Ohio’s Opioid Addiction Forces Rethinking

HEAL Blog is the recipient of the ADAP Advocacy Association’s  2015-2016 ADAP Social Media Campaign of the Year Award

By: Marcus J. Hopkins, Blogger

When rescue teams arrived on the scene, they had to break out two windows in her still-running truck to get to Debra Hyde and her eight-month-old grandson. Hyde’s truck was still in “Drive” in front of a large wall of propane tanks, when rescue workers found her overdosed on heroin in the backseat of her truck.

This is at least the second time in the past month that Ohio authorities have found a grandparent or guardian overdose in a vehicle with a child. Earlier in the month, Ronda Pasek and her boyfriend were found overdosed with a child in the backseat, and she is now sentenced to a 180-day sentence for a misdemeanor charge of “child endangerment.” In both cases, the children involved were remanded to the care of child services.

Woman laying on the ground after overdosing on Heroin, with the needle on the ground nearby

Photo Source: JustThinkTwice

1,424 people died in Ohio, in 2015, as a result of drug overdoses. This has forced first responders to reconsider not only how they prepare for their jobs – Naloxone kits are essentially a “must,” these days – but, how they respond to the burgeoning epidemic that plagues their state. In Marion, OH, and across the nation, heroin has fundamentally altered the work of police and emergency-service workers. Police and paramedics are now expected to play the roles of social workers, drug-treatment specialists, and experts at connecting with kids in drug-prevention programs (as those of us who remember D.A.R.E. can attest).

Marion Police Chief, Bill Collins, told his officers to stop charging those who overdosed, while at the same time, he was making connections with religious leaders, healthcare professionals, addition treatment providers, and teachers to find ways to help better address drug addiction within his community. He followed the evidence: many addiction surveys indicate that a large number of opioid addicts became addicted to prescription pain killers after gaining access to their parents’, grandparents’, or guardians’ properly (or improperly) prescribed opioid painkillers and began using them recreationally. In addition, he noticed that many of the people who were being found overdosed had kids in local schools, which further indicated that a great place to start would be within the educational paradigm.

With these things in mind, Collins and his allies helped create the “Too Good for Drugs” campaign, that teaches age-specific strategies that students can use to resist drugs. The program won a $25,000 Ohio Department of Education grant to fund the ten-week program for 6th-12th grade students. Teachers were so passionate about the project that they volunteer to teach it. Officials are still waiting to find out if another grand to extend the program to K-5th grade students is approved.

But, beyond the fact that these functions are becoming unlisted job requirements in these fields, should law enforcement officers and other first responders be expected to fill these roles? What few people contest is that “something” needs to be done; beyond that, there’s little agreement between healthcare professionals, law enforcement organizations, and advocacy groups on exactly what that “something” is.

Do we need more treatment centers for drug addiction, both in- and out-patient? Absolutely. Do we need more qualified social workers and staffing resources to adequately address opioid and other drug addiction? Yep. Do we need to do a better job of providing these recovery and addiction services to people in more rural parts of states – areas where opioid and heroin addiction are currently hitting states hardest? There’s no doubt of that.

But, the reality is that all of these approaches, while both the “right things to do” and the best ways we currently have to address the problem, are costly and require resources that, on the state and local levels, may simply not exist. Further complicating these efforts is the seeming inability of our elected leaders at the Federal level to work together toward accomplishing mutually beneficial goals. For states currently watching their cities turn into drug dens with a body count, it really does seem like the time for them to just get it together, and get to work.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Ohio Opioid Epidemic Grows As Death Toll Mounts

By: Marcus J. Hopkins, Blogger

Two weeks ago, police in East Liverpool, Ohio, made global news after posting an arrest scene photo of a four-year-old child in his car seat, while with his grandmother and her boyfriend sat in the front seats, overdosed on heroin. The image has served as both a poignant reminder of the often overlooked consequences of opioid and heroin addiction and as a point of controversy for addiction and child advocates.

