supplying data, training and analytics to end viral hepatitis.

Treating more than 7% of the HCV infected population with no restrictions, working on harm reduction, and screening patients are key requirements for reaching the 2030 target, Razavi said.
           
“The US is already treating more than 7% of the infected population, but it needs to remove restrictions so that therapies are available to all — independent of fibrosis stage,” Razavi said.
           
Brazil, which hosted the World Hepatitis Summit in Sao Paulo from November 1 to 3, will appear on the “on track” list in 2018, he said. The country has pledged to open access to everyone next year, screen the whole population, and treat 100,000 patients per year.
             
“Brazil did announce at the WHS that they will do everything above in 2018 and they will be on the Polaris list next year,” Razavi said.
           
Australia, 1 of the 9 countries already on track to attain the 2030 target, has been at the forefront of HCV elimination efforts.

The country was among the first to subsidize new HCV medicines, making a range of direct acting antiviral (DAA) drugs available starting on March 1, 2016.

In August 2017, the government announced it would subsidize Gilead Sciences’s Epclusa (sofosbuvir/velpatasvir).

Australia treated 32,400 of its chronic HCV patients (14%) in 2016, Greg Dore, head of the Viral Hepatitis Clinical Research Program at the Kirby Institute in Sydney, told MD Magazine in August.

A Kirby report released earlier this year estimated that Australia is set to eliminate HCV by 2026 — 4 years earlier than the WHO’s goal.

The WHO targets include a 90% reduction of new hepatitis B (HBV) and HCV infections and a 65% reduction in mortality related to hepatitis by 2030.  The organization set these goals in 2016.

The United States is not among the “on track” countries because the combination of baby boomer and risk-based screening isn't working, Ninburg said. The CDC recommends that the baby boomer generation born from 1945 to 1965 be screened, but that may not be adequate, Ninburg said.

  TO CONTINUE READING-  https://www.specialtypharmacytimes.com/news/united-states-falling-behind-other-countries-eliminating          

We, members and representatives of the viral hepatitis community - a community that includes people living with viral hepatitis, doctors, nurses, social workers, researchers, public health experts, and people who use drugs - are concerned over the growing gap between the enormous impact of hepatitis B and hepatitis C over people who use drugs and their almost non-existent access to prevention, diagnosis and treatment services around the world. Sharing unsterile drug injecting equipment puts people at high risk of hepatitis B and hepatitis C infections. Globally it is estimated that among the 15.6 million people who currently inject drugs 52% are hepatitis C antibody positive, and 9% are living with chronic hepatitis B infection [1]; From a public health and human rights perspective, improving access to prevention and treatment for people who use drugs is crucial to reducing hepatitis C incidence and eliminating the epidemic, as sharing of needles, syringes and other injecting equipment is estimated to account for 23% of new infections [2]. Ensuring access to interventions such as low-threshold needle and syringe programmes, opioid substitution therapy, hepatitis C treatment and other harm reduction interventions are essential to reduce hepatitis C incidence and prevalence among people who inject drugs [3][4], and these interventions are cost-effective [5][6]. In 2016, the Member States of the World Health Organization (WHO) adopted the first ever Global Health Sector Strategy (GHSS) on viral hepatitis [7]. It identified harm reduction as one of five core interventions needed to reach the goal of viral hepatitis elimination by 2030. Despite the evidence and WHO recommendations, comprehensive harm reduction services are inaccessible for most people who use drugs worldwide. In 2017, among the 179 countries and territories where injecting drug use has been reported, just 86 (48%) have implemented opioid substitution therapy and 93 (52%) have needle and syringe programmes [8]. Furthermore, the regional and national coverage varies substantially and is most often below WHO indicators, with less than 1% of people who inject drugs living in countries with high coverage of both services [8]. Even where services do exist, people who use drugs face more difficulties in accessing hepatitis C prevention and treatment due to poor access to health services, their exclusion through treatment criteria, threats of violence and abuse when disclosing status as drug users, and universal stigmatization. As a result, the hepatitis C epidemic continues to grow among people who use drugs [9]. This lack of access to hepatitis care for people who use drugs is deeply rooted in and driven by our laws and policies which criminalize drug use, drug possession and, ultimately, people who use drugs themselves [10][11]. Punitive drug law enforcement is a direct barrier to harm reduction services in many ways: - the prohibition of drug paraphernalia possession impedes harm reduction service delivery and uptake; - many national laws impose severe and disproportionate custodial sentences for minor, non-violent drug offenses (such as drug use, possession and low-level supply); - people who use drugs are frequently incarcerated or extra-judicially detained, often leading to interruption of medical treatments, without access to prevention and other harm reduction services, and at heightened risk of hepatitis infection; - policies criminalizing drug use fuel stereotypes and negative assumptions of people who use drugs, ultimately reinforcing stigmatization and discrimination. 
TO CONTINUE:
​ http://www.worldhepatitisalliance.org/sites/default/files/resources/documents/declaration_of_the_hepatitis_community-_no_e

