Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C

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

On Wednesday, April 26th, 2018, Elizabeth Paukstis, Public Policy Director for the National Viral Hepatitis Roundtable (NVHR), joined me in Washington, DC to deliver presentations about Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C. This was the second such meeting held by the Community Access National Network (CANN) in as many years dedicated to the topic of correctional healthcare.

My presentation – Viral Hepatitis in Correctional Settings – included original research conducted by CANN that attempted gather the testing protocols for Hepatitis B (HBV) and Hepatitis C (HCV) from Departments/Divisions of Corrections (DOCs) in all fifty states and the District of Columbia. The findings of this research are as follows:

  • Only fourteen (14) states publicly post specific protocols on their state DOC websites
  • Twenty-five (25) states require or offer HBV testing during intake
  • Thirty-two (32) states require or offer HCV testing during intake
  • Only seven (7) states follow the Federal Board of Prisons’ (BOP) recommendation of offering HBV testing using an Opt-Out delivery model (informed refusal)
  • Only fifteen (15) states offer HCV testing using an Opt-Out delivery model
  • Twenty-three (23) states only test for HBV on inmate request or if they meet clinical criteria (e.g. – inmate has HIV, contact with someone who has HBV, injection drug use)
  • Seventeen (17) states only test for HCV on inmate request or if they meet clinical criteria (Hopkins, 2018)

My report can be found here.

State/Federal HCV-Related Lawsuits Involving Prisons (2017-2018)

Photo Source: CANN

Ms. Paukstis’ presentation – Hepatitis C and Incarceration: Policy Proposals and Challenges – focused on treatment statistics within prisons, the challenges prisons face when procuring prescription drugs, provided a case study regarding Mississippi’s myriad issues related to HCV in their prison populations. Highlights of this presentation include:

  • An estimated 17% of inmates in U.S. state prisons are infected with HCV
  • Less than 1% (0.89%) of those known to have HCV were receiving treatment in 2016
  • The Federal BOP receives at least a 24% discount on HCV drugs – a discount to which state prisons are not privy
  • State prisons are not eligible for discounts under the Federal 340B Drug Pricing Program
  • Incarcerated persons face an additional risk of having their sentences extended if they are charged with “endangerment by bodily substance” (causing a correctional employee, visitor, or another inmate to come into contact with blood, seminal fluid, urine, feces, or saliva)

Download Elizabeth’s report.

References:

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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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CDC Releases 2016 Viral Hepatitis Surveillance Data

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

…and the news isn’t good.

The U.S. Centers for Disease Control and Prevention (CDC) released, last week, the 2016 Viral Hepatitis Surveillance report. Acute Hepatitis B (HBV) infections remained largely stable, while Acute Hepatitis C (HCV) saw a 21.8% increase in new infections from 2015 to 2016. The CDC attributes the continually rising incidence of HCV to rising rates of Injection Drug Use (IDU) and, to a lesser extent, improved case detection (CDC, 2018b).

Photo of the CDC Headquarters

Source: George Mason University

According to the CDC, HCV has seen a 350% increase from 2010 (CDC). Despite this increase, nearly 1 in 5 states do not gather, track, or report HCV data. In 2015, eleven states did not deem HCV a reportable condition; in 2016, that number decreased to nine state (AK, AZ, DC, HI, IA, MS, NH, RI, & WY), as both Connecticut and South Dakota began surveilling the disease. This collection of states is particularly concerning, as many of them are in areas of the country where the burden of infectious disease is high – two states in New England, one in the Midwest, two in the South, and Arizona, which has the 6th-highest incarceration rate in the nation.

This last point is important, as it is estimated that 1 in 3 in U.S. jails and prisons has HCV. Arizona’s high rate of incarceration is particularly troubling, given the ongoing class-action lawsuit against the Arizona Department of Corrections (ADC), Parsons v. Ryan (2012), which not only found that ADC systematically refused to treat inmates, but failed to provide even basic healthcare services. Worse, last year saw both an additional post-settlement hearing in which ADC employees were further accused of both retaliating against inmates who testified, and violating the terms of the settlement in 2,127 incidents (Weill, 2017).