Map of Ohio, showing East Liverpool

Photo Source: Google Maps

The East Liverpool police posted the photo in an effort to bring attention to the havoc that opioid and heroin abuse wreaks on not only the user, but on the lives of the people around them. Both overdose victims received doses of naloxone – a fast acting drug that reverses the effects of opioid drugs – at the scene, an act which very like saved their lives. The driver, James Acord (47), was sentenced to 360 days in jail after pleading ‘No Contest’ to charges of child endangerment and operating a vehicle under the influence. the boy’s grandmother, Rhonda Pesak (50), who was awarded custody of the child on July 25, 2016, was sentenced to 180 days in jail after withdrawing her initial ‘Not Guilty’ plea to a charge of child endangerment, and reentering a plea of ‘No Contest.’

The child has since been relocated to live with his great aunt and uncle in South Carolina. His mother initially lost custody of him in December 2012 – four-and-a-half months before he was birth – as a result of her addiction to crack. Custody had initially been awarded to his great grandparents, and custody battles for the boy have involved his birth parents, a grandmother, two great aunts, and a friend, spanning four different states. Essentially, this boy’s life has been negatively impacted by drug addictions of some sort since before he was born.

Addiction advocates have criticized the East Liverpool police for “shaming” people who use drugs; child advocates have criticized the city for failing to obscure the identity of the child, which was done after the images were posted by news agencies. East Liverpool Service-Safety Director, Brian Allen, responded with the following statement:

If we hadn’t, Rhonda Pasek would have received a slap on the wrist and that little boy would have gone back to her – that’s not going to happen now. I doubt she will see that child again (Gould & Graham, 2016).

In the five days that followed the posting of the photograph, East Liverpool, a city of only 11,000 people, saw seven more overdoses and one death from heroin. But, this is just a small vignette of a much larger portrait. On Friday, September 09, Ohio authorities reported at least 21 overdoses in a single day in Akron, OH, bringing the total number of overdose deaths, this year, to 112 in the city. At least 24 people were hospitalized for overdoses, last month, while attending a music festival in the state (Karimi, 2016). In July, along, Akron police reported more than 90 overdoses and eight deaths (Las Vegas Review-Journal, 2016).

Ohio’s recently enacted Good Samaritan law offers immunity from prosecution to people trying to get help for someone overdosing on drugs or overdose victims, themselves, who seek assistance. The law, which went into effect, this month, covers people calling 911, contacting a police officer, or taking an overdose victim to a medical facility for up to two times; upon the third time, they would become subject to prosecution. This law, sign by current Ohio Governor, John Kasich, was passed in an effort to provide those offering assistance to overdose victims some measure of protection in the face of Ohio’s clear opioid and heroin abuse epidemic.

HEAL Blog will continue covering the epidemic in the coming weeks with more information and updates as they become available.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Veteran’s Administration $1.5 Billion for HCV to Expand Coverage

By: Marcus J. Hopkins, Blogger

Veterans Administration logo

Photo Source: VA

The Veteran’s Administration (VA) has requested $1.5 billion in the Fiscal Year 2017 (FY2017) budget in order to treat more veterans for Hepatitis C (HCV). This move comes after the announcement in March that the VA would be expanding treatment protocols to include all veterans in its health system with the virus, regardless of age or progression into liver cirrhosis (Kime, 2016). This coverage expansion was covered in the HIV/HCV Co-Infection Watch Report in April, and was recently reported in the Journal of the American Medical Association (JAMA) in the September edition.