                                                                          October 27th,2017
The NYC Board of Health Amended the Health Code to Improve Complete Hepatitis C Diagnostic Testing in NYC
In order to improve complete hepatitis C diagnostic testing, care and treatment rates in New York City at the population level, the Board of Health adopted an amendment to the Health Code to require laboratories to automatically perform an hepatitis C RNA confirmatory test when there is an initial positive antibody test for hepatitis C. Complete diagnostic testing for hepatitis C is an important first step to ensuring that people are aware of their status and have the opportunity to be treated and cured. Combining these two steps will ensure that patients with hepatitis C are diagnosed immediately the first time they are tested, rather than having to return to the clinician for follow-up visits and testing. The Board of Health approved the Amendment in September 2017, and the law went into effect on October 20th 2017.
In the newly released Annual Report, “Hepatitis B and C in New York City 2016” , the Health Department reported that among 11, 847 newly reported cases of hepatitis C in 2016, 23% never received hepatitis C RNA confirmatory testing to determine whether they have active, current infection. The Health Department also reports on an analysis of patient outcomes for people reported with active hepatitis C infection in 2015, finding that only a third initiated treatment. And more than half of deaths related to hepatitis C in 2015 occurred prematurely, in people aged 65 or younger.
Hepatitis C related liver disease progression, cancer, premature death and ongoing transmission of the virus can be prevented by ensuring that people with active hepatitis C are appropriately tested and treated to cure the infection. Treatment is now only eight to twelve weeks with all oral well tolerated medications, and almost all people treated can be cured regardless of comorbid conditions, drug use or alcohol consumption.
The Health Department’s policy approach to improving hepatitis C clinical practice is important as 146,500 people are estimated to be infected hepatitis C and only 16% are estimated to be cured. New York City is the first in the nation to mandate hepatitis C antibody to reflex RNA testing by laboratories, an important health policy advancement strategy that may be replicable across the nation.
This letter has been sent to NYC laboratories informing them of the amendment.

https://hepfree.nyc/media-advisory-hep-c-rna-reflex-testing-health-code-amendment-adopted/

​Updated by German Lopez@germanrlopezgerman.lopez@vox.com  Jan 25, 2016, 11:10am EST

Amid all the horrors of the opioid painkiller and heroin epidemic, one good bit of news is that it hasn't hit minority communities very hard. But there's never really been, in my view, a satisfactory explanation for this: Why are minority communities avoiding the worst of the epidemic?
Well, the New York Times has a possible explanation — and it's disheartening. Gina Kolata and Sarah Cohen reported for the Times:
There is a reason that blacks appear to have been spared the worst of the narcotic epidemic, said Dr. Andrew Kolodny, a drug abuse expert. Studies have found that doctors are much more reluctant to prescribe painkillers to minority patients, worrying that they might sell them or become addicted.
"The answer is that racial stereotypes are protecting these patients from the addiction epidemic," said Dr. Kolodny, a senior scientist at the Heller School for Social Policy and Management at Brandeis University and chief medical officer for Phoenix House Foundation, a national drug and alcohol treatment company.
It's a troubling possibility: Basically, doctors didn't give black patients drugs that were thought to be needed for pain treatment due to racist stereotypes. Then white patients who got the drugs became addicted, and some, over time, shifted to another, cheaper, more potent opioid — heroin — to satiate their addiction.
TO CONTINUE READING: https://www.vox.com/2016/1/25/10826560/opioid-epidemic-race-black

BY Kumasi Aaron  ABC Action News   WFTS Tampa Bay
Posted 5:49 PM, Oct 24, 2017

It's a disease that kills more people a year than HIV. Yet, millions of people in the U.S. are living with it and don't know. We're talking about Hepatitis C, and baby boomers are 5 times more likely than any other group to have it.     
Stella Armenta just celebrated her birthday.
"Yeah it's going to be a good year," Armenta says.
It's a day she didn't know if she'd be here to see this time last year.
 
​"I started feeling tired and I started to swell a little bit around my belly," Armenta remembers.
Armenta went to the ER trying to find out what was causing these symptoms. And wasn't prepared for her diagnosis.
"I felt like I got hit in the head when they said you got Hepatitis C," Armenta says. "I was like me, how in the world?"
Hepatitis C is a virus that can slowly damage the liver. It's spread by blood to blood contact, like IV drug use and transfusions. And the Centers for Disease Control says 1 in 30 baby boomers has the virus and don't even know it.

​"I just thought well I wasn't a drug user. I never was like you know dirty bathrooms and stuff where they say you can get stuff," Armenta says. "I was always just regular mom and working person."
But Armenta had a hysterectomy, and blood transfusion in the 80's. Hep C wasn't discovered until 1989, and donated blood wasn't screened for the virus until 1992.

TO CONTINUE READING:​ http://www.abcactionnews.com/news/national/1-in-30-baby-boomers-living-with-disease-and-don-t-know