In the United States, mortality is rising, with more deaths than ever attributable to alcohol and drug poisoning and to suicide, in conjunction with increasing rates of obesity and type 2 diabetes. Yet many other wealthy nations have seen rates of these so-called “deaths of despair” decreasing.
“In Europe, Canada, Japan, Australia, they’re not having a problem or they’re having it to a much smaller degree,” says Penn neuroscientist Peter Sterling. “Here, we’re having a massive problem.” He and colleague Michael Platt wanted to understand the disparity and what the U.S. might learn.
“They have not seen this meteoric rise in people dying from drugs, smoking, eating badly, deaths through dislocation, suicide,” says Platt, the James S. Riepe Penn Integrates Knowledge University Professor. “We wanted to isolate what’s different between those countries and ours.”
In a new JAMA Psychiatry paper, the researchers look at the matter through the lens of neuroscience, anthropology, and primatology, finding that, unlike in the U.S., the countries they analyzed offer communal assistance at every life stage, from universal child care to affordable college. Such support, the researchers conclude, protects individuals and families in the long term.
Countering conclusions
Platt and Sterling have known each other for decades, and since Platt arrived at Penn in 2015 have corresponded frequently. “We seem to share similar concerns,” Platt says. “We’d been looking at the epidemic in deaths of despair the past few years. It hit home personally for me because where I grew up in a gritty part of Cleveland has been pretty devastated.”
Then, in March 2021, the National Academy of Sciences (NAS) published a report on the subject, comparing the U.S. to 16 wealthy nations, including Canada, Australia, Japan, and countries in Western Europe. “It was this 476-page document,” Sterling says. “They don’t ask in the whole 476 pages, what are these other places doing? How come they don’t have this problem?”
The NAS report drew a twofold conclusion, Platt says. “Basically, it acknowledged that this is an epidemic, but the prescription is very mild. ‘We need more research, and we can’t define despair.’ But how do you create an animal model of despair? I was dismayed.”
Platt and Sterling decided to take a closer look themselves. First, they asked, from a neurological perspective, what do humans need to thrive? Second, they wondered whether understanding that could explain why deaths of despair were rising in the U.S. but not in these culturally, politically, and economically equivalent countries. They turned to the neurological question first.

​TO CONTINUE: https://www.mdlinx.com/physiciansense/what-can-be-done-to-fix-ehrs/?mdl_cp_loc=top_extender&mdl_cp_imp=1vvaMk6PzOtcOEbfFmHVh5%7C3wemZS8dB

During her third pregnancy, Jamie Smith was itchy. Crazy itchy. Her obstetrician diagnosed her with cholestasis of pregnancy, a serious complication associated with liver disease. Her baby was at risk for being premature or even stillborn, so she was induced at 38 weeks.
Smith’s baby was healthy, but her own problems continued. She had muscle pain, brain fog and icy white hands and feet. Maybe at age 39, she figured, she was just getting older. Her new primary care doctor suggested some tests, including for hepatitis C. It was just a precaution. Her obstetrician had said her liver enzymes were normal and the regular screening tests were negative. While walking her dog near her home in Ohio, Smith casually scanned the electronic results on her phone.
“It said, ‘positive,’ ” she recalled, “And I’m like, ‘I don’t even know what hep C means.’ Wait, positive is a bad thing, right?”
At home, she searched “What is hep C?” online, which sent her down an Internet rabbit hole of common risk factors, including IV drug use, tattoos or piercings, having HIV or spending time in prison. She cried.
“I have lived the most boring life,” Smith said. “So it was a shock that I had this virus that comes with this stigma.”
Only later did her doctor connect the hepatitis C diagnosis to lifesaving blood transfusions she received in 1981, when she was a premature baby. Smith had lived with hepatitis C her entire life and exposed each of her three children. Women with hepatitis C have a higher risk of cholestasis of pregnancy, the liver problem that caused her severe itching.
Hepatitis C is the leading blood-borne disease in the United States, affecting at least an estimated 2.5 million Americans. Half of them don’t know they have it. The disease used to occur mostly among baby boomers. After World War II, a combination of increased medical procedures and recreational drug use drove the spread of the disease before widespread screening was available in the 1990s. But now people ages 20 to 39 are most likely to get infected, according to the Centers for Disease Control and Prevention, a shift experts attribute to the opioid crisis and needle-sharing. The CDC says adults with hepatitis C are at higher risk for severe illness from covid-19.

