Judy George, Senior Staff Writer, MedPage Today December 17, 2020

​Is COVID-19 response to blame? Probably, Redfield suggests

The CDC issued a Health Alert Network advisory to medical and public health professionals and others Thursday, saying drug overdose deaths have soared to the highest number ever recorded in a 12-month period.
Approximately 81,230 drug overdose deaths occurred in the U.S. in the 12 months ending May 2020, with the largest spike after the COVID-19 public health emergency started, from March 2020 to May 2020.
Drug overdose deaths were rising before March, but the findings suggest they accelerated during COVID-19, the agency said.

"The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard," said CDC Director Robert Redfield, MD, in a statement. "As we continue the fight to end this pandemic, it's important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences."
The number of deaths increased 18.2% from the 12-month period ending in June 2019 to the 12-month period ending in May 2020 and appeared to be driven largely by deaths involving synthetic opioids like illicitly manufactured fentanyl, according to the CDC.
Of 38 jurisdictions with available synthetic opioid data in the CDC's analysis, 37 reported increases in synthetic opioid overdose deaths. Eighteen reported increases greater than 50%. Ten western states reported more than a 98% increase in synthetic opioid-involved deaths.
Cocaine-related overdose deaths also increased by 26.5% in the 12-month period; these were likely connected to using cocaine together with illicitly manufactured fentanyl or heroin, the CDC noted.

TO CONTINUE READING: https://www.medpagetoday.com/publichealthpolicy/opioids/90304

The people directly affected by conditions like substance use disorder should be involved at the state and federal levels in developing policies.
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Ryan Hampton, Opinion contributor, USA TODAY Published December 31st, 2020

Connections, whether with friends and family, support groups or other types of programs, are critical to recovery. The coronavirus pandemic has interrupted support and services, amplified stress and anxiety, and added physical distancing requirements to people already feeling isolated. Those factors have made it even harder for people to take the first step toward remission from substance use disorder.
As a result, experts have called for more resources and heightened intervention to reduce substance use disorders since early in the pandemic. With little action from federal and state governments over the past 10 months, however, we are starting to see alarming trends.
This month, the American Medical Association noted that more than 40 states have reported increases in opioid-related deaths. In my home state of Nevada, we saw a 50% increase in opioid and fentanyl-involved drug overdose deaths in the first six months of the year. A Centers for Disease Control and Prevention report published in August found respondents were more likely to start or increase substance use to cope with COVID-19 stress and emotions, including 24.7% of essential workers.
This much is clear: To prevent further loss of life, COVID-19 recovery efforts must include mental health treatment and substance use recovery — and advocates from the recovery community need a seat at the table.
There’s a rallying cry in the recovery community: “Nothing about us, without us.” This means that the people directly affected by conditions like substance use disorder should be involved at the state and federal levels in developing policies.
We may not all have doctorates, but we’re certainly experts in our conditions. To that end, President-elect Biden must ensure that people in recovery are represented in his administration, ensuring that any policy solutions around drug use and addiction are informed by the experiences of people who have lived with that reality.
Support peer recovery effortsIn the recent COVID relief package, a late revision by the Senate wiped out a critical component from the original proposal — $75 million for peer recovery support services. These essential services provide a lifeline to Americans who fall through gaps in addiction treatment.
Peer recovery support provides non-clinical services that educate and support individuals as they make changes necessary for recovery from substance use disorder. This is a striking example of why voices with personal experience must have substantial weight in decision-making within this new administration: to avoid catastrophic policy blind spots that could lead to increased overdoses.
Lost in the flurry of Biden’s recent high-level nominations are key roles that will guide the nation’s response to our worsening addiction and mental health crisis. The Assistant Secretary for Mental Health and Substance Use and directors at the Substance Abuse and Mental Health Services Administration will have a strong influence on how treatment is provided.

​TO CONTINUE READING: https://www.usatoday.com/story/opinion/2020/12/31/how-joe-biden-can-reduce-surge-drug-overdoses-column/4084961001/

December 22, 2020
Rachel Lutz     HCP Live

​The investigators measured a 3.5-month period before and after a policy was implemented to preserve hospital resources.

