BY EMILY ALPERT REYESSTAFF WRITER 
MARCH 9, 2023 1:14 PM PT   LA Times

The Biden administration is seeking billions of dollars for a new push to wipe out hepatitis C, a virus that has continued to kill thousands of people annually in the U.S. despite the existence of extremely effective medications that can cure the infection within months.

The five-year program, outlined as part of a broader budget proposal Thursday by White House officials, has been estimated to have a net cost of $5 billion over a decade, said Dr. Francis Collins, a special advisor to the president for special projects.

It would require an upfront investment now estimated at more than $11 billion over five years, which Collins said would be offset by government savings from preventing liver failure and other conditions that result from hepatitis C — and therefore avoiding the costs of treating them.

The exact costs would hinge on negotiations with drugmakers, who would be paid a lump sum to make an unlimited supply of direct-acting antiviral pills available to patients on Medicaid, as well as those who are uninsured, incarcerated or treated through the Indian Health Service, said Collins, the former director of the National Institutes of Health.
Such “subscription” deals have already been tested in some states in an effort to expand access to the lifesaving medication.
White House officials said the medicines can now cost roughly $20,000 per patient, but researchers have found curing patients can ultimately save money that would later be spent treating liver ailments.

TO CONTINUE READING: https://www.latimes.com/world-nation/story/2023-03-09/biden-seeks-billions-to-wipe-out-a-hepatitis-c

WASHINGTON — The Biden administration will request “significant investments” to help eliminate hepatitis C in the United States in its forthcoming budget proposal, according to Francis Collins, the former NIH director leading the project.
Collins declined to provide too many further details before the official budget request later this week, but Rep. Hank Johnson, (D-Ga.), who joined Collins at a STAT event on the subject Tuesday, suggested the request could potentially be as big as $10 billion over five years. Collins also pointed out that the plan “fits nicely” with President Biden’s broader cancer moonshot, an initiative aimed at halving the cancer rate in 25 years, since hepatitis C is one of the leading causes of liver cancer.
“I would like, if it’s possible, to be as bold as possible, and contemplate not just an effort that would improve the situation, but that would eliminate hepatitis C in the United States,” Collins said at the event. “That’s a scary word, and obviously would require a huge investment, to try to reach everybody.”

He also said he’s hoping the initiative would be funded as “mandatory” spending, which would ensure it would not need to be renewed each year by Congress. Johnson, too, referenced a potential request for mandatory spending.
The Biden administration is expected to release more details about its federal budget later this week.

​TO CONTINUE READING: https://www.statnews.com/2023/03/07/francis-collins-budget-eliminating-hep-c/

​By Lisa Marie Basile | Fact-checked by Barbara Bekiesz 
| Published February 22, 2023 MD Linx

Key Takeaways

• Xylazine (or “Tranq”) is a dangerous new recreational drug often combined with other substances. It is responsible for a growing number of overdoses. 
• It can lead to skin ulcers, central nervous system and respiratory depression, hypotension, and other health complications, including death.
• There are no FDA-approved medications available to treat xylazine dependence. Naloxone does not work to reverse potential overdoses.

​A dangerous new recreational drug, xylazine—also referred to as “tranq”—has made its way through cities across America. Its effects can cause serious health consequences and, in many cases, overdose and death, according to the journal Drug and Alcohol Dependence.[1] 
Xylazine’s impact in recent years is undeniable. For example, deaths related to xylazine in Pennsylvania jumped from 2 percent to 26 percent from 2015 to 2020, while xylazine was involved in 19 percent of all overdose deaths in Maryland in 2021.[2]  Deaths related to xylazine may also be underreported, as many forensic labs and toxicology tests do not test for xylazine. Its popularity comes down to how cheap it is to access and how strong its effects are. According to Abid Nazeer, MD, a psychiatrist and senior medical advisor for Symetria Recovery, “Xylazine’s popularity is connected to its ability to potentially extend the effect of other drugs, such as heroin and fentanyl.” Xylazine can also be bought very cheaply by dealers, who can order it online, Nazeer tells MDlinx.

​TO CONTINUE READING: https://www.mdlinx.com/article/lethal-street-drug-resistant-to-naloxone-gains-popularity/6Sl08mQtC5IoZK7QjkqjSA?

Over the past year, we have seen a sweeping and ferocious attack on the rights and dignity of transgender people across the country.
In states led by Republicans, conservative lawmakers have introduced or passed dozens of laws that would give religious exemptions for discrimination against transgender people, prohibit the use of bathrooms consistent with their gender identity and limit access to gender-affirming care.
In lashing out against L.G.B.T.Q. people, lawmakers in at least eight states have even gone as far as to introduce bans on “drag” performance that are so broad as to threaten the ability of gender-nonconforming people simply to exist in public.
Some of the most powerful Republicans in the country want to go even further. Donald Trump has promised to radically limit transgender rights if he is returned to the White House in 2024. In a video address to supporters, he said he would push Congress to pass a national ban on gender-affirming care for transgender youth and restrict Medicare and Medicaid funding for hospitals and medical professionals providing that care.