​TO CONTINUE READING: https://www.washingtonpost.com/health/hepatitis-c-pregnancy/2022/01/28/3e5f6e24-7d32-11ec-8d71-0e9ca350d4b1_story.html

​The organization operating the nation’s first and only sanctioned supervised consumption centers announced a milestone in overdose interventions on Monday.
As of Jan. 23, 114 drug overdoses were averted at the two supervised injection sites in Manhattan, both of which are operated by OnPoint NYC.
The sites, in Washington Heights and East Harlem, first opened on November 30, 2021. 

What You Need To Know

• OnPoint NYC opened the nation’s first and only sanctioned supervised consumption centers on November 30, 2021


• As of January 23, 2022, the organization reported 114 drug overdose interventions

• Their facilities have been used 4,974 times by 585 registered people

Officials report that 585 people have registered at the sites and have used the locations 4,974 times.
“We are humanizing and giving hope to people that far too often society sees as disposable and defines them by their mistakes,” said Sam Rivera, executive director at Onpoint NYC. “And while the number of overdose interventions is a significant milestone, my staff and I don’t see the number, we see the beautiful people that we work with behind the stat – the participant struggling with addiction and desperately trying to secure a job to buy holiday presents for his daughter or the participant whose family has given up on them and is now desperately looking for a support system to help them through trauma.”
Since their opening, many neighbors in both Washington Heights and East Harlem have spoken out against the sites. Residents say they’ve seen a negative impact in the communities that already struggled with drug use on the streets.
“We're already dealing with the homelessness, the loitering, the public urination, defecation, the crime, everything that's happening,” says Peggy Morales, district leader for the 68th Assembly District Part B. “Well, why is it that other communities are not absorbing their fair share of the responsibility? These people do deserve these services and they need our assistance. And we should never turn our backs on them because that would be wrong. We are here. We need to look out for one another, but we also need to be fair about how that happens.”
Community members feel drug users from all over the city are flocking to the centers. 
It’s a concern the executive director of the sites says is a valid one. 

THIS SITE SAVES LIVES
ESTE SITIO SALVA VIDAS
​
​By Meryl Kornfield
January 15, 2022 at 12:00 p.m. EST, Washington Post- Health

NEW YORK — In tears, Kailin See recounts a story that would not have been possible just weeks before.  A man addicted to heroin, who otherwise would have injected himself alone, visited one of the country’s first authorized locations to use drugs with supervision in early December. He had a job interview later that day, hoping to earn two paychecks by Christmas so he could afford gifts for his children, he told staffers at the Washington Heights site. But when he drew the drugs into his veins, he began to nod off and go pale, a sign of what could have been a lethal overdose. The trained workers sprang into action, giving him oxygen. He quickly came to, said See, one of the main organizers of the site.

In nondescript commercial buildings in Washington Heights and East Harlem, workers watch people use illegal drugs and step in when they overdose, a solution to the drug crisis once considered too fringe to operate in the open. Years of legal battles and debate delayed efforts by cities and states to supervised consumption sites, forcing the facilities to operate underground. These new locations, approved by the then-mayor of New York City, could spur a shift toward offering services nationwide, drug policy experts say. But these sites still present a tangled knot of concerns: The federal government has not approved overdose-prevention centers, still considered an untested concept, and neighbors worry about drawing crime to their area.

TO CONTINUE READING: https://www.washingtonpost.com/health/2022/01/16/inside-first-supervised-overdose/?fbclid=IwAR2C-tDKs9OSuiB7Ef0GCZgSqolov8PYqi-zN-LFZDszDD2XST

By: Dan Grossman
Posted at 12:16 PM, Jan 04, 2022      ABC 15 Arizona

Six years ago, fentanyl was a relatively new and unheard-of drug. Developed in 1959, it was primarily used as an anesthetic and pain reliever for medical purposes without the side effect of nausea. It is 100 times more potent than morphine and 50 times more potent than heroin.
In 2015, however, fentanyl started to make its way into the United States in noticeable doses. As a synthetic drug, it is cheaper to produce than drugs like heroin, which require cultivation. Because of its potency, people require far less fentanyl to get highSix years ago, fentanyl was a relatively new and unheard-of drug. Developed in 1959, it was primarily used as an anesthetic and pain reliever for medical purposes without the side effect of nausea. It is 100 times more potent than morphine and 50 times more potent than heroin.


