Monthly Archives: April 2015

Massachusetts Witnesses HCV Resurgence

By: Marcus J. Hopkins, Blogger

Hepatitis C (HCV) has made a resurgence in Massachusetts, where hundreds of Intravenous Drug Users (IDUs) have created both a problem with opioid-related overdoses and an epidemic in new diagnoses, according to Kevin Cranston, director of the state Department of Public Health’s Bureau of Infectious Diseases.

HCV has long been associated with the Baby Boomer generation, most of whom contracted the virus through blood transfusions received prior to proper HCV screening. Thanks to education, blood screenings, and needle exchange programs (in states where they’re legal), HCV infections had been on the decline throughout the 1990s. That is no longer the case.

Drugs and drug use is, like other trends, cyclical – certain types of drugs come into and go out of fashion in roughly five-to-ten-year cycles. Opioids, however, have come back in a big way, and this time, heroin isn’t the only game in town. With the widespread introduction of pharmaceutical opioids in the mid-1990s (e.g. – Oxycodone), abuse of those drugs has become an increasing problem, not only for its addictive qualities, but also for the increase in IDU-related viral infections.

In Massachusetts, most new cases of HCV are occurring in people under the age of 30. This is largely attributed to heroin and pharmaceutical opioid abuse in a new generation of IDUs who can get their fix much more cheaply than their peers who prefer accelerants as their drugs of choice. The epidemic is so great that, over the past few years, Massachusetts has identified over 2,000 new cases annually.

The trend for younger IDUs starts where most problems start – the home. Young people typically begin their addiction by taking their parents’ prescribed painkillers, or by becoming addicted by using the pain medications prescribed to them after a sports-related injury. Once the pharmaceutical options are no longer available to them, many turn to heroin, which is much more readily available and cheaper on the streets than prescription opioids.

More troubling than the drug abuse, itself, is the sense of invincibility that often accompanies youth. Many younger IDUs don’t view HCV (or HIV, for that matter) as something that can “…happen to [them],” and if it does, there are always drugs to treat them.

As a Health Communication Specialist, I often get questions from younger attendees regarding HIV and HCV asking, “But…haven’t they cured that, yet,” or “Well, if you get it, can’t you just treat it with medication?”

MassHealth logo embedded on map of Massachusetts

Photo Credit: Association of Developmental Disabilities Providers

Unfortunately, treating infectious diseases is just not that simple, nor is it cheap. While Massachusetts does have a fantastic open formulary/PDL for their MassHealth (Medicaid) program for lower income citizens (one of the other common indicators for IDUs), the cost of newer HCV treatment regimens has largely contributed to a dramatic increase in spending, further stressing already stretched budgets to their breaking points.

Needle exchange programs are legal in Massachusetts, and are largely credited with a decline in new HIV diagnoses amongst IDUs. There are fears, however, that the same behaviors that have led to a sharp increase in HCV diagnoses will lead to a new resurgence in HIV infections, as well, within the same population. These fears are largely substantiated by HIV statistics from the CDC, showing that the largest increase in new infections over the last decade has occurred in those aged 13-25

Image promoting needle exchange for IDUsExchange programs have long been controversial, particularly in conservative circles, where the common belief is that such programs will bring the “wrong kind of element” into communities, and will encourage drug use and abuse, rather than having any sort of positive impact. These beliefs do not, however, stand up to scientific scrutiny, as research has repeatedly shown that needle exchange programs contribute to lower rates of injection-related viral infections; additionally, they consistently show no appreciably increase in drug use and abuse in area where needle exchange programs are readily available an accessible.

As of March 2015, the Massachusetts state public health lab began automatically testing every blood sample received for both HIV and HCV, a very positive step forward, and certainly a very progressive step in a state known for its bold action on public health fronts. This is, obviously, a step I would like to see being taken in every state; that being said, the reality is that it’s both too costly for most states to undertake and very unlikely to occur, particularly in the states where such actions are most needed (i.e. – the American South).

We, at HEAL Blog, will continue to monitor the situations in both Massachusetts and Indiana as more information becomes 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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Scott County & the Case for Needle Exchange

By Marcus J. Hopkins, Blogger

The past week in the state of Indiana has been, if nothing else, hectic. The signing of the legislature’s “Religious Freedom Restoration Act” bill has largely overshadowed a considerably more pressing issue – a sudden outbreak of HIV infections in a single county related to injection drug use.