Preserving hospital resources in the face of the novel coronavirus (COVID-19) pandemic has led to gaps in routine coverage, including screening and identifying patients with hepatitis C, according to a paper published in the Journal of Primary Care & Community Health.
A research team from Boston Medical Center said that the COVID-19 pandemic has led to modifications to their health care system, which were designed to preserve resources and decrease ambulatory in-person visits beginning March 16, 2020. The study authors also noted that telemedicine was incorporated into clinical workflows but preventative care, including hepatitis C testing, was not routinely performed.
Thus, the investigators wanted to determine what impact their COVID-19 restructuring response had on hepatitis C testing as well as identification hospital-wide and in ambulatory settings. To do so, they compared unique patient data tests for a period of 3.5 months before and after March 16.
Boston Medical Center described their testing process as utilizing reflex confirmatory testing for hepatitis C, and when a sample is Ab positive, it is automatically sent for RNA and genotype testing. They routinely screen for hepatitis C in the emergency department and their ambulatory clinics, aligned with the United States Preventive Services Task Force (USPSTF) guidelines released in March and the US Centers for Disease Control and Prevention (CDC) guidelines released in April.
Hepatitis C Ab testing and new hepatitis C RNA identification decreased hospital-wide and in the ambulatory clinics alone after the preservation of resources restructuring took affect on March 16.
TO CONTINUE READING:​https://www.hcplive.com/view/flu-vaccine-could-reduce-severity-covid-19

DEC 15, 2020 Tanya Albert Henry Contributing News Writer AMA

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A few countries in Europe in the 1980s tried something new to reduce the harms associated with the use of illicit drugs: A supervised, hygienic facility where people could consume pre-obtained drugs, be monitored for overdoses, have access to counseling, and get referrals to health care and social services, including drug treatment.

Today, about 120 legally sanctioned supervised consumption sites operate in 11 countries globally, including Canada, Germany and Switzerland. Now there’s a proposal for the first supervised consumption site to open in the United States, but the federal government filed a lawsuit to block it from opening in Philadelphia. They argue it violates a section of the Controlled Substances Act that was aimed at making it easier for police to arrest individuals who opened and used buildings to produce, sell, or use crack cocaine.

Medical experts disagree.

​In an amicus brief, the Litigation Center of the American Medical Association and State Medical Societies joined the Pennsylvania Medical Society, Philadelphia County Medical Society and about a dozen other organizations to provide information to the U.S. Court of Appeals for the 3rd Circuit that years of evidence show that these facilities provide evidenced-based medical and health interventions that help save lives, offer access to necessary services, and provide support to people who use drugs.

TO CONTINUE READING: https://www.ama-assn.org/delivering-care/opioids/will-us-get-its-first-supervised-drug-consumption-site

By Elizabeth Elizalde     December 18, 2020 | 6:16pm | Updated NEW YORK POST

Drug overdose deaths have substantially increased in the U.S., and set a new record for fatalities in the year ending in May, the Centers for Disease Control and Prevention announced.
The CDC’s Health Alert Network released a report Thursday saying 81,230 drug overdose deaths occurred during that time starting in June 2019.
“This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded,” the agency said.
The CDC noted that “after declining 4.1% from 2017 to 2018, the number of overdose deaths increased 18.2% from the 12-months ending in June 2019.”
Drug overdose fatalities were already on the rise before the start of 2020, but accelerated once the COVID-19 pandemic stuck, the CDC says.


Synthetic opioids have been the primary source of the increases in overdose deaths, the agency continued, and that, “The 12-month count of synthetic opioid deaths increased 38.4% from the 12-months ending in June 2019 compared with the 12-months ending in May 2020.”
The CDC recommends expanding the use of naloxone, a medication that treats overdoses during emergencies, and that people should take overdose prevention classes.

TO CONTINUE READING: https://nypost.com/2020/12/18/us-drug-overdoses-skyrocketing-cdc/?fbclid=IwAR19tSp2iA77WieBv-elmY4eoiAIpXnKElTzrf7zuLUtS3rlJyPc1Q2xU2o

David Lombardo Times Union Nov. 16, 2020 Updated: Nov. 16, 2020 8:05 a.m.

ALBANY  — Terri Wilder fondly recalls the fanfare surrounding the spring day in 2015, when Gov. Andrew M. Cuomo formally embraced a plan to end the AIDS epidemic in the state.
“I was really proud of that work,” said Wilder, who had been part of the task force assembled six months earlier by the governor to craft the blueprint that he would publicly tout and aggressively implement.

