Madison Heck, MPH, CHES

The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.
Among patients with hepatitis C virus (HCV) infection with a history of injectable drug use, those who underwent rapid treatment with a 7-day course of sofosbuvir-velpatasvir achieved significantly increased cure rates compared with those treated with usual care, according to research presented at IDWeek, held virtually from September 29 to October 3, 2021.


 Researchers conducted a study on patients aged 18 to 29 years with HCV who were treatment naïve and had used injectable drugs within the past 30 days. Patients were randomly assigned in a 1:1 fashion to receive either rapid treatment with sofosbuvir-velpatasvir or usual care. In addition to a 7-day course of sofosbuvir-velpatasvir, patients in the rapid treatment group received a same-day medical evaluation, confirmatory and baseline laboratory testing. Patients in the usual care group received same-day HCV confirmation and facilitated referral to a local healthcare provider. The primary endpoint was sustained virologic response at 12 months.

​TO CONTINUE: https://www.infectiousdiseaseadvisor.com/home/meetings/id-week-2021/sofosbuvir-velpatasvir-treatment-in-patients-with-hepatitis-c-who-inject-drugs/



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SEPTEMBER 29, 2021  Albany, NY
Governor Kathy Hochul today announced Mary T. Bassett, MD, MPH, has been appointed Commissioner of the Department of Health. With more than 30 years of experience devoted to promoting health equity and social justice, both in the United States and abroad, Dr. Bassett's career has spanned academia, government, and not-for-profit work. Her appointment is effective December 1.
"Our recovery from this pandemic requires tested leadership and experience to improve health equity and access across the state, and Dr. Bassett is perfectly equipped to lead the New York State Department of Health during this critical moment," Governor Hochul said. "When I was sworn in as Governor, I pledged to build a talented team with the skills, knowledge, and expertise to stop the spread of COVID-19, return our lives to normalcy, and move our state forward. Dr. Bassett is both a highly regarded public health expert and an exemplary public servant, and I look forward to working with her to keep New Yorkers safe and healthy." 
"I am humbled and honored to return to my home state of New York to lead the Department of Health at this pivotal time," incoming Health Commissioner Mary T. Bassett said. "The pandemic underscored the importance of public health, while also revealing inequities driven by structural racism. As we move to end the pandemic, we have a unique opportunity to create a state that is more equitable for all New Yorkers. I look forward to working toward this with Governor Hochul and the team at the Department of Health."
TO CONTINUE READING: ​https://www.governor.ny.gov/news/governor-hochul-appoints-dr-mary-t-bassett-commissioner-department-health

SEPt 21, 2021 AMA Press Releases

​CHICAGO—The American Medical Association (AMA) issued a report (PDF) today showing a 44.4 percent decrease in opioid prescribing nationwide in the past decade. At the same time, the country is facing a worsening drug-related overdose and death epidemic.
To address this continuing epidemic, the AMA is urging policymakers to join physicians to reduce mortality and improve patient outcomes by removing barriers to evidence-based care. The report shows that overdose and deaths are spiking even as physicians have greatly increased the use of prescription drug monitoring programs (PDMPs), which are electronic databases that track controlled substance prescriptions and help identify patients who may be receiving multiple prescriptions from multiple prescribers. The report shows that physicians and others used state PDMPs more than 910 million times in 2020. In 2019, physicians and others used state PDMPs about 750 million times.
Yet, the nation continues to see increases in overdose mainly due to illicit fentanyl, fentanyl analogs, methamphetamine and cocaine, according to the U.S. Centers for Disease Control and Prevention. In addition, state public health, media and other reports compiled by the AMA (PDF) show that the drug-related overdose and death have worsened across the nation. Research and data from the National Institutes of Health, U.S. Substance Abuse and Mental Health Services Administration (PDF), and Indian Health Service underscore the continued challenges and inequities for Black, Latinx and American Indian/Native Alaskan populations.
Opioid prescriptions  have decreased (PDF) by 44.4 percent between 2011-2020, including a 6.9 percent decrease from 2019-2020. Along with the sharp decreases in opioid prescriptions, new AMA data  (PDF) also show that physicians and other health care professionals used the state PDMP more than 910 million times in 2020. The report also highlights that more than 104,000 physicians and other health care professionals have an “X-waiver” to allow them to prescribe buprenorphine for the treatment of opioid use disorder. This is an increase of 70,000 providers since 2017, yet 80 to 90 percent of people with a substance use disorder receive no treatment.
“The nation’s drug overdose and death epidemic has never just been about prescription opioids,” said AMA President Gerald E. Harmon, M.D. “Physicians, have become more cautious about prescribing opioids, are trained to treat opioid use disorder and support evidence-based harm reduction strategies. We use PDMPs as a tool, but they are not a panacea. Patients need policymakers, health insurance plans, national pharmacy chains and other stakeholders to change their focus and help us remove barriers to evidence-based care.”
Actions that states can takeThe AMA is urging policymakers to act now:

• Stop prior authorization for medications to treat opioid use disorder. Prior authorization is a cost-control process that health insurance companies and other payers use that requires providers to obtain prior approval from the insurer or payer before performing a service or obtaining a prescription. It is used to deny and delay services—including life-saving ones—as physicians are required to fill out burdensome forms and patients are forced to wait for approval.
• Ensure access to affordable, evidence-based care for patients with pain, including opioid therapy when indicated. While opioid prescriptions have decreased, the AMA is greatly concerned by widespread reports of patients with pain being denied care because of arbitrary restrictions on opioid therapy or a lack of access to affordable non-opioid pain care.
• Take action to better support harm reduction services such as naloxone and needle and syringe exchange services. These proven harm reduction strategies save lives but are often stigmatized.
• Improve the data by collecting adequate, standardized data to identify and treat at-risk populations and better understand the issues facing communities. Effective public health interventions require robust data, and there are too many gaps to implement widespread interventions that work.

TO CONTINUE READING:
https://www.ama-assn.org/press-center/press-releases/report-shows-decreases-opioid-prescribing-increase-overdoses?utm_source=SFMC&utm_me

Alistair Gardiner|September 15, 2021, MEDICAL PRACTICE MED LINX

Many medical forms begin with two checkboxes, one of which the patient is required to tick: male or female. But millions of Americans don’t fit into this binary. Furthermore, this represents just a sliver of the bias, discrimination, and barriers to medical care that transgender people face.
There are many simple steps physicians can take to make their practice transgender-inclusive.
Along with other LGBTQ+ patients, trans people often navigate a medical system that is not equipped to provide adequate treatment. The setback begins in medical school, where transgender medicine is not often part of the curriculum, and continues into clinics and institutions, where physicians may be unprepared, uneducated, or consciously or unconsciously biased.
Change is coming, albeit slowly. In May, the Biden administration said it would reverse a Trump administration policy that removed gender identity from a section of the Affordable Care Act that prohibits discrimination based on race, color, national origin, sex, age, or disability. By reversing that decision, the more than 1.7 million people in the United States who identify with a different gender from the one assigned to them at birth are now legally protected from discrimination by medical institutions that receive federal funding. 
TO CONTINUE READING: https://www.mdlinx.com/article/do-you-have-a-transgender-friendly-practice/5EHamJqUMhAm7K5cgJU9a6?

Only in the past few years, as gender nonconforming, nonbinary or transgender people come out, has Mx. gained ground as a gender-neutral honorific.

STEVEN PETROW | OPINION COLUMNIST | 7:00 am EST February 28, 2019 USA TODAY

Maddie Luebbert teaches 9th grade English in a Philadelphia public school and, according to a recent NBC News report, is much admired by the students. As in most public schools, the teachers use “Mr.” or “Ms.” (and sometimes, “Mrs.”) as their title when addressed by students. Luebbert, 25, prefers “Mx.” (pronounced “mix”), a gender-neutral alternative to the usual titles. Luebbert herself identifies as “nonbinary” — which is to say neither male nor female.
Say what? Mx.
Most Americans haven’t come across this title yet, likely for two reasons. Other than teachers, doctors, professors and members of the clergy, we generally don’t use courtesy titles — or what are also known as honorifics — anymore. The second reason: It’s only in the past handful of years in this country that as more people who identify as gender nonconforming, nonbinary or transgender come out, Mx. has gained some currency as the gender-neutral cousin to Ms.