In Scott County, Indiana, a mere five unique cases of HIV infection are reported (on average), every year; that number has seen a dramatic increase to 81 unique infections. This type of mass infection is no longer commonplace, as injection drug (ID) use accounts for a very small number of new HIV infections, nationally, but it does spell trouble, not only for residents in and around Scott County, Indiana, but in every area in the country with a high incidence of ID use and abuse.

Map showing Scott County, Indiana

Photo Credit: Family Search

Injection drug use is unique amongst drug statistics in that it disproportionately impacts economically depressed regions. From heroin to prescription opioid abuse, wherever there is a high concentration of lower-income residents combined with less economic opportunity and social mobility, one is likely to find a high incidence of ID use.

As this is a blog related to Hepatitis C, it becomes more relevant to our pet cause – much of the burgeoning Hepatitis C infection rate in younger Americans (between the ages of 13-35) is directly related to ID use. What is more concerning, to me, is how those demographics play such a large part in this crisis and how legislators are responding to this clear and present crisis.

In response to this outbreak, the Indiana legislature has taken time out of its busy Jim Crow Revitalization schedule to actually craft a piece of functional legislation that would allow for the short-term establishment of needle exchange programs in high-risk counties.

If this sounds like a case of “Too Little, Too Late,” it is; but that seems to be the way with health care initiatives, in America. As a nation, we have a high predilection towards “Reactive Measures,” rather than “Proactive Measures.” The topic of needle exchange programs has long been both a highly effective measure, proven to result in fewer ID-related infections, as well as a highly contentious issue for politicians who are hell bent on marginalizing and criminalizing ID users.

Needle exchanges have consistently demonstrated their importance and effectiveness in areas where ID use is high; the ability for users to exchange used and potentially “dirty” needles for clean ones helps to stem the spread of highly virulent infections, such as Hepatitis and HIV. This has been shown to be the case all around the U.S. for over twenty-five years, and yet, they remain largely absent in the healthcare landscape.

The controversy stems from a [mostly Conservative espoused] belief that implementing needle exchange programs is tantamount to encouraging ID use, and that if these programs exist, they will lead to the quick and furious destruction of the American way of life, as heroin zombies are well-known to spread their disease to everyone with whom they come in contact, and soon, armies of the walking drug addled will overwhelm security forces and leave the nation a wasteland of burning cities and devastated landscapes.

Wait…those are just regular zombies.

Sign reading,

Indiana Needle Exchange

These arguments against the establishment of needle exchange programs have, time and again, proven to be both spurious and demonstrably false. Areas who’ve created and maintained exchanges have consistently shown a decrease in new ID-related infections, and are consistently paired with more effective and far reaching outreach, support, and recovery programs for ID users who are looking to break the cycle of drug abuse.

Unfortunately, science, facts, and evidence supported by research rarely play a part in the creation of healthcare legislation, as elected officials seem more often to rely on a game of numbers (profits over people…in the short-term, anyway), combined with a healthy dose of hysteria, faux moral outrage, and political posturing.

What’s troubling about the legislation crafted in Indiana to respond to this acute HIV outbreak is that it’s not only too little, too late, it’s likely to prove ineffective in the short-term time frame they’ve established for these high-risk counties.

Politicians who are skeptical of any public health initiative that might actually work consistently fail to understand that, in order for any public health initiative to be effective, they have to not only be established, they must also be well-funded and permanent. Long-term health outcomes require long-term solutions, and this seems to be something that anti-government elected officials can’t quite understand – they only work if the efforts are maintained and continuous.

Reactive approaches to healthcare rarely prove effective – how does one stop an outbreak from becoming an outbreak, if there’s already an outbreak? – and, though I applaud the temporary bout of sanity with which the Indiana legislative bodies have been suddenly stricken, I am dubious of the long-term continuance of said sanity (remember – long-term problems require long-term approaches).

And so, despite this sudden outbreak of HIV infections, I am not optimistic that this incident, or any other incident that negatively impacts people who have very few resources to contribute to political campaigns, will lead to any sort of long-term solution until we can manage to get sensible, fact- and research-based legislative efforts to move forward in elected governmental bodies. And, as this will require the election into office of legislators who are willing to buck the faux moral outrage of their very vocal, yet uniquely ill-informed, constituents in favor of sensible policy creation, that’s just not very likely to occur.

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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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