With more than $2 billion appropriated for new HCV drugs during the past two years, the VA has treated 65,000 veterans for the virus (Wentling, 2016). One of the primary concerns expressed by veterans’ groups – Disabled Veterans (dot) Org, in particular – has been the rationing of care to only those whose liver fibrosis scores met what they feel are arbitrary measures that focus more on saving money, rather than saving lives. Tom Berge, head of the Vietnam Veterans of America (VVA) health care panel, went so far as to say the following: “When I found out that they were prioritizing the treatments, that’s when I said they were death panels (Krause, 2016).” The “death panels” claim is reminiscent of political arguments against single-payer or Universal healthcare coverage, wherein bureaucrats essentially decide which people would live or die, based on a set of predetermined markers.

The rationing of treatment to the sickest or most financially able to pay is nothing new – public and private insurers and payers, alike, have utilized these formulae and markers in an effort to reduce costs while still maintaining the visage that they “cover” drugs, even if actual utilization on the part of patients is low. With HCV drugs, in particular, many Medicaid and ADAP programs have indicated in their respective Preferred Drug Lists (PDLs) and formularies that they cover the new Direct Acting Agents (DAAs) that are currently considered to be the Standard of Care (SOC) for HCV, only to have the Centers for Medicare and Medicaid Services (CMS) release a guidance in November 2015 reminding Medicaid programs that “cost” was not an acceptable reason to deny coverage. Certain states – Arizona, for example – openly stated that they would not be following said guidance.

The VA currently estimates that 107,000 vets have undiagnosed or untreated HCV (Wentling, 2016), with Vietnam War-era veterans born between 1945 and 1965 being one of the demographics most likely to have been infected, as this generation (generally referred to as “Baby Boomers”) may have been the recipients of blood transfusions and organ transplants prior to the discovery and screening of blood for HCV. It wasn’t until 1992 that widespread screening of the blood supply began in the United States.

While this demographic is a target for HCV screening, most new HCV infections occur as a result of sharing syringes or other equipment to inject drugs (Centers for Disease Control and Prevention, 2016). Veterans are particularly susceptible to prescription opioid and heroin addiction. According to VA officials, roughly 60% of those returning from deployments from current engagements in the Middle East and 50% of older veterans suffer from chronic pain. That’s compared to about 30% of Americans, nationwide. Additionally, veterans are twice as likely to die of accidental opioid overdoses than non-veterans. Prescriptions for opioid drugs rose by 270% over a twelve-year period by 2013 (Childress, 2016). This places veterans at particular risk of contracting HCV as a result of Injection Drug Use (IDU).

Though the cost of treating HCV are currently astronomical, on a national scale, the VA does benefit from a requirement that drug manufacturers provide the system with the “best price,” though those discounts are currently shielded by Trade Secrets laws that specifically forbid programs from publicizing any deals, discounted prices, or pricing arrangements struck between pharmaceutical companies and payer programs. But, we have asked of our veterans that they make sacrifices to ensure our continued freedom and safety; is any price too high to ensure their continued health and wellbeing if and when they return from battle? I think not.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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A Case of Northern Overexposure

By: Marcus J. Hopkins, Blogger

The face of Hepatitis C (HCV) continues to change, as the State of Alaska Section of Epidemiology is reporting – nay, warning – of yet another example of rapid increase in HCV rates among people aged 18-29 (State of Alaska, 2016). Of the 1,486 cases of HCV reported in 2015, the aforementioned age group represented 459 of those cases – roughly 31% – putting them on par with people aged 30-49 (461, roughly 31%). The remaining cases in 2015 were seen in people aged 50 or older.

This data conforms to national trends in HCV. While the majority of cases tend to occur within the 50+ age range, the fastest rate of increase continues to exist amongst the young, largely driven by opioid prescription drug and heroin abuse. Injection Drug Use (IDU) is consistently pegged as the largest driver of new infections, and the problem continues to grow and more people are being prescribed addictive prescription opioid drugs for pain management for injuries that may not necessitate them.

