By  CARLA K. JOHNSON
Updated 9:17 AM EDT, September 20, 2024 AP NEWS

The first big update to U.S. methadone regulations in 20 years is poised to expand access to the life-saving drug starting next month, but experts say the addiction treatment changes could fall flat if state governments and methadone clinics fail to act.
For decades, strict rules required most methadone patients to line up at special clinics every morning to sip their daily dose of the liquid medicine while being watched. The rules, built on distrust of people in the grip of opioid addiction, were meant to prevent overdoses and diversion — the illicit selling or sharing of methadone.
The COVID-19 pandemic changed the risk calculation. To prevent the spread of the coronavirus at crowded clinics, emergency rules allowed patients to take methadone unsupervised at home.
Research showed the looser practice was safe. Overdose deaths and drug diversion didn’t increase. And people stayed in treatment longer.
With evidence mounting, the U.S. government made the changes permanent early this year. Oct. 2 is the date when clinics must comply with the new rules — unless they’re in a state with more restrictive regulations.

TOCONTINUE: https://apnews.com/article/methadone-opioids-addiction-treatment-6dc1634de4cdac06410149e6a1372e18#

​Published August 27, 2024 | Originally published on Pennsylvania State University Health and Medicine News

According to the Centers for Disease Control and Prevention, nearly 108,000 people died from drug overdoses in 2022, 76% of which involved an opioid. However, there is limited research that examines the risk factors for overdose particularly among women who may face different challenges compared to men.
“Women who use drugs are heavily stigmatized because many are also mothers. This stigma may prohibit women from seeking harm reduction programs and substance use treatment,” said Abenaa Jones, the Ann Atherton Hertzler Early Career Professor in Health and Human Development, assistant professor of human development and family studies and senior author of the paper.

CME Activity: Optimizing Care for Prurigo Nodularis - Evidence-Based Treatment Approaches and Personalized Strategies RealCME
Women who use drugs and are involved in the criminal legal system are in a particularly vulnerable state, the researchers said. Not only do they face a high chance of overdose immediately following release but involvement in the criminal legal system also imposes longer-term challenges to recovery.
“These stigmas and barriers can make it hard to attain the forms of ‘recovery capital’ that are so needed to sustain recovery,” said Kristina Brant, assistant professor of rural sociology and co-author of the study. “Finding unique ways to support this group facing so many intersecting vulnerabilities is essential to promoting well-being.”

TO CONTINUE: https://www.mdlinx.com/news/harm-reduction-education-tools-access-may-help-women-prevent-opioid-overdose/23n71EiP8I3JNQBTlKbeMK?show_order=7&utm_campaign=reg_daily-alert_240828_daily-nl-am-v4_registered-users-a180&utm_source=iterable&utm_medium=email

Findings reveal shortfalls in hepatitis C elimination efforts in the United States and Mexico
UC San Diego Today July 30,2024

An international team of researchers from University of California San Diego and el Colegio de la Frontera Norte in Mexico have revealed a significant association between the use of illicit fentanyl and the transmission of hepatitis C virus (HCV) among people who inject drugs in San Diego, California and Tijuana, Mexico. The findings, published in Clinical Infectious Diseases, suggest that illicit fentanyl use could be driving recent increases in HCV incidence.
"
Our study provides the first evidence that illicit fentanyl use is linked to an increased risk of acquiring hepatitis C infection, which disproportionately affects people who inject drugs," said Steffanie Strathdee, Ph.D., senior author and professor of medicine at UC San Diego School of Medicine. "This underscores the importance of making point-of-care HCV viral load testing more widely available in the U.S., so those needing treatment can access it immediately."

HCV is one of several types of hepatitis, inflammation of the liver most often caused by a viral infection. HCV is most often transmitted through blood, which means that people who inject drugs are at particularly high risk of acquiring the disease.

Once acquired, the virus is easy to transmit unknowingly, because symptoms of HCV often don’t emerge until months or years after the initial infection. According to the U.S. Department of Health and Human Services (HHS), about half of people with HCV do not know they have it.
HCV prevalence is also on the rise in recent years; according to the Centers for Disease Control and Prevention (CDC), the number of reported cases of acute hepatitis C has doubled since 2014 and, during 2021, increased by 5 percent from 2020.
The new study, which followed a cohort of 398 people who inject drugs over two years, found that illicit fentanyl use was associated with a 64 percent increased risk of acquiring HCV.
TO CONTINUE READING:​https://today.ucsd.edu/story/illicit-fentanyl-use-linked-to-increased-risk-of-hepatitis-c-among-people-who-use-drugs