In 2015, however, fentanyl started to make its way into the United States in noticeable doses. As a synthetic drug, it is cheaper to produce than drugs like heroin, which require cultivation. Because of its potency, people require far less fentanyl to get high.
In the years since, drug dealers started using fentanyl as a cheap substitute to cut their drugs and stretch them farther. Today, according to the CDC, fentanyl is the leading cause of death for adults ages 18-45 in the United States.
“We are in the worst overdose crisis we’ve ever been in in the United States,” said Lisa Raville, executive director of the Harm Reduction Action Center in Denver. “In a magical world there would be no drugs, but we live here.”
In the year ending in April 2021, fentanyl claimed the lives of 40,010 Americans ages 18-45. That’s more than car accidents (22,442), suicide (21,678), COVID (21,335), and cancer (17,114).
“What is driving these behaviors in the illicit market is clearly just profit, it’s greediness,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

TO CONTINUE READING: https://www.abc15.com/news/national/fentanyl-is-the-leading-cause-of-death-in-americans-ages-18-45?fbclid=IwAR0O28bWzLm4oaVTNe7N-eLja_HxLsVGyK

Jon Levine and Kerry J. Byrne                     By January 1, 2022 10:49am Updated
New York Post

City health officials plan to install 10 vending machines across the Big Apple that will dispense clean needles and overdose-reversing Naloxone to drug users — an initiative it claims will help tear down barriers created by “white privilege.”
The Dec. 8 request for proposals was issued by the non-profit Fund for Public Health in New York, on behalf of city Department of Health and Mental Hygiene, which wants to launch a pilot program for the machines.
“Public health vending machines (PHVM) are an emerging strategy to support low-barrier access to naloxone, sterile syringes, and other harm reduction and wellness supplies,” reads the RFP for the machines, which will cost taxpayers $730,000.
The RFP also launched into a woke ideological exposition:
“The … DOHMH is committed to improving health outcomes for all New Yorkers by explicitly advancing racial equity and social justice. Racial equity does not mean simply treating everyone equally, but rather, allocating resources and services in such a way that explicitly addresses barriers imposed by structural racism (i.e. policies and institutional practices that perpetuate racial inequity) and White privilege.”

TO CONTINUE READING: https://nypost.com/2022/01/01/nyc-to-install-clean-needles-naloxone-vending-machines/

The Health Department and Hep Free NYC released the Plan to Eliminate Viral Hepatitis as a Major Public Health Threat in New York City by 2030 (Viral Hepatitis Elimination Plan), a set of strategies to reduce the number of hepatitis C infections, improve the health of people with hepatitis B and C, and reduce health inequities related to viral hepatitis infection in New York City.
Read the New York City Viral Hepatitis Elimination Plan
Viral Hepatitis Elimination Plan Goals

1. Reduce new Hep C infections among people in NYC by 90% by 2030 
2. Reduce premature deaths among people with chronic Hep B and chronic Hep C in NYC by 65% by 2030; Improve the health of people with Hep B and C in NYC 
3. Reduce health inequities related to viral hepatitis infection among people in NYC

​TO CONTINUE READING: ​https://mailchi.mp/hepfree.nyc/viralhepatitiseliminationplan?e=4319dc4b7f
​

Heavy alcohol use during the pandemic was linked to a rise in waiting list registrations and transplants due to alcohol-related hepatitis

December 13, 2021 • By Sukanya Charuchandra, Hep Magazine

Liver transplants and waiting list registrations due to alcohol-related liver disease (ALD) increased during the COVID-19 pandemic in association with a rise in retail alcohol sales, according to study results published in JAMA Network Open.
Alcohol drinking has soared during the pandemic. Alcohol-related liver disease, driven by excessive alcohol consumption, can lead to cirrhosis, liver cancer and liver failure. Maia Anderson, MD, of Michigan Medicine, and colleagues looked at national changes in the number of people with ALD who were put on a waiting list or received a transplant and the potential links to alcohol sales in recent years.

TO CONTINUE: https://www.hepmag.com/article/need-liver-transplants-due-alcohol-use-spiked-covid19-pandemic