While opioid and heroin IDU is a growing problem, Alaska has long been utilizing Harm Reductions methods to attempt to mitigate the harm to IDUs. Four Syringe Exchange Programs (SEPs) are currently operating in Alaska in four cities: Anchorage, Fairbanks, Homer, and Juneau. Only once of these cities – Juneau – is present in the hardest hit region of the state, where the rate of infection for 18-29-year-olds saw a 490% increase from 2011-2015. Of further concern is that no SEP programs are operative in other parts of the state, which means that people in those areas are least likely to receive IDU support services.

The State of Alaska is quick to state that these data should not be considered the final word on HCV infections for 2015; many people who are infected with HCV are not diagnosed until years after the initial infection (Juneau Empire, 2016).

In similar news, Clark County in Indiana has become the sixth county in the state to qualify for permission to open an SEP under a 2015 emergency law that allows states to open an approved exchange if the state’s health commissioner declares a public health emergency in the county (. This was in response to a massive outbreak of HIV and HCV in southern Scott County in late-2014/early-2015 related to IDU.

While Clark County has received approval for the opening of an SEP, it spent a full eight months attempting to work out issues with its initial application. The primary issue, according to County Health Commissioner Kevin Burke, was that state officials didn’t support how the SEP would have been funded. Funding for the program was and will be provided by the Los Angeles-based AIDS Healthcare Foundation (AHF), which has garnered both high praise and sharp criticism in its approach to negotiating contracts with states and counties. After the problematic funding models were hammered out, a second application was submitted and approved.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Pre-Requisite Treatment Standards Still Abound

By: Marcus J. Hopkins, Blogger

Remember that time when county health officials refused medical treatment coverage to people living with HIV if they were drug users and openly admitted it in a radio interview? Yeah…me, either. This was, however, the case on August 24th, 2016, when Dr. Hal Lee, Los Angeles County Health Services’ Chief Medical Officer and liver specialist, freely admitted to the practice with the following statement:

It’s our obligation to offer treatment in a manner that’s rational and logical. We identify the individuals for initial treatment right now, based on how we can offer the most care to the most people, who are going to benefit from it the most now. We believe it is likely that patients who are not using drugs are more likely to complete the treatment than people who are actively using illicit drugs (Plevin, 2016).

This policy is in direct conflict with the Medi-Cal – California’s Medicaid program – Treatment Policy for the Management of Chronic Hepatitis C, a set of guidelines that went into effect on July 1st, 2015, well over a year prior to the date of this interview (State of California, 2015). What makes Yee’s statement ironic is that Medi-Cal is very likely the agency that would be paying for the services that his office is failing to provide.

In this interview, the reporter states that Yee has developed a checklist of criteria to determine if patients are eligible for treatment – one that apparently disregards the very specific checklist put forth by the State of California. One of the criteria requires patients to be free of drug use for six months prior to receiving Hepatitis C medications.

To bring this further into focus, Health Services, which provides health care for about a half-million low-income Los Angelinos, has approved treatment for only 160 people, as of the beginning of August. By comparison, San Francisco Health Network, which serves only 65,000 people overall, treated 631 people by late June 2016. This is a stark difference in treatment approaches, and speaks, I believe, to the social and socioeconomic stratification that exists in Los Angeles County.

My own experiences with L.A. County’s Health Department left much to be desired. As someone who has relocated to several states and been the beneficiary of their respective health agencies, my experiences within L.A.’s low-income health care programs presented a stark and sad reflection of how L.A. treats its residents who don’t reside in the best zip codes.

Hospitals were run essentially like prisons, with barred windows, numerous metal detectors, and employees who behaved more like judgmental prison workers, rather than health care professionals. Facilities were overcrowded, parking was nearly impossible to find, and locations were so far-flung that taking public transportation to them would take hours. After enduring hours-long commutes on the 5 and 405 freeways just to get to an appointment, I finally gave up on the County program and switched my treatment facility to the AIDS Healthcare Foundation in Van Nuys.

Just beyond the Sepulveda Pass in “The Valley” (San Fernando, that is), this facility that catered to low-income patients was in the right zip code. Though small, it was rarely crowded, focused solely on patients with HIV, and the employees treated everyone, regardless of their mental or physical state, without judgment. There were no metal detectors or barred windows; just good healthcare providers.