Arizona Department of Corrections is killing prisoners

Photo Source: Survivors of Prison Violence – Arizona

Other troubling statistics involve the changing face of HCV. The three largest increases in new infections occurred in people aged 40-49 years (33.3%), 30-39 years (29.4%), and 20-29 years (12.5%). All of these groups fall outside of the Birth Cohort – Baby Boomers born between 1945-1965 – and indicate that non-medical exposure is likely to be the largest cause of new infectious. More troubling was that people aged 20-29 had the highest rate of infectious of any age group (2.7). This is likely attributable to IDU.

As for race demographics, American Indians and Alaskan Natives are disproportionately impacted by HCV, as a percentage of the population, with an infection rate of 3.1 per 100,000.

More concerning for advocates is that 52.5% of the Acute HCV cases reported to the CDC did not include risk factor data, meaning that states aren’t doing their due diligence during testing/reporting. Of those that did include risk factor data, the data suggest that IDU is the leading risk factor for transmission, with 68.6% of new HCV infections listing IDU as the primary risk factor.

Clearly, the U.S. has more work to do, when it comes to identifying HCV infections. Realistically, it is uncertain that much support will be coming from the Federal level, as even the most benign legislation winds up stalled for whatever reason. Until the composition of the Federal legislature occurs, states will end up shouldering most of the burden in the interim.

References:

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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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Trump’s War on the Poor is a War Against Us

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

On April 10th, current President, Donald J. Trump, fired the latest Republican salvo against the poor and social welfare programs by signing an executive order intended to force recipients of food assistance, Medicaid, and low-income housing subsidies to “get a job” or lose their benefits. A question that has yet to be answered is whether or not this edict will apply to recipients of Ryan White benefits, which provide low- or no-cost HIV medications, medical and dental treatment coverage, and other ancillary, yet vital services to an estimated 52% of people diagnosed with HIV in the United States (Health Resources and Services Administration, 2016). Those co-infected with Hepatitis C (HCV), whose cure requires treatment with some of the most expensive drugs on the market, are likely to be harmed, as well.

Make no mistake – this latest royal decr…executive order – unironically titled, “Reducing Poverty in America” – is specifically designed notto actuallypull people up out of poverty, but to force the “undeserving” off of the public dole. The order is directed at “any program that provides means-tested assistance or other assistance that provides benefits to people, households, or families that have low incomes” (Thrush, 2018). This is concerning for healthcare advocates, because the qualification for Ryan White services is predicated upon “means-tested assistance.” Essentially, how much money you make determines if you’re eligible for coverage.

Recent HCV incidence and prevalence reports indicate that an increasing number of new infectious occur in rural and suburban areas of the country, with higher rates of infection occurring in Injection Drug Users, particularly in people aged 18-45, and in areas where unemployment is high, educational achievement is lower, and access to healthcare services often faces several barriers. Essentially, HCV is prevalent among people and in places that are poor; people who often rely upon means-tested assistance to pay for healthcare.

As with virtually every Republican-initiated attempt to “reform” social services programs, this is a solution looking for a problem. Roughly 60% of working age, non-elderly Medicaid enrollees are working; plus, nearly 8 in 10 –  recipients (78%) live in families where at least one person works (Garfield, et al, 2018). The statistics are similar for recipients of the Supplemental Nutrition Assistance Program (SNAP)…  And for WIC…  And for virtually every other social safety net program.

76% of Louisiana's Medicaid expansion enrollees are working, caring for family members, or in school.

Photo Source: Louisiana Budget Project

Ryan White recipients, in particular, face an undue burden, as income requirements – particularly in more conservative states – are so low that working virtually any job will make them ineligible to receive coverage for medications that are prohibitively expensive. This will apply to both those mono-infected with HIV and co-infected with HCV.  For those receiving Medicaid, the burden will be just as high.

All of this stems from the Federal Poverty Level (FPL), a percentage of which determines eligibility for these means-tested programs. For an individual, the FPL is $12,140 per year in 2018. This means that an individual must make that amount, or less, to be considered “in poverty” in the United States. In states that expanded their Medicaid programs, most raised that qualification limit to 138% percent of the FPL ($16,753). The FPL percentage for Ryan White varies wildly from state to state.