Published July 18, 2024 | Originally published on MedicalXpress Breaking News-and-Events

A new study has identified the top reasons why some physicians may be reluctant to intervene in addiction. The comprehensive review, pulling 283 studies published on this topic within the last 61 years, showed that "institutional environment" was the reason most frequently reported in these studies.
"Institutional environment" refers to factors like lack of support from a physician's institution or employer; insufficient resources, such as staff and training; challenges in organizational culture; and competing demands. This reason was cited in 81% of the studies reviewed, followed by insufficient skill (74%), lack of cognitive capacity to manage a certain level of care (74%), and inadequate knowledge (72%).
Around 66% of studies cited negative social influences—or beliefs about public and community acceptance of addiction care—while 56% of studies cited fear of harming the patient-physician relationship as deterrents for physicians to intervene in addiction.
These may represent the manifestation of stigma associated with substance use disorder, the authors say. Reimbursement concerns for the cost of delivering addiction interventions were also observed.
The study's findings point to the need for institution-wide changes to improve the adoption of evidence-based substance use disorder treatment practices among physicians. These changes include increasing organizational support, leadership and staff buy-in, and education and training.
The study, titled "Physician Reluctance to Intervene in Addiction: A Systematic Review" and published in JAMA Network Open, was led by the National Institute on Drug Abuse (NIDA) of the National Institutes of Health.
"People with substance use disorders must be able to access compassionate and evidence-based care at any touchpoint they have with a health care provider," said Nora D. Volkow, M.D., Director of NIDA.

​TO CONTINUE: https://www.mdlinx.com/news/doctors-reluctant-to-treat-addiction-most-commonly-report-lack-of-institutional-support-as-barrier/3lEMhZeaywZL8F0cVcQGgJ

By Sara Lorenz Taki and Lipi Roy July 16, 2024

Hepatitis C and opioid use disorder are both chronic but treatable conditions. Yet many Americans living with this deadly combination aren’t offered treatment. Imagine going to your doctor with strep throat and instead of being prescribed an antibiotic you are told it isn’t urgent and you can wait to treat it.
A solution is within reach: It starts with recognizing the power of integrating hepatitis C treatment with addiction care.

People with hepatitis C (HCV) and substance use disorders are often marginalized in traditional medical settings. These individuals are at much higher risk for liver cancer, liver cirrhosis, liver failure, and premature death, as well as diabetes, kidney disease, thyroid disease, and autoimmune disorders. All of which beg the question: In a country with more than 2,000 opioid treatment programs and more than 17,000 addiction treatment centers, why aren’t these health facilities providing broader access to a cure for the nation’s most common blood-borne infection?

As addiction and internal medicine doctors at the Greenwich House Center for Healing, a New York City-based opioid treatment program, we believe that addiction treatment facilities are the perfect delivery system for hepatitis C treatment. Utilizing all types of addiction treatment programs, withdrawal management and stabilization programs, outpatient programs, opioid treatment programs, sober houses, residential programs, harm reduction centers, etc. could be one of many effective interventions in the nation’s effort to eliminate hepatitis C for the nearly 4.7 million people infected with HCV nationwide. Most new hepatitis C infections in the U.S. occur in people who inject drugs, making addiction treatment centers an increasingly important place for people to access hepatitis C treatment.

TO CONTINUE: https://www.statnews.com/2024/07/16/dual-epidemic-hepatitis-c-opioid-overdose-new-role-for-addiction-treatment-centers/

New York aims for a 90% reduction in people living with HCV and an 80% increase in people being treated and cured by 2030.
July 8, 2024 • By Laura Schmidt  hep

​New York state is ramping up efforts to eliminate hepatitis C by 2030 by increasing screening, treatment and more, according to Spectrum News.

Hepatitis C (HCV) is a contagious but curable disease caused by a virus that infects the liver. HCV is a blood-borne virus that can cause lifelong infection, liver fibrosis, cirrhosis, liver cancer, liver failure and death.

About 2.4 million Americans are living with HCV, and nearly 2.2 million people could be living with hepatitis B, according to the Centers for Disease Control and Prevention.  

By 2030, New York aims for a 90% reduction in people living with HCV and an 80% increase in people being treated and cured.