But it’s time to add Mx. into the daily mix of titles we use. In considering the addition of Mx. to the OxfordDictionaries.com, published by the venerable Oxford English Dictionary, its assistant editor explained in the London Times, “This is an example of how the English language adapts to people’s needs, with people using language in ways that suit them rather than letting language dictate identity to them.”
'Ms.' sets a good precedent
TO CONTINUE: https://amp.usatoday.com/amp/2993966002

​OPINION| Betraying the Victims of the Opioid, NY Times

Sept. 11, 2021
By Ryan Hampton 
Mr. Hampton was a co-chair of the Official Unsecured Creditors Committee in the Purdue Pharma bankruptcy.

​On Sept. 26, 2019, the Department of Justice appointed me to serve on the Official Unsecured Creditors Committee in the bankruptcy case against Purdue Pharma, the company that helped fuel the opioid overdose crisis through the misbranding and reckless marketing of the powerful painkiller OxyContin. The committee acted as a mega-plaintiff, with broad powers to subpoena records, take depositions and cross-examine witnesses. For nearly two years, I attended countless negotiations, depositions and chambers meetings. I read thousands of pages of confidential documents revealing the true nature and depth of Purdue’s liability in the crisis.
The proceedings came to a close on Sept. 1, 2021. The final settlement promises as much as $10 billion to be distributed among states, municipalities, the federal government, victims and other corporate creditor groups through a restructured company. $4.5 billion of that will come from the company’s former owners, members of the Sackler family, in exchange for civil releases from any future litigation pertaining to the overdose crisis. Only about $750 million was reserved for direct payments to those most injured by the company — more than 130,000 victims who filed claims for harms associated with OxyContin, ranging from addiction to death by overdose.
Ignored by a system devised to protect extreme wealth and perpetuate social disparity, Purdue’s victims find themselves doubly victimized. I know this because I not only represented the victims; I’m one of them.
After my appointment to the nine-member committee, I was elected one of its two co-chairs. We had a fiduciary responsibility to over 600,000 parties with claims against Purdue. They included state and local governments, hospitals, pharmacies, insurance companies and individuals who had been harmed by the pharmaceutical giant.
On Sept. 26, 2019, the Department of Justice appointed me to serve on the Official Unsecured Creditors Committee in the bankruptcy case against Purdue Pharma, the company that helped fuel the opioid overdose crisis through the misbranding and reckless marketing of the powerful painkiller OxyContin. The committee acted as a mega-plaintiff, with broad powers to subpoena records, take depositions and cross-examine witnesses. For nearly two years, I attended countless negotiations, depositions and chambers meetings. I read thousands of pages of confidential documents revealing the true nature and depth of Purdue’s liability in the crisis.
The proceedings came to a close on Sept. 1, 2021. The final settlement promises as much as $10 billion to be distributed among states, municipalities, the federal government, victims and other corporate creditor groups through a restructured company. $4.5 billion of that will come from the company’s former owners, members of the Sackler family, in exchange for civil releases from any future litigation pertaining to the overdose crisis. Only about $750 million was reserved for direct payments to those most injured by the company — more than 130,000 victims who filed claims for harms associated with OxyContin, ranging from addiction to death by overdose.
Ignored by a system devised to protect extreme wealth and perpetuate social disparity, Purdue’s victims find themselves doubly victimized. I know this because I not only represented the victims; I’m one of them.
After my appointment to the nine-member committee, I was elected one of its two co-chairs. We had a fiduciary responsibility to over 600,000 parties with claims against Purdue. They included state and local governments, hospitals, pharmacies, insurance companies and individuals who had been harmed by the pharmaceutical giant.

TO CONTINUE:  ​https://www.nytimes.com/2021/09/11/opinion/purdue-sacklers-opioids-oxycontin-settlement.html

Sep 7, 2021,09:48pm EDT

Janet Burns
Senior Contributor,Consumer Tech FORBES
I cover labor, culture, drugs, AI, and more

A new quantitative and qualitative study on fentanyl use in the Bay Area offers fresh insights on contemporary usage patterns while bringing to mind an Ancient adage: “The more you know, the more you realize you don't know.” Out now in the journal Drug and Alcohol Dependence, it also underscores the urgency and variability of the ongoing overdose crisis, and how nations like ours must commit to understanding drug supplies, use, and users if we mean to curb historic rates of death by overdose.