Based on that experience, she was optimistic about her appointment by Cuomo in the fall of 2018 to a task force charged with making recommendations toward eliminating hepatitis C, a viral infection that can cause serious liver damage and effects more than 200,000 New Yorkers.
But nearly 18 months have passed since the hepatitis C task force held its final meeting and their work hasn’t been released by the Cuomo administration. A key accountability measure is caught in limbo, task force members are discouraged from publicizing their recommendations and the virus has likely made a resurgence during the pandemic.
“I don’t know where (the hepatitis C recommendations) are at this point. I stopped asking because it’s too frustrating,” said Wilder, who was a director of an HIV and hepatitis C clinical education program. “I think that work is just as important as our work with ending the AIDS epidemic, and those lives are just as important.”
State health department spokesman Jonah Bruno maintains the task force’s plan will be released “soon,” but did not address the delay or the secrecy surrounding the task force.
New York has traditionally been at the forefront of national efforts to combat hepatitis C, with the highlight being a 2013 law that dramatically expanded testing for the virus among baby boomers. And while that testing law reflected the need at the time, the state’s focus hasn’t necessarily kept up with emerging trends, according to Mike Selick of the Harm Reduction Coalition, which tries to mitigate the negative effects of drug use.
“We found out in the last year or two that young people injecting drugs upstate is one of the biggest populations living with hepatitis C,” Selick said. “Guess where most of our programs are targeted? To middle age and older, Black and Latino men in (New York City).”
In the summer of 2018, after receiving a letter from a coalition of 62 health care providers, caregivers and activists about the need for a coordinated response to the “alarming rise” of the virus, Cuomo announced the creation of a hepatitis C task force.
The hope from the coalition was that a task force endorsed by the governor would have better luck in steering state policy. Many in the coalition were veterans of an earlier partnership with the state Department of Health that produced over 30 hepatitis C recommendations in 2017 that hadn’t been implemented.


The focus on hepatitis C was bolstered by a two-year, $5 million annual commitment in state funds - a 400 percent year-to-year increase - with the bulk of the money going upstate.
“It was very exciting at the time,” remembers Ronni Marks, one of the few task force members who had also lived with the virus.
After an initial Albany meeting in November 2018, the task force members did the bulk of their work in groups on the phone until convening back in Albany for their last meeting in June 2019, when they signed off on a final plan.

“We crossed the t’s, we dotted the i’s, and made sure everybody was on board,” Marks said.

TO CONTINUE READING:​ https://www.timesunion.com/news/article/Hepatitis-efforts-shelved-as-experts-fear-surge-15728536.php?IPID=Times-Union-HP-CP-Spotlight#photo

Compiled by INPUD and the Asian Network of People who Use Drugs (ANPUD)
The need to change our language in relation to people who use drugs has become an increasing topic of discussion, but there is still a long way to go. People who use drugs are highly diverse and their relationship with drug use takes many different forms. Current prohibitionist approaches to drug use and ‘war on drugs’ rhetoric does little to encourage language that acknowledges this diversity. Instead, it promotes and maintains negative stereotypes that construct people who use drugs as morally flawed, inferior, unreliable, and dangerous.
Language does not stand still. It is dynamic, and the language and words we use are always changing. This makes it difficult to be absolute in the way we use language. Nevertheless, there are times when certain language and words used in relation to people who use drugs can be disempowering, divisive, confusing, or give offence.
Compiled by INPUD and the Asian Network of People who Use Drugs (ANPUD), this guide aims to explain our current position on the use of language and to provide clear advice on what is acceptable to us as communities of people who use drugs. We want to encourage all people to be thoughtful about the language and words they use, and have therefore provided a reference guide that identifies stigmatising language and gives non-judgemental, strengths-based, and respectful alternatives.
Read  HERE:https://www.inpud.net/sites/default/files/000596_INP_Terminology%20booklet_v11.pdf

John Ward- The Lancet
Published Oct 29th 2020020https://doi.org/10.1016/S0140-6736(20)32282-0