Knowing your HCV status is the first step toward treatment and a cure. While current guidelines recommend that all adults should be tested for HCV at least once, New York state recently implemented a new testing law requiring universal screening for all adults over 18 and pregnant individuals.
TO CONTINUE: ​https://www.hepmag.com/article/new-york-implements-strategies-reach-hep-c-elimination-goal

Published July 9, 2024 | Originally published on ScienceAlert Latest, MD Linx

More needs to be done to ensure that tattoo inks and other permanent makeup products are bacteria-free, according to the authors of a new study that found worryingly high numbers of commercial samples with bacteria in them.
Testing found bacteria in about 35 percent of the tattoo inks and permanent makeup sampled in the US. That includes both aerobic bacteria that need oxygen to live, and anaerobic bacteria that don't – meaning they could survive in the dermal layer under the surface of the skin, even without an air supply.
The research was carried out by a team from the National Center for Toxicological Research (NCTR) and the Center for Food Safety and Applied Nutrition (CFSAN), both part of the US Food and Drug Administration (FDA).
"Our findings reveal that unopened and sealed tattoo inks can harbor anaerobic bacteria, known to thrive in low-oxygen environments like the dermal layer of the skin, alongside aerobic bacteria," says microbiologist Seong-Jae Kim from the NCTR.
"This suggests that contaminated tattoo inks could be a source of infection from both types of bacteria."
TO CONTINUE READING: https://www.mdlinx.com/news/more-than-1-in-3-tattoo-inks-tested-in-us-harbor-a-potential-infection-risk/3nGayeDOHeweYh8zpV1ujk?show_order=8&utm_ca
​

Test Enables Single-Visit Testing and Treatment for Hepatitis C
For immediate Release:  June 27, 2024

Today, the U.S. Food and Drug Administration granted marketing authorization to Cepheid for the Xpert HCV test and GeneXpert Xpress System, the first hepatitis C virus (HCV) test that can be used to bring diagnosis to appropriately certified point-of-care settings for individuals at risk for hepatitis C. The test may be performed in settings operating under a CLIA (Clinical Laboratory Improvement Amendments) Certificate of Waiver, such as certain substance use disorder treatment facilities, correctional facilities, syringe service programs, doctor’s offices, emergency departments and urgent care clinics. Rather than requiring a sample to be sent to a central lab for testing, the test detects HCV RNA and delivers results in about an hour using a blood sample from the fingertip. 
The authorization of this test enables a test-and-treat approach where a person can be tested for HCV, and if positive for HCV RNA, be linked to care and potentially receive treatment during the same health care visit. Prior to the availability of a rapid, point-of-care test, HCV testing has been a multi-step process which often results in patients needing follow-up appointments for test results and additional testing, which can lead to patients not receiving a diagnosis and not receiving necessary treatment. 
​TO CONTINUE READING:https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-point-care-hepatitis-c-rna-test

Published May 23, 2024 | Originally published on MedicalXpress Breaking News-and-Events
Now that smoking has replaced injecting as the most common way to consume fentanyl, UCSF researchers have uncovered an increased risk of fatal overdose from the residue that accumulates in smoking equipment.
The researchers found that people both shared fentanyl resin and consumed it accidentally. This may be increasing the risk of overdose, especially among those who use the equipment to smoke other drugs, like methamphetamine, and have not developed tolerance to opioids like fentanyl.
"The risk of overdose when sharing smoking devices with fentanyl resin could be seen as analogous to the risk of shared injection paraphernalia and HIV transmission," said Daniel Ciccarone, MD, MPH, Justine Miner Professor of Addiction Medicine at UC San Francisco in the Department of Family & Community Medicine, who is the first author of the paper. "Harm reduction-based and culturally attuned education campaigns need to be rapidly advanced to address this new risk."
The paper is the first to explore fentanyl resin as a key contributor to overdose and appears May 22 in PLOS ONE.
Smoking fentanyl is rising locally and nationallySan Francisco reached an all-time high of 806 deaths in 2023, with 653 from fentanyl. Nationwide, the number of fentanyl deaths declined modestly in 2023, dropping from 76,226 to 74,702; but they remain high, and fatal overdoses from psychostimulants, including methamphetamine and cocaine, are on the rise.
In recent years, mirroring national trends, fewer people in San Francisco have been injecting fentanyl and more have been smoking it. But the beliefs and behaviors surrounding this development have not been well understood to date.
To conduct the study, the researchers observed people in their own environment in 2022, conducting face-to-face interviews with 34 participants who were recruited from syringe service programs.
They asked about the progression of the participants' substance use, as well as their modes of use, experiences with overdose, and the changes they had observed in the local drug supply. The interviews were supplemented with daily field notes, video-recorded smoking sequences, and photography of drugs and equipment.
The researchers observed that fentanyl was extremely cheap, as low as $10 a gram; and most people used foil to smoke it, although glass bubbles, bongs, and dabbing devices were also popular. The quality of the fentanyl varied, and people had no apparent method to determine it. Participants could gauge potency upon inhalation, however, and they had developed techniques to regulate their dose. Several participants reported frequent use, up to one or more grams a day.
Shared equipment poses significant dangersIt was both the difficulty of injecting and the fear of overdose that motivated people to start smoking fentanyl instead. Smoking was also more social, and people shared equipment, drugs, and information. The researchers were surprised to find that this caused participants to reflect on the changing risk environment for people with varying opioid tolerances and to develop strategies to protect others.
Early during fieldwork, the researchers observed an interaction in which a random person attempted to borrow a glass pipe from a participant, who vehemently refused. The participant explained that the pipe had been used for fentanyl and did not want to share it with someone who only used methamphetamine. Smoked fentanyl and methamphetamine residues look similar, and the equipment used often overlaps.
"The overdose risk arises when there is a potential mismatch between the potency of the residual drug and the recipient's tolerance," Ciccarone explained.
While some participants took precautions to prevent others from using their smoking equipment and overdosing on the residues, the shared smoking culture still poses increased risks, particularly given high consumption rates.