Entitled “Transition from injecting opioids to smoking fentanyl in San Francisco, California,” the study sought input from hundreds of people who inject drugs (PWID) and compared their responses regarding opioid use from during the second half of 2018 to the first half of 2020, amid “the new era of fentanyl availability in San Francisco.” Researchers also conducted qualitative interviews with PWID “asking about motivations for injecting and smoking opioids.”
What they found was a significant drop in study participants’ median number of past-month injections. Numerous participants who were interviewed by researchers said (among many other noteworthy things) that this drop corresponded with an increase in non-injected fentanyl use, predominantly by smoking it. Some participants said they switched from heroin to fentanyl entirely, citing reasons such as cost, health, or social stigma (e.g. reducing visible ‘track marks’ from injections that might preclude jobs).

​TO CONTINUE READING: https://www.forbes.com/sites/janetwburns/2021/09/07/study-some-fentanyl-users-in-ca-choosing-to-smoke-vs-inject-raising-lots-of-questions/?sh=2b028f6379c9

Medically reviewed by Carissa Stephens, R.N., CCRN, CPN — Written by Mary West on August 20, 202

• Can newborns get it?, Symptoms ,Do newborns need treatment?
• Diagnosis and treatment, Complications, Questions for a doctor​,Summary

Hepatitis C in newborns may occur if the person who birthed them has acquired infection with the hepatitis C virus (HCV). This happens when an unborn child contracts the infection while in the womb.
However, the Centers for Disease Control and Prevention (CDC)Trusted Source state that the risk of this is very low, at around 4–7%. The CDC also recommends that newborns of people with HCV undergo screening for the virus when they are 1–2 months old. Furthermore, they advise testing for antibodies against HCV after infants are 18 months old.
Many infants with HCV do not have symptoms, but they may grow more slowly and fail to gain weight. The HCV goes away without treatment in approximately 25–50% of infants by the time they reach 4 years of age. For children aged 3 years who still have HCV, there are effective antiviral treatments available.
Keep reading to learn more about the symptoms, diagnosis, and treatment of hepatitis C in newborns.
Can newborn babies get hepatitis C?
Newborn babies have a risk of hepatitis C while in the womb if the person carrying them has contracted the infection. The likelihood is 4–7%Trusted Source per pregnancy, but the risk is higher if the pregnant individual has a high viral load, which is the amount of virus in the blood. There is also a greater likelihood if they develop a coinfection of HIV.

Having a cesarean delivery does not increase the risk.
It is also safe for the person with HCV to breastfeed their infant because no evidence shows transmission can occur in this way. However, if the breastfeeding person has nipples that are cracked and bleeding, they should stop nursing temporarilyTrusted Source. Since HCV spreads through blood carrying the HCV infection, it is best to delay nursing until the nipples have healed.
If a male parent or caregiver has HCV, they cannot transmit the virus to a baby in the womb. For this to occur, it would be necessary for them to transmit HCV to the pregnant person first, and then the pregnant person would have to transmit HCV to the baby. The likelihood of such a scenario is close to zero.

​TO CONTINUE READING: https://www.medicalnewstoday.com/articles/hepatitis-c-in-newborns#can-newborns-get-it


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People treated with direct-acting antivirals had better overall survival than those whose hepatitis C remained untreated.
August 2, 2021 • By Sukanya Charuchandra , Hep Magazine

​

People who were treated for hepatitis C with direct-acting antivirals lived longer after receiving potentially curative therapy for liver cancer even if they experienced cancer recurrence, according to findings published in the Journal of Viral Hepatitis.

Chronic hepatitis C virus (HCV) infection can lead to serious liver complications, including hepatocellular carcinoma (HCC), the most common type of liver cancer. Treating HCV with direct-acting antiviral therapy is known to improve liver function and lower the risk of developing liver cancer in the first place and experiencing cancer recurrence in people who were not previously treated for HCC. Takamasa Ohki, MD, PhD, of the Mitsui Memorial Hospital in Japan, and colleagues studied the impact of antiviral therapy on people treated for recurrent liver cancer.
Initially, the researchers recruited 146 individuals with HCC arising from HCV. These participants had undergone potentially curative treatment with radiofrequency ablation, a procedure that destroys tumor cells with high-energy radio waves. They then received direct-acting antiviral (DAA) therapy for HCV between January 2015 and December 2017. The researchers compared this group with a control group comprising 184 individuals with HCV-related liver cancer who were treated with radiofrequency ablation but did not receive antiviral therapy between January 2009 and July 2014 (before DAAs were available). DAAs can cure hepatitis C in most people, including those with advanced cirrhosis or liver cancer.
Ultimately, after matching patients for age, sex, liver function and HCC severity, the researchers short-listed 47 people in each group. Across this study population, 64% were men, the median age was 75 years and 87% were categorized as Child-Pugh class A, indicative of less severe cirrhosis. The median number of tumors was one, and the median tumor diameter was 20 milimeters; these individuals had experienced cancer recurrence a median of three times. The primary endpoint for the study was time to curative treatment failure—described as the time between starting potentially curative cancer treatment and when that therapy was prematurely stopped (for example, because it was no longer working or could no longer be tolerated).

