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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
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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
“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]
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 STAT Investigates: America's prisons refuse to treat hundreds of patients dying of hepatitis C12/20/2022 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
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 ROLLCALL POLICY - By Sandhya Raman, Posted October 25, 2022 at 11:15am
The plan would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic The Biden administration is preparing a comprehensive initiative to fight hepatitis C that would streamline testing and treatment and secure an agreement with drugmakers to bring down the cost of treatment of the disease, which has spiked during the pandemic. Francis Collins, special project adviser to President Joe Biden and former longtime director of the National Institutes of Health, said Monday the administration hopes to secure some funding this year for the yet to be formally unveiled initiative. He said he has briefed Biden on the plan, and the Office of Management and Budget is “enthusiastic about figuring out how to fit this into the budgetary requests.” The plan, he said, would include agencies including the Centers for Disease Control and Prevention, Substance Abuse and Mental Health Services Administration, the Indian Health Service, Food and Drug Administration and the Federal Bureau of Prisons. “It would certainly involve virtually all of the government agencies that have a major role to play,” he said. TO CONTINUE: https://rollcall.com/2022/10/25/administration-eyes-national-hepatitis-c-treatment-plan/ WASHINGTON — For nearly a decade, many experts assumed the biggest obstacle to eliminating hepatitis C was the sky-high cost of the new cures.
So when Washington state and Louisiana signed flashy, unprecedented deals with the pharmaceutical companies that make the medicines back in 2019, and dedicated personnel and money toward the lofty goal, many celebrated. Just last week, the White House held the states up as a potential model for a forthcoming multibillion-dollar national effort with the same aim. But those states are nowhere near achieving the overarching goals they set, a new STAT investigation reveals. In Washington, the rate of treatment for the state’s Medicaid program now is actually lower than it was before the initiative began. The rocky roads in each state underscore that eliminating hepatitis C will likely be far more difficult than it seems, as STAT’s interviews with more than two dozen experts, including current and formerly incarcerated people, drug industry officials, the intellectual architects of the Washington and Louisiana deals, and a U.S. senator show. Though we have now had a miracle cure for the condition for nearly a decade — and though its cost is falling — there are more intractable problems than mere access. The condition often affects people who don’t see doctors regularly and might miss the infection, or who don’t even have a safe place to store medication. Big goals and a stockpile of pills, experts told STAT, aren’t enough. TO CONTINUE READING: https://www.statnews.com/2022/09/13/louisiana-washington-hep-c-investigation/?utm_source=STAT+Newsletters&utm_campaign=a418d40f4b-Pharmalot&utm_medium=email&utm_term=0_8cab1d7961-a418d40f4b-151392865 Team Takes on Virus Behind Liver Disease in Tens of Millions Globally
By Nicole Tenly Aug 24, 2022 The National Institute of Allergy and Infectious Disease (NIAID) awarded $6.9 million to researchers at the Institute for Bioscience and Biotechnology Research (IBBR) to design a vaccine to combat the virus that causes Hepatitis C (HCV), which affects an estimated 71 million people worldwide and puts them at risk for severe liver disease, including cancer. This five-year award will support a multidisciplinary research team based at IBBR, a joint research enterprise of the University of Maryland, College Park (UMCP), the University of Maryland, Baltimore (UMB) and the National Institute of Standards and Technology (NIST). The researchers aim to develop a vaccine to induce broadly neutralizing antibodies and long-term memory T cell responses to help prevent HCV infection. This recent award follows a $6 million grant awarded to the IBBR research team in 2017 based on its significant progress in the field. TO CONTINUE: https://today.umd.edu/6-9m-niaid-award-to-fund-design-testing-of-hepatitis-c-vaccine Patient Management > Prescribing By Jules Murtha | Fact-checked by Barbara Bekiesz Published August 26, 2022, MEDLinx Key Takeaways
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