Dr. Hal Lee

Photo Source: L.A. Care Consult

What makes me sad about the interview with Dr. Yee is the following quote:

If 70 percent of individuals would live out their lives without any consequences of their hepatitis C infection, none of those people will benefit from treatment. I know that if you come talk to me in one year, in five years, in ten years, you’re going to see these numbers climb, because we’ve put in infrastructure that I know allows us to provide the kind of care that other counties can’t even begin to think about.

Make no mistake – Yee’s approach to treatment is not only outside of California’s long-established treatment guidelines, they are also part of a greater issue: the belief that not everyone is deserving of treatment; that some patients are just “better” than others; that one’s station in life makes them more deserving of quality healthcare.

This interview with not just a county healthcare employee, but the Chief Medical Officer, is a sad reminder of how some doctors fail to live up to their obligations to their patients in a nation where healthcare is not considered a human right. Opponents of Universal/Single-Payer Healthcare love to bandy about the boogieman of “Death Panels,” failing to see that those types of panels already exist, right here in our United States.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Milk, Bread, Ground Beef, and Overdose Medication

By: Marcus J. Hopkins, Blogger

The HEAL Blog has been following the issue of opioid addiction very closely, largely because Injection Drug Users (IDUs) represent a large proportion of new Hepatitis C (HCV) infections in the U.S., particularly in rural parts of the country. The Appalachian Mountain region serves as a prime example of how heroin and opioid addiction can lead to a rash of both HIV and HCV outbreaks; it also serves as excellent proving grounds for how Harm Reduction methods can help to prevent mass outbreaks, as well as save lives.

Harm Reductions measures are those that focus on preventive measures that have been shown to lessen the risk to individuals through various legal means. As they relate to opioid addiction, one of the most important measures is increased access to Naloxone, a medication that is used to block the effects of opioid drugs, such as slowed breathing and loss of consciousness. Naloxone – sold under the brand name, Narcan – is a nasal spray that is used to counteract the effects of an opioid overdose. It is currently listed on the World Health Organization’s “List of Essential Medicines,” the most important medications needed in a basic health system, and increasing ease of access without a prescription is something for which advocates have long fought.

Last week, in the city of Huntington, WV, 26 people overdosed on opioid drugs in a period of only four hours from a particularly potent batch of heroin. Of those 26 overdose cases, none of the patients died, as first responders and hospitals were quick to react, delivering a total of 12 doses of Naloxone, including the two used by Huntington police. One patient had to be revived using three doses (Struck, 2016). The remaining patients were revived using bag valve masks, a handheld device used to provide ventilation to patients who aren’t breathing. The users who overdosed ranged in age from 20 to 59, demonstrating that the opioid epidemic affects people of virtually every age range. In Cabell County, where Huntington is located, there were 440 overdoses by June of this year, 26 of which resulted in death; the state of West Virginia, itself, ranks highest in the number of overdose deaths in the U.S.

In Kentucky, the next state over and less than fifteen miles from Huntington, Kroger grocery store locations with pharmacies on site began offering Naloxone over the counter without a prescription at 96 locations, including 80 pharmacies in the Louisville Division (Warren, 2016). Kentucky currently ranks in the top five states for overdose deaths, which makes it an excellent test market for the efficacy of offering Naloxone without a prescription. That said, the Kroger locations in Ashland, KY – the city nearest Huntington, WV – does not yet offer the drug over the counter.

Naloxone rescue kit

Photo Source: Yourblogondrugs.com

When we discuss expanding Naloxone access, there are a number of ways that access can be broadened – (1.) Naloxone can be carried by first responders; (2.) Naloxone can be carried also by state employees (such as school officials); (3.) Naloxone can be sold without a prescription to anyone. WV does not currently allow the sale of Naloxone without a prescription, although WV HB 4035 seeks to do just that. Access to first responders, including police and other emergency personnel, was expanded beyond just Emergency Medical Technicians (EMTs) in May of this year, but it is unclear, yet, whether or not HB 4035 will be ratified and made into law by the end of this year. In an election year, particularly in the latter half, little of substance seems to get done.