This places potential recipients in a terrible position: At the current Federal Minimum Wage ($7.50/hour), an individual working 40 hours a week for 52 weeks will have an annual income of $15,080. If they cross this threshold by even a few hundred dollars, it makes them ineligible for the program, but still leaves them unable to afford the basic cost of living, much less any insurance premiums or medications they may have added to their monthly expenditures. Even with a second income, which would likely make them ineligible for services because they make “too much money,” the cost of living is so far removed from how the FPL is set, no person can reasonably expect to subsist off of that amount for any extended period of time in a First World country.

Adding work requirements to social programs also poses a logistical reality: simply demanding that “able-bodied” people “get jobs” doesn’t magically create jobs for there to be gotten. Nor are these requirements bolstered by any additional wraparound services, such as increased infrastructure spending to extend public transportation services out to far-flung locales, transportation assistance funds to cover the cost of fuel or low-cost public transportation passes.

The reality is that these “cost-saving” measures (ultimately designed to purge these programs of ‘undeserving’ recipients) will result in immeasurable costs that will be paid in human lives.

References:

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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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We Have a Cure for HCV; Few People Can Get It

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

Numerous films and novels have predicted this fate: there’s a fatal disease and someone invents a cure, but nobody can get it, and people die because of it. It’s a metaphor about the dangers of unchecked capitalism – the greedy owner of the cure who holds the rest of the world hostage until his demands are met.

And here it is – 2018, and we’ve had a cure for Hepatitis C (HCV) that’s easily tolerated since 2013, but it’s so prohibitively expensive that private and public payors, alike, have strictly limited access to it. They make patients, physicians, and pharmacists jump through as many hoops as possible to get the cure, from the strictest prerequisite abstinence guidelines, to allowing the disease to progress until it’s “bad enough” to cover it.

Medical Benefits Claim Form with the word, "REJECTED"

Photo Source: NPR

Sure, the cost of the newest drugs to cure HCV have dropped to ¼ of the introductory price of Sovaldi (Gilead), but, still – $30k for eight weeks of treatment? That’s still prohibitively expensive, even with the deep discounts and rebates given to many payors by manufacturers during the negotiation process. Those expenditures are only going to increase.

Now, there is evidence suggesting that undiagnosed HCV is more prevalent than undiagnosed HIV (Torian et al, 2018). Since the 1990s, hospitals and emergency departments have actively touted “routine HIV” screening, but have failed to deliver on those promises:

Lessons from HIV are both instructive and sobering: routine HIV screening is not truly routine; linkage continues to challenge even experienced providers; and linkage and treatment initiation vary widely across sites (Torian et al, 2018).

The findings from this study indicate not only a need to increase screening and linkages to care for HIV, but that this increase needs to be spread to HCV, as well. The latter argument, while correct, is unlikely to occur, in no small part because states and patients simply don’t have the resources to successfully implement this type of public health initiative.

Beyond just testing, minorities and Medicaid recipients – a significant portion of those infected with HCV – enjoy some of the lowest treatment rates in the nation (Wong et al, 2018). Hispanic patients were siginifantly less likely to receive treatment for HCV than white patients, and those on Medicaid, state insurance, or indigent care or no insurance were significantly less like to receive treatment than those with commercial insurance.

That last part comes to a head in rural America, where patients are far likelier to rely upon Medicaid as their primary payor for medical services, and where Injection Drug Use (IDU) of prescription opioids and/or heroin is high. In states like Ohio, Indiana, West Virginia, and Kentucky, IDU and rates of overdose go hand in hand with increased rates of both Hepatitis B and HCV.

The sad reality is that, given the existing political makeup of both state and Federal legislatures, it’s highly unlikely that the significant resources needed to effectively combat the spread of HCV will be allocated. At a time when budgets are being slashed in order to accommodate tax cuts for corporation and the wealthy, to suggest that conservative lawmakers are suddenly going to provide an exponential (or even incremental) increase in funding is unrealistic.