​TO CONTINUE READING: https://www.nytimes.com/2023/02/10/opinion/trump-desantis-transgender-rights.html?auth=login-google1tap&login=google1tap

By Noah Weiland, NY Times    Feb. 10, 2023, 5:00 a.m. ET

​President Biden has endorsed “harm reduction,” which aims to cut down on overdoses by encouraging safer drug use. But the organizations carrying out that strategy are severely underfunded.

OSCEOLA, Iowa — So many of Deborah Krauss’s friends and neighbors have died of drug overdoses during the pandemic that she said she felt as if she had been living inside of a dream. The longest she has gone without someone dying, she noted, is three weeks. Her calendar grew cluttered with funerals.
“I lost count at 40,” she recalled on a recent evening in a Des Moines office as she organized supplies to help people consume drugs more safely. “And it just keeps happening.”
The next day, Ms. Krauss was on the road, parked outside a Walmart in the small Iowa town of Osceola, her trunk brimming with boxes of syringes, fentanyl test strips and overdose-reversing medication. A former hair stylist, she recalled the stress of grooming an ex-boyfriend’s facial hair to make him presentable at his funeral after he died from an overdose in 2018.

Ms. Krauss, 38, is one of the few practitioners in Iowa of a public health strategy known as “harm reduction,” a wide-ranging set of policies that President Biden and many federal and local health officials and physicians have made central to their efforts to curtail record-breaking overdose deaths. The strategy does not seek to cut people off from drug use. Instead, it aims to give them tools to use drugs in a safer manner, like the supplies in Ms. Krauss’s trunk.

In his State of the Union address on Tuesday, Mr. Biden, the first president to endorse the strategy, highlighted the federal government’s attention to some of the core features of harm reduction work, including a provision in a recently enacted spending package that makes it easier for doctors to prescribe buprenorphine, an effective addiction medication that Ms. Krauss works to get to drug users. During his speech, Mr. Biden recognized the father of a 20-year-old from New Hampshire who died from a fentanyl overdose, citing the more than 70,000 Americans dying each year from the potent synthetic .

TO CONTINUE:   
https://www-nytimes-com.cdn.ampproject.org/c/s/www.nytimes.com/2023/02/10/us/politics/harm-reduction-overdoses-iowa.amp.html

Less than one third of infants born to mothers with the virus were screened for HCV.
​January 26, 2023 • By Sukanya Charuchandra

Active hepatitis C virus (HCV) infection during pregnancy is associated with premature birth, and a high viral load increases the risk of vertical transmission, according to findings published in the Journal of Hepatology. However, only a minority of infants born to mothers with HCV are screened for the infection, as is recommended by treatment guidelines.
Previous studies have shown that the mother-to-child HCV transmission rate is around 6%. But the viral load level needed for transmission and the impact of hepatitis C on pregnancy outcomes are not well understood.
Tatyana Kushner, MD, of the Icahn School of Medicine at Mount Sinai in New York City, and colleagues conducted a retrospective study to better understand vertical transmission of hepatitis C and its impact on pregnancy outcomes.
Using administrative healthcare data, the team identified 2,170 pregnancies among 1,636 women in Ontario who acquired hepatitis C before pregnancy. In 1,780 of these cases (82%), the women continued to test positive for HCV RNA during their pregnancies, indicating active infection.
Women who tested positive for HCV RNA during pregnancy were more likely to deliver their babies prematurely than those who did not have active HCV infection (18% versus 12%, respectively). The former group was also at greater risk for intrahepatic cholestasis of pregnancy (blocked bile flow) and postpartum hemorrhage. However, women with active HCV infection during pregnancy were less likely to develop gestational diabetes than those who had cleared the virus.
Less than a third (29%) of the newborns born to women with hepatitis C were screened for HCV after birth. Of those who were screened, the mother-to-child transmission rate was 3.5%. Women with an HCV RNA level of at least 6.0 log, or about 1,000,000 copies, had more than a threefold greater likelihood of vertical transmission.

​TO CONTINUE READING: https://www.hepmag.com/article/hepatitis-c-pregnancy-linked-worse-outcomes

By Jules Murtha | Fact-checked by Barbara Bekiesz  MD Linx
| Updated December 20, 2022

Key Takeaways

• Those who struggle with substance use disorders often deal with the stigma of being perceived as dangerous, incapable of recovering, or blamed for the state of their condition.
  