What is important, however, is that we continue to fight to expand access to this lifesaving drug. Politics and personal peccadillos aside, saving someone’s life should never fall prey to moralizing of whether or not opioid abuse is wrong, nor should saving a life be predicated upon whether or not one agrees with the lifestyle choices of the victim. When lives are at risk, every reasonable action should be taken to ensure that those lives are saved.

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Rhode Island Reports Explosion of Chronic HCV, Injection Drug Use

By: Marcus J. Hopkins, Blogger

A new report from the Rhode Island Public Health Institute at Brown University found that the state is currently in the midst of a steep rise in chronic Hepatitis C (HCV) infections, as well as in opioid dependence and overdose. Referred to in the report as a “syndemic,” the study paints a grim picture for the densely populated New England state.

Report Cover: Epidemiological Profile: The Hepatitis C Epidemic in Rhode Island

Photo Source: Rhode Island Department of Health

The study found a 500% increase in HCV-related deaths in the state; it also estimated a prevalence rate of 3.7% – 6%, suggesting that the HCV disease burden – the impact of a health problem as measured by financial cost, mortality, morbidity, or other indicators – may be higher than the state previously estimated. Additionally, Rhode Island’s Medicaid program reporting data suggests that 13,000 Medicaid beneficiaries were screened for HCV in 2014 and 2015; of those beneficiaries, approximately 1,700 returned HCV-positive test results in 2014 and 2015, though it is unknown if all of those individuals sought treatment for their diagnoses. Medicaid reported financing treatment for 215 Medicaid beneficiaries in 2015.

As it relates to last week’s HEAL Blog (HCV in prison populations), the Rhode Island Department of Correction (RIDOC) reported that the prevalence rate for inmates screened for HCV is 17%, and have responded with increased screening, treatment, and cure efforts in the last year.

This new report also indicates that opioid addition and overdose is on the rise within the state, ranking 6th in the nation for drug overdose deaths, the highest in New England. More concerning, perhaps, than the fata overdose rate is that of the non-fatal – at least five times as many non-fatal drug overdoses were reported, which suggests a high level of drug dependence in a relatively small, but densely packed state.

New England, as a whole, continues to battle a growing opioid addiction and overdose epidemic, particularly in the rural and suburban parts of the states – areas which had previously managed to be largely unaffected by the ravages of drug abuse. This trend is reflective of the opioid epidemic in most of the country, and speak to a larger national opioid abuse issue that Federal, state, and local governments are desperate to adequately address.

On the national front, efforts to tighten regulations on prescription opioid drugs face considerable pushback from pharmaceutical manufacturers, whose political sway has largely paralyzed regulatory bodies in their attempts to move forward on the issue. That said, the FY2017 budget currently working its way through the House and Senate includes a significant increase in funds to various programs directed at combating opioid abuse. There has been some movement on efforts to lift the blanket ban on Federal funding for syringe exchange programs, a harm reduction method proven to decrease the spread of blood borne infections, such as HIV and HCV, within Injection Drug User (IDU) populations.

At the state level, Rhode Island’s sole syringe exchange program, ENCORE (Education, Needle Exchange, Counseling, Outreach, and REferrals), is an anonymous program that can provide any individual over the age of 18 with safer sex materials, including clean syringes, bleach, alcohol swabs, cookers, and cotton, as well as condoms. ENCORE outreach workers can also provide anonymous HIV testing, referrals to drug treatment programs, medical care, and social services, as well as clothing and personal hygiene items. The program is located in Providence, RI, and information can be found at http://www.aidscareos.org/.
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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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