References:

  • Torian, L.V., Felsen, U.R., Qiang, X., Laraque, F., Rude, E.J., Rose, H., Cole, A., et al. (2018, April 04). Undiagnosed HIV and HCV Infection in a New York City Emergency Department, 2015. American Journal of Public Health 108, no. 5 (May 1, 2018): pp. 652-658. DOI: 10.2105/AJPH.2018.304321 Retrieved from: https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304321
  • Wong, R.J., Jain, M.K., Therapondos, G., Shiffman, M.L., Kshirsagar, O., Clark, C., & Thamer, M. (2018, March 09). Race/ethnicity and insurance status disparities in access to direct acting antivirals for hepatitis C virus treatment. The American Journal of Gastroenterology. DOI: 10.1038/s41395-018-0033-8. Retrieved from: https://www.nature.com/articles/s41395-018-0033-8

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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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I Just Want Current Data

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

I’m a data person. While I can feign empathy, when it comes to reporting about HIV, Hepatitis B (HBV), and Hepatitis C (HCV), I’m much more of a “numbers” person. So, when Emory University announced, last year, that they were releasing a pair of websites (funded by Gilead Sciences who, in the effort of full disclosure, also fund the Community Access National Network’s HIV/HCV Co-Infection Watch) that would provide advocates, activists, and organizations with tools to help them advocate, I was super excited.

“You can create one-sheets to serve as starting points for state-level and Federal advocacy,” they announced. This is an awesome tool that saves organizations and individuals from having to dig through mounds of data and create their own one-sheets. This tool has so much potential to be a turning point in the way we organize advocacy efforts.

And then, I visited the sites.

The data was (and still is) out of date. AIDSVu was (and still is) using old numbers. The data presented on AIDSVu haven’t changed, and when the sites rolled out in 2017, they were already a year out of date, presenting 2014 data, when 2015 had been available for nearly six months.

The data on HepVu was (and still is) even worse. In 2017, when the site launched, HepVu was using statistics from 2010 – a full four years out of date with the information that was released by the U.S. Centers for Disease Control and Prevention (CDC) in May 2017. Within a month, the data became five years out of date, as the numbers from 2015 were released in summary, and then in detail by June 17th, 2017.

This is a problem.

Any person who works in healthcare advocacy can and will tell you that, unless you have accurate and current data to support your advocacy, you aren’t going to accomplish what you set out to do. The expectation that we are going to sway local, state, and/or Federal legislators with data that are not only woefully out of date, but represent years before there was an explosion of new infections, is a pipe dream.

To use my home state as an example, the data presented by HepVu for West Virginia indicates that in 2010, WV had 21 new Acute HCV infections, with a rate of 1.1 (per 100,000). Had that data been updated in May 2017, they would’ve been using 2015 statistics, in which there were 63 infections, with a rate of 3.4 – literally triple the amount of new infections, and more than triple the rate. Were they using the most recent statistics from the state, they would be showing that, in 2016, there were 132 new HCV infection, with a rate of 7.2 – more than double the year prior.

West Virginia - In 2014, 120 of every 100,000 people were living with diagnosed HIV.

Photo Source: AIDSVu

West Virginia - In 2010, an estimated 24,000 people were living with Hepatitis C.

Photo Source: HepVu

It is easy to understand why the 2016 numbers, which are the most current available, will be more effective in any advocacy efforts.

But, the problem doesn’t just begin and end with AIDSVu/HepVu. As I’ve been gathering state-level data for an upcoming presentation, virtually every state in the U.S. has woefully outdated information available on their respective epidemiology (or equivalent) websites:

Kentucky – the state with the third-highest rate of HCV in the nation (2.7 in 2015) – hasn’t updated its Hepatitis C Department for Public Health website since February 24, 2016, and is still inviting people to attend the 2016 Kentucky Conference on Viral Hepatitis on July 26th, 2016.

Colorado – the state’s quarterly HIV surveillance reports just stop after the 2nd Quarter 2017.

Georgia doesn’t even seem to have published reports on disease statistics, and requesting that data (which, by the way, is supposed to be public data) requires a minimum fee of $25.

Hawaii – the state department of health hasn’t put out an annual report since 2012.