• To help destigmatize patients who deal with substance misuse, clinicians can use person-first language and scientifically accurate terminology when talking about addiction.
  
• Examples of non-stigmatizing language include “return to use” (instead of “relapse”), “drug misuse” (instead of “drug abuse”), and “person in active use” (instead of “junkie”).
  

“The only constant in life is change.”
This quote from Heraclitus didn’t specifically refer to the evolving nature of medical terminology, or the consequences of stigmatizing language. Yet, it perfectly applies to research on the language of addiction, which urges clinicians to rethink how they speak about the disease.
The link between language and stigmaThe US government has recognized the harsh effects of stigmatizing language on patients with substance use disorders.
A 2017 memo written by Michael P. Botticelli, the former director of the White House Office of National Drug Control Policy, recognized how stigmatizing language may negatively alter societal perceptions of people with substance use disorders.[1]
According to Botticelli, although people with substance use disorders are capable of recovery, “sometimes the terminology used in the discussion of substance use can suggest that problematic use of substances and substance use disorders are the result of a personal failing; that people choose the disorder, or they lack the willpower or character to control their substance use.”
This, along with the perception that those who use substances are dangerous, could converge to create a stigma associated with substance use that can do real damage. This is especially true for women and mothers, who often have poor self-esteem, depression, fear, and anxiety as a result of addiction-related stigma.
A 2021 article published by the NIH stated that stigma has the power to prevent patients with substance use disorders from seeking proper treatment, as well as negatively affecting physicians’ understanding of them.[2] This may ultimately influence the quality of care they receive.
Person-first languageResearchers urge doctors to adapt their terminology by using person-first language.
Person-first language is defined by the NIH as language that “maintains the integrity of individuals as whole human beings by removing language that equates people to their condition or has negative connotations.”[3]
But what does person-first language sound like? What vocabulary should be used in the hallways and the exam room, when referring to substance use disorders and the patients who struggle with them?
Read Next: Identifying drug-seeking behaviors in your patients

Different ways to describe substance useWhen it comes to changing the language of addiction, there are a few concrete terms and phrases to use in place of potentially stigmatizing ones.
According to the NIH and an article published by StatNews.com, this list of revised, person-first terms is as follows:[4]

• Abuse → Use, misuse, or used other than prescribed
  
• Addict → Person with substance use disorder
  
• Alcoholic → Person with alcohol use disorder
  
• Junkie → Person in active use
  
• Relapse → Return to use
  
• Former addict → Person in recovery or person in long-term recovery
  
  ​TO CONTINUE: https://www.mdlinx.com/article/the-evolving-language-of-addiction-your-words-matter-to-your-patients/4OhHwgrWfLUbSlXjBw7RHa?show_order=2&article_
  
  

Too many Americans are missing out on a cure for hepatitis C
ByLAURAN NEERGAARD AP Medical Writer   ABC News-  December 20, 2022, 12:35 PM

WASHINGTON -- Too many Americans are missing out on a cure for hepatitis C, and a study underway in a hard-hit corner of Kentucky is exploring a simple way to start changing that.
The key: On-the-spot diagnosis to replace today's multiple-step testing.
In about an hour and with just a finger-prick of blood, researchers can tell some of the toughest-to-treat patients — people who inject drugs — they have hepatitis C and hand over potentially life-saving medication.
Waiting for standard tests “even one or two days for someone who’s actively using drugs, we can lose touch with them,” said Jennifer Havens of the University of Kentucky, who's leading the study in rural Perry County. To start treatment right away "that’s huge, absolutely huge.”
Single-visit hepatitis C diagnosis already is offered in other countries, and now the White House wants to make it a priority here.
​
​“It’s frankly an embarrassment” that the U.S. doesn’t have such an option, said Jeffrey Weiss of New York’s Mount Sinai health system, who works with a community hepatitis C outreach program. “We have many people we’ve tested and want to give their results to and can’t find them.”
At least 2.4 million Americans are estimated to have hepatitis C, a virus that silently attacks the liver, leading to cancer or the need for an organ transplant. It leads to more than 14,000 deaths a year. That's even though a daily pill taken for two to three months could cure nearly everyone with few side effects.
Yet in the U.S., more than 40% of people with hepatitis C don't know they're infected. Fewer than 1 in 3 insured patients who are diagnosed go on to get timely treatment. And new infections are surging among younger adults who share drug needles.

​“This is a travesty,” said Dr. Francis Collins, the former National Institutes of Health director who’s now a White House adviser devising a new national strategy to tackle hepatitis C.
Most likely to fall through the cracks are “people in tough times” -- those who inject drugs, are uninsured or on Medicaid, or are homeless or incarcerated -- who can’t navigate what Collins calls the “clunky” diagnosis process and other barriers to the pricey pills.

“It’s frankly an embarrassment” that the U.S. doesn’t have such an option, said Jeffrey Weiss of New York’s Mount Sinai health system, who works with a community hepatitis C outreach program. “We have many people we’ve tested and want to give their results to and can’t find them.”

​At least 2.4 million Americans are estimated to have hepatitis C, a virus that silently attacks the liver, leading to cancer or the need for an organ transplant. It leads to more than 14,000 deaths a year. That's even though a daily pill taken for two to three months could cure nearly everyone with few side effects.
Yet in the U.S., more than 40% of people with hepatitis C don't know they're infected. Fewer than 1 in 3 insured patients who are diagnosed go on to get timely treatment. And new infections are surging among younger adults who share drug needles.

“This is a travesty,” said Dr. Francis Collins, the former National Institutes of Health director who’s now a White House adviser devising a new national strategy to tackle hepatitis C.
Most likely to fall through the cracks are “people in tough times” -- those who inject drugs, are uninsured or on Medicaid, or are homeless or incarcerated -- who can’t navigate what Collins calls the “clunky” diagnosis process and other barriers to the pricey pills.

​TO CONTINUE STORY: https://abcnews.go.com/Health/wireStory/us-starts-grappling-travesty-untreated-hepatitis-95611164

DEATH SENTENCE

There is a simple, outright cure for hepatitis C. But state prisons across the country are failing to save hundreds of people who die each year from the virus and related complications.
 
A STAT investigation has found that more than 1,000 incarcerated people died from hepatitis C-related complications in the six years after a curative drug hit the market. The death rate in 2019 was double that of the broader U.S. population.In the stories on this page, reporter Nicholas Florko documents prisons’ blatant refusal to test and treat people with the condition, even, in some cases, in the face of legal orders to do so. He introduces incarcerated people who watched their health deteriorate or lost their lives because of the rationing of hepatitis C drugs. Prisons say the medicine, even as its price drops, is too expensive for them to distribute widely. But incarcerated people are fighting back: Some have fought for the treatment in the courts and won, forcing the system to care for them and, in some cases, other incarcerated hepatitis C patients.
​
TO READ MORE:​ https://www.statnews.com/death-sentence/?utm_source=email_nns&utm_campaign=hep_investigation_launch&utm_medium=email&utm_source=STAT+Newsletters&utm_campaign=6315953c4e-EMAIL_CAMPAIGN_2022_12_08_08_25&utm_medium=email&utm_term=0_-6315953c4e-%5BLIST_EMAIL_ID%5D

By Joe Hannan | Medically reviewed by Kristen Fuller, MD 
| Updated November 17, 2022    MDLinx

Key Takeaways

• Overdose deaths stemming from opioid addiction remain a leading cause of the death in the US.
  
• Clinicians find themselves awash with the third wave (as documented by the CDC) of opioid addiction, which is driven in large part by synthetic opioids such as fentanyl.
  
• Medication for opioid use disorder is an effective treatment modality, but access—as well as patient, public, and clinical attitudes—have a decisive impact on its utilization.
  

Opioid addiction has gone from a relic of bygone eras to an epidemic raging in American homes and communities. No spot on the US map is untouched by the addiction crisis, and it's common to know someone who has been struck by this tragedy.
But much has changed in the fight against opioid addiction. New diagnostic approaches and treatments, as well as shifting attitudes, are hopefully poised to lay this problem to rest.
How we got hereChart out the pattern of opioid overdose deaths in the US, beginning in 1999, and you get a hockey-stick graph.[1]
Between 1999 and 2020, an estimated 546,000 people died from opioid overdoses.
The CDC charts the rise of opioid addiction and its deadly wake in three distinct waves. Wave 1 began to crest in the 1990s with the wide distribution of prescription opioids. Wave 2 marked a shift toward fatal heroin overdoses beginning in 2010.
Clinicians find themselves struggling to stay afloat as Wave 3 pummels the US healthcare system. Driving this surge are synthetic opioids such as fentanyl. Increasingly, fentanyl and its synthetic analogs (acetylfentanyl, furanylfentanyl, and carfentanil) have made their way into combinations with heroin, cocaine, and counterfeit pills—all with deadly implications, including accidental overdose.
The CDC estimates that 187 people are dying each day from opioids.
TO CONTINUE: ​https://www.mdlinx.com/article/opioid-crisis-update-whats-changed-and-where-are-we/2iqSkO3VbVT9WwLQNq0Ae?show_order=2&article_type=selected&tag=Morning&utm_campaign=daily-alert_all-specialties_221118_malert_a90&ipost_environment=m3usainc&utm_medium=email&utm_source=iPost&iqs=9z2zrtc58f4bcnhgjr6g5vi8bpasbkbcjtrb1g1lomg