This year, Michael Houghton, Harvey Alter, and Charles Rice were awarded the Nobel Prize in Physiology or Medicine for their discovery of the hepatitis C virus (HCV).
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 Equally important to recognising the rigorous methods employed by these scientists, the Nobel committee also credited this discovery with later development of diagnostic tests and curative treatments. Science is not an end but a means to achieve a greater purpose. The Nobel committee issued a challenge, “For the first time in history, the disease can now be cured, raising hopes of eradicating Hepatitis C virus from the world population”.
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 I, together with my colleagues in the Coalition for Global Hepatitis Elimination, agree.
The discovery of HCV placed the world on the path to elimination. Within a few years, reliable tests were available to screen donated blood, reducing the risk of HCV from one in every 14 units to one in every million. Over the following decades, with improvements in blood safety and infection control, new HCV infections declined an extraordinary 90%.
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​TO CONTINUE READING: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32282-0/fulltext​

Having hep C can increase your odds of this other tricky liver condition. Get the facts on risk factors and treatment options.

​Lara DeSanto HEALTH WRITER Oct 20, 2020
iHEALTHCENTRAL

If you have hepatitis C, the fun doesn’t stop with one illness. Often, this liver disease is linked to several other health conditions, including nonalcoholic fatty liver disease (NAFLD). Understanding how the two are connected can help you learn the symptoms to look out for, plus the best ways to get treatment if the need arises. We asked the experts for more details about NAFLD and how it’s connected to hepatitis C. These are the need-to-know facts about living with both of these diseases.

What Is Fatty Liver Disease?
As the name implies, fatty liver disease occurs when fat deposits build up in your liver. “The fat in the liver can damage it, causing inflammation and scarring,” explains Rena Fox, M.D., a professor of general internal medicine at the University of California, San Francisco, and a UCSF Health hepatitis specialist. Although doctors still aren’t sure exactly what causes it, NAFLD is linked to obesity, insulin resistance, high blood sugar, and high triglycerides levels.
There are different types of fatty liver disease, but NAFLD is the most common, affecting 30% to 40% of adults in the United States, according to the National Institutes of Health (NIH). While some types of fatty liver disease are linked to heavy alcohol use, people with NAFLD are not over-drinkers.
One of the challenging things about this disease is that it can be hard to detect, since it often has no obvious symptoms until the liver damage is already extensive. “When someone is at a very advanced stage, they may have some pain in the upper-right part of the abdomen, and they may feel tired,” says Dr. Fox. “At a very late stage, they could have fluid in the abdomen, and they could develop yellowing of the eyes and skin. We want to help patients avoid getting to this point.”
There’s also a more aggressive subtype of NAFLD called nonalcoholic steatohepatitis (NASH), which is generally diagnosed via liver biopsy. “Patients with NASH are really at risk for progression of disease,” says Rohit Satoskar, M.D., a transplant hepatology specialist at MedStar Georgetown University Hospital in Washington, D.C. This subtype is less common, accounting for about 20% of people with NAFLD. It’s not clear why some people develop NASH, but if left untreated, NASH can lead to serious health problems like cirrhosis or liver cancer.
The NAFLD and Hepatitis C ConnectionWhy should you care about fatty liver disease if you have hepatitis C? While one condition doesn’t necessarily cause the other, there is an important link. “Even without hepatitis C, patients can have fatty liver disease—they can be separate entities,” says Dr. Satoskar. “However, in patients that do have a hepatitis C infection, there is a higher prevalence of fatty liver disease than in the general population.”
In fact, up to 50% of people with hep C also have fatty liver disease. “We believe that the hepatitis virus itself does something to the metabolism of fats within the liver that can lead to more fat deposition,” he says.
This increased risk might have something to do with your particular strain—or genotype—of hep C virus. “If a patient with hepatitis C has what’s called ‘genotype 3,’ they are a little bit more likely to get fatty liver disease,” Dr. Fox says.
About 20% of people with hepatitis C are infected with genotype 3, according to a 2018 study in Annals of Gastroenterology. And while experts don’t know for sure why genotype 3 leads to fatty liver disease more often than other genotypes, it’s likely related to a unique reaction that occurs between the genotype 3 virus and the cells in the liver that leads to greater expression of fatty acid enzymes. Those with hep C genotype 3 who do get fatty liver disease are also more likely to see the disease worsen faster, leading to liver fibrosis.
Even without this particular genotype, people with hep C can get fatty liver disease for other reasons. “Any hepatitis patient could get fatty liver disease from all of the other conditions that put one at risk,” says Dr. Fox, namely being overweight and having high blood sugar or cholesterol issues.