For people who received DAA therapy, 94% and 73% were still benefiting from curative HCC treatment at one year and three years, respectively. The cumulative overall survival rates for this group were 94% and 73% at one and three years.
For people in the control group not treated with DAAs, 73% and 37% were still benefiting from liver cancer treatment at one and three years, respectively. The cumulative overall survival rates for this group were 73%, and 37% at one and three years.

​So people who were treated for HCV with direct-acting antiviral therapy experienced longer times to cancer treatment failure and better overall survival rates.

TO CONTINUE READING: https://www.hepmag.com/article/curing-hepatitis-c-improves-liver-cancer-outcomes

OPINION BY JENEEN INTERLANDI, NY Times Aug 8th, 2021

​It’s been more than two decades since Purdue Pharma released its patented pain medication OxyContin to an unsuspecting public. Since then, more than 500,000 people have died in the United States in an addiction and overdose crisis triggered by the excessive marketing and overuse of that drug and others like it. Thousands of lawsuits have been filed against Purdue and other opioid makers, but for the most part only small-time scapegoats — street dealers and opioid users — have truly been held to account for the epidemic.

That picture won’t change much on Monday, when one of the nation’s biggest opioid settlements is set to be effectively resolved. A federal judge is expected to certify Purdue’s bankruptcy plan, which sits at the center of a $4.5 billion settlement between the company and thousands of state and municipal governments that have sued for damages related to the opioid epidemic. In many ways, that settlement is atrocious. Members of the billionaire Sackler family, which owns Purdue and profited most heavily from the company’s opioid dealings — will not have to admit to any wrongdoing. They will secure near-total immunity from any future litigation, and by the time the settlement is paid out they most likely will be as wealthy as they ever were.

But the deal will achieve at least some good: Millions of pages of documents, detailing the full scope of the company’s malfeasance, will be made public. Communities across the country will finally receive some of the money they need to address the ongoing crisis. And the resolution of so many lawsuits at once will bring a small measure of closure to a plague that has felt interminable and shows no signs of abating. That is nothing to scoff at, for a nation weary of epidemics and starved for closure of any kind.

As one chapter in this long and terrible story ends, it’s crucial not to lose sight of the human faces behind the grim statistics. Five hundred thousand is an incomprehensible figure, even — or especially — in the age of Covid. It includes sons and daughters and siblings and parents and spouses and friends. It includes the suffering of all the people who loved them. It includes so much heartache and despair that hardly anyone in America today remains untouched by it. And, of course, there are the two million or so more people who are still living, and struggling, with opioid use disorder and its consequences. 
In the face of that struggle, it’s important to remember that there are still more causes for hope than for despair.
For starters, we know what does and doesn’t work against addiction epidemics. Criminalization of drug use, and the war on drugs that undergirds it, has been a dismal failure by just about every conceivable metric. People suffering from substance use disorders have been stigmatized, nonviolent drug offenders remain imprisoned and the crisis has continued unabated.
What does work is evidence-based treatment and harm reduction. Decades of data make clear that medication assisted therapies like methadone and buprenorphine can cut the mortality rate of opioid addiction in half. Likewise, the balance of evidence shows that harm reduction programs — like needle exchanges, safe injection sites and routine use of the overdose reversal drug naloxone — can reduce the number of overdose deaths by helping people with opioid use disorder consume these drugs more safely.
TO CONTINUE:  ​https://www.nytimes.com/2021/08/08/opinion/opioid-epidemic-sacklers-settlement.html?campaign_id=2&emc=edit_th_20210809&instance_id=37477&nl=todaysheadlines&regi_id=35747334&segment_id=65763&user_id=ccde51e4ec9251b4505257eedc2ee927