The point is this: there will always be data lag – the time between the end of the year when a state’s data is gathered and the time when it’s verified and published. For most diseases, that seems to be about a two-year lag. But, if we ever intend to become better advocates, we need to rethink how data is gathered and presented in a timely manner.

I get it – not every state has the resources to track every disease, publish a report, and update their website (hell – Alaska’s Medicaid program hasn’t updated its Preferred Drug List since literally March 2015; I even E-mailed to ask, and was told that that date is correct…). But, we are getting to the point where, in 2018, these types of data need to be made readily available quickly and accurately. We literally have the technology; we can do it.

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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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Prescription Opioid Diversion and Its Role in HCV Transmission

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

In last week’s post, we discussed efforts to force pharmaceutical companies to report payments made to nonprofit organizations and patient advocacy groups in an effort to track which groups are funded primarily (or wholly) by pharmaceutical companies to promote their own business interests. Essentially, by funding certain organizations (such as Pain Advocacy groups), these companies can wage war against legislative attempts to restrict access to and/or prescribing of their highly addictive products (thus losing them money). This week, we’re going to take a look at the diversion of prescription opioid drugs, and how this can lead to both an increase in the likelihood of opioid addiction, and how it contributes to an increase in disease transmission via Injection Drug Use (IDU).

Each day, more than 1,000 people are treated in emergency departments for not using prescription opioids as directed

Photo Source: CDC

When I moved back to Kingsport, Tennessee as an adult in my late-20s, I began to notice a pattern: my co-workers and high school friends would tell me about their exploits with illicitly obtained “pills” – mostly OxyContin, as this was the late-00s. While working in a casual dining restaurant, I frequently heard about and witnessed efforts by my co-workers to obtain these drugs from other restaurant employees. Money would change hands, furtive glances were made around the restaurant to ensure no one was watching, and a few pills would be received, either loose or in a plastic bag. This activity was, of course, both illegal and against company policy, but it’s just SO easy to do, and I never reported the activity.

These drugs were often obtained by the seller either through a legitimate prescription for their own pain, or through getting them off of a third party. This type of drug dealing is called “diversion” – when legitimately prescribed opioid drugs are used outside of their prescribed purpose. It’s also the way that most prescription opioid addicts begin their path to addiction.

In 2015, HEAL Blog talked about the havoc prescription opioids wreaked upon my state (Hopkins, 2015). Teenagers would gain access to their parents’, grandparents’, or friends’ legitimately prescribed opioid drugs and use them recreationally. Unbeknownst to them, Purdue Pharma failed to mention that they knew their product was highly addictive, and before long, entire towns were in the throes of addiction. Fast forward to the ‘10s, and many of those prescription opioid addicts have moved away from the now-difficult-to-obtain prescription drugs to the much easier and cheaper to obtain heroin. Unfortunately for them, a good percentage of those heroin batches contain Fentanyl or Carfentanil – highly potent synthetic opioids that often lead to overdoses.

At the end of 2014, Scott County, Indiana, saw an huge spike in new HIV infections, caught because healthcare workers noticed a spike in new Hepatitis C infections. These new infections were driven almost entirely by IDU of Opana – a highly addictive prescription opioid that was removed from the market in 2017 (Kean, 2017). By the end of 2016, the county had 216 new HIV infections in the span of just two years, and of those, 95% were co-infected with HCV (May, 2016). So severe was the problem that Indiana and several surrounding states took the unprecedented approach of legalizing Syringe Services Programs – a move that was nigh unthinkable, since the early days of its proposal in the 1980s.

Here, in West Virginia, the rate of new HCV infections more than doubled from 2015 to 2016, from 3.4 to 7.2 (per 100,000), 68% of which were likely the result of IDU (WVDHHR, 2018). Despite this, Danny Jones, the mayor of Charleston, WV – the state capital – is on the warpath against the Kanawha County Harm Reduction Clinic because of an increase in used needles left throughout the city (Jenkins, 2018). Never mind that much of this refuse could be eliminated would the city spring for the Biohazard Disposal Kiosks requested by the health department, who instead had to fund them using