TO CONTINUE READING: https://www.healthcentral.com/article/hepatitis-c-and-fatty-liver-disease

Journal of Studies on Alcohol and Drugs, 81(5), 556–560 (2020).
              
Matthew Bonn , a,* Adam Palayew , M.Sc.,b Sofia Bartlett , Ph.D.,c Thomas D. Brothers , M.D.,d Natasha Touesnard , a & Show All...
+ Affiliations
*Correspondence may be sent to Matthew Bonn via email at: matthewbonn00@gmail.com.
https://doi.org/10.15288/jsad.2020.81.556

Abstract    People who use drugs (PWUD) face concurrent public health emergencies from overdoses, HIV, hepatitis C, and COVID-19, leading to an unprecedented syndemic. Responses to PWUD that go beyond treatment—such as decriminalization and providing a safe supply of pharmaceutical-grade drugs—could reduce impacts of this syndemic. Solutions already implemented for COVID-19, such as emergency safe-supply prescribing and providing housing to people experiencing homelessness, must be sustained once COVID-19 is contained. This pandemic is not only a public health crisis but also a chance to develop and maintain equitable and sustainable solutions to the harms associated with the criminalization of drug use.
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​The syndemic argumentThe criminalization of personal drug use marginalizes people who use drugs (PWUD), affecting their life, liberty, and security. Prohibition forces PWUD to engage in illegal activities to procure and consume drugs. This creates an international underground economy that generates billions of dollars despite escalating enforcement efforts (United Nations Office on Drugs and Crime, 2020b). This foments an environment in which drugs have inflated prices and unpredictable content, are potentially toxic, and are often consumed in unsafe ways. Along with deaths caused by the unintentional consumption of toxic drugs, there are also severe social punishments for drug use, such as being unemployed due to a low-level drug possession charge and/or being denied housing because of a criminal record, resulting in persistent homelessness. These conditions greatly increase the risk of overdose and overdose deaths, as well as injection-related infections—including HIV and hepatitis C virus (HCV)—while pushing PWUD away from the traditional health care system (Csete et al., 2016).

The coronavirus disease-2019 (COVID-19) pandemic, and the associated public health response of social distancing, physical isolation, and international border restrictions, creates greater harms for PWUD who rely on an illicit drug supply (United Nations Human Rights Office of the High Commissioner, 2020). Without a regular supply of drugs, PWUD are less able to physically isolate and will need to travel to obtain funds or purchase drugs. Physical isolation leads to using drugs alone, which increases the risk of overdose death. Many harm reduction and addiction treatment services have had to scale back based on social distancing guidelines (Bartholomew et al., 2020; Dunlop et al., 2020). International border restrictions related to COVID-19 have made the illicit drug supply even more unpredictable and deadly (Canadian Centre for Substance Use & Addiction & Canadian Community Epidemiology Network, 2020; United Nations Office on Drugs and Crime, 2020a).
As a consequence, PWUD face concurrent public health emergencies (United Nations Office on Drugs and Crime, 2019): increasing overdoses, HIV, HCV, and COVID-19. The confluence of these factors is leading to an unprecedented syndemic. A syndemic occurs when multiple health and social issues intersect and interact to worsen or accelerate disease progression and social outcomes (Singer et al., 2017; Tsai et al., 2017). Health issues such as HIV and HCV overlap with each other because they share similar routes of transmission and risk factors, and multiple social issues frequently co-occur with these infections, such as poverty, homelessness, and injection drug use (Butt et al., 2017; Cleland et al., 2017; Morano et al., 2013). For example, among people living with HCV infection, HIV co-infection accelerates liver disease progression. Poverty and homelessness are frequently found to reduce the likelihood of HIV antiretroviral medication adherence, so when HIV/HCV coinfection, poverty, and homelessness co-occur, they result in accelerated disease progression and poorer health outcomes (Klein et al., 2013).

TO CONTINUE READING:
https://www.jsad.com/doi/full/10.15288/jsad.2020.81.556fbclid=IwAR0CNHeD6S_wKe17xgbE17NFruCHlibCWAOISw8Oe4_RojvH2h7WoNwfgk4
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