Krishen Samuel
Published:10 December 2021, INFOHEP

Access to direct-acting antivirals to cure hepatitis C has slashed incidence rates for groups most affected in Australia. Among gay and bisexual men living with HIV, incidence fell by 78% in 2019 when compared to 2015, the year before direct-acting antiviral treatment became widely available. A similar trend in hepatitis C infections was seen for HIV-negative men taking PrEP, with an 80% decline in 2019 compared to 2016.
BackgroundHepatitis C disproportionately affects gay, bisexual, and other men who have sex with men living with HIV. A smaller number of HIV-negative gay and bisexual men – particularly those taking HIV pre-exposure prophylaxis (PrEP) – are also affected. Common risk factors include condomless anal sex, sexualised drug use, sharing injecting and other drug equipment, fisting and sharing sex toys.
The introduction of direct-acting antivirals has simplified and improved hepatitis C treatment significantly – over 90% of people who take them are fully cured of the infection. This contrasts with prior treatments, which lasted for a year, produced many side effects, and only resulted in a cure rate of 50% to 60%. Additionally, the efficacy of direct-acting antivirals is not affected by HIV status.
Based on the success of direct-acting antivirals to reduce rates of hepatitis C, the World Health Organization set a goal of 80% incidence reduction by 2030, relative to a 2015 baseline. With targeted resources, this can be achieved faster in highly affected subgroups, such as gay and bisexual men living with HIV.
There are studies that have looked at national-level changes in hepatitis C incidence among gay and bisexual men with HIV after introducing direct-acting antivirals. Some examples include France, the Netherlands, Switzerland and England. However, there have been no published studies looking at hepatitis C incidence among HIV-negative PrEP users.
In Australia, both medications became broadly available from 2016 after the government subsidised direct-acting antivirals, with no restrictions on treatment based on liver disease stage, substance use, or reinfection status. 
The treatment could also be prescribed by nonspecialist primary care providers, and was made available in general practices and sexual health clinics. 
PrEP, which was initially available to 7,500 people (predominantly gay and bisexual men) through implementation trials in 2016, also became widely accessible in 2018 through government subsidisation and general practitioner prescriptions among gay and bisexual men with HIVA total of 6,744 men with HIV were included in the incidence analysis, comprising 33,150 person-years of follow-up with 290 new hepatitis C infections for the period. This produced an overall incidence of 1.03 per 100 person-years, with the highest incidence in 2010 (2.12 per 100 person-years) and the lowest in 2019 (0.22 per 100 person-years).
As direct-acting antivirals only became widely available in 2016, 2015 was used as the baseline comparison year. Incidence declined in all subsequent years, falling by 60% in 2017, 45% in 2018 and 78% in 2019, relative to 2015. There was no significant change in the overall incidence trend between 2009 and 2015 and between 2016 and 2019. But a distinct difference was present between 2015 and 2016, indicating the importance of direct-acting antivirals in the incidence decline between the two periods.

TO CONTINUE READING: http://www.infohep.org/Australia-on-track-to-eliminate-hepatitis-C-among-gay-and-bisexual-men-before-2030/page/3550464/?utm_source=NAM-Email-Promotion&utm_medium=conference-bulletin&utm_campaign=English&utm_source=infohep-english&utm_medium=email&utm_campaign=2021-12-21

We are New York district attorneys and health officials. Here’s why New York City is opening sites for people to safely use drugs.

Darcel ClarkBronx District AttorneyCy VanceManhattan District AttorneyEric GonzalezBrooklyn District AttorneyDave A. ChokshiNYC Health CommissionerMelinda KatzQueens District AttorneyPosted on December 15, 2021, at 12:04 p.m. ET

Two weeks ago, New York City became the first city in the nation to open two overdose prevention centers, located in Manhattan. Already, 25 overdoses have been averted — 25 people who are alive today thanks to these centers. Now we are calling on the Biden administration to formally authorize overdose prevention centers in the US.
Overdose prevention centers are supervised, hygienic spaces for people who use drugs to do so safely, while also providing harm reduction, physical health, and behavioral health services.

Every neighborhood in every community has experienced the tragedy of the overdose epidemic. Nationally, over 100,000 Americans died of an overdose between April 2020 to April 2021. In New York City, 2,062 people died of an overdose in 2020, the highest number of deaths since reporting began 20 years ago. The spread of fentanyl — a dangerous, synthetic opioid 80 to 100 times stronger than morphine and the primary driver of the rise in overdoses — exponentially increases the need for even more overdose prevention innovation.
Thirty years of research conducted across 100 sites on three continents has demonstrated the efficacy of overdose prevention centers. There has never been a single overdose death at any site. Participants are provided with basic human needs day after day: a smile, a sandwich, or a shower. Over time, trust is built between participants and clinical staff, which leads to participants beginning substance use disorder treatment and referrals to healthcare and other social services.
In addition, research shows overdose prevention centers reduce public drug use, syringe litter, and drug-related crime in surrounding neighborhoods. They can also function as safe havens for women who use drugs, reducing violence against women associated with street-based substance use.
We believe the overdose prevention centers in New York City will be a model for other cities to follow.
Biden recently embraced harm reduction, becoming the first president to include it in his drug policy priorities.
In another first, Congress appropriated $30 million in the American Rescue Plan to be provided to state, local, and tribal governments and organizations for overdose prevention and harm reduction services.

TO CONTINUE: https://www.buzzfeednews.com/article/dadarcelclark/new-york-overdose-prevention-centers?fbclid=IwAR0hZB_TZea_5_Xreys1HYn2vX2abltVm-AYdQgPPZ8iIzSIOyYC3ZquVBE