TO CONTINUE:​https://www.mdlinx.com/news/the-smoking-of-fentanyl-is-rising-in-san-francisco-a-deadly-new-risk-for-overdose/2735OfDsAkm1bkDgFMGkKP?show_order=

Published May 14, 2024 | Originally published on NIH News News Release Monday, May 13, 2024

Over 115 million pills containing illicit fentanyl seized by law enforcement in 2023NIH-supported study highlights increasingly dangerous illicit drug supply, risk of pills not coming from a pharmacy.
Law enforcement seizures of illicit fentanyl increased dramatically in number and size between 2017 to 2023 in the U.S., especially in pill form, according to a new study funded by the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA). The number of individual pills containing fentanyl seized by law enforcement was 2,300 times greater in 2023 compared to 2017, with 115,562,603 pills seized in 2023 vs. 49,657 in 2017. The proportion of fentanyl pill seizures to the total number of fentanyl seizures more than quadrupled, with pills representing 49% of illicit fentanyl seizures in 2023 compared to 10% in 2017. The study also found a significant increase in the number and weight of fentanyl-containing powder seizures during this time.
“Fentanyl has continued to infiltrate the drug supply in communities across the United States and it is a very dangerous time to use drugs, even just occasionally,” said NIDA Director Nora D. Volkow, M.D. “Illicit pills are made to look identical to real prescription pills, but can actually contain fentanyl. It is urgently important that people know that any pills given to someone by a friend, purchased on social media, or received from any source other than a pharmacy could be potentially deadly – even after a single ingestion.”
Although fentanyl seizures were historically less common in the Western U.S., this analysis found that this region now accounts for most of law enforcement seizures of fentanyl overall, as well as total weight of fentanyl seized. The proportion of fentanyl pill seizures compared to the overall number of fentanyl seizures was also highest in the West, with 77.8% of all law enforcement seizures of fentanyl in the West being in pill form in 2023. These data emphasize the need for continued monitoring of regional shifts in the fentanyl supply, to help inform targeted prevention and public health responses.
In 2022, over 107,000 people died of a drug overdose, with 75% of those deaths involving an opioid. The overall rise in overdose deaths is largely attributable to the proliferation of illicit fentanyl, a synthetic opioid. Illicit fentanyl is highly potent, cheaply made, and easily transported, making it extremely profitable. Fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as two milligrams.
While some people knowingly consume fentanyl, many people do not know if the drugs they plan to use contain fentanyl. This is especially true of illicit counterfeit pills, which are often made to resemble prescription medications such as oxycodone or benzodiazepines, but really contain fentanyl. Recent studies have reported a dramatic rise in overdose deaths among teens between 2010 to 2021, which remained elevated well into 2022 according to a NIDA analysis of CDC and Census data. This increase in deaths has been largely attributed to widespread availability of illicit fentanyl, the proliferation of counterfeit pills containing fentanyl, and the ease of purchasing pills through social media.

​TO CONTINUE READING: https://www.mdlinx.com/news/over-115-million-pills-containing-illicit-fentanyl-seized-by-law-enforcement-in-2023/34fFubzuHid4NkKNtEiMUC?show_order=5&utm_campaign=reg_daily-alert_240520_daily-nl-am-v4_registered-users-a180&utm_source=iterable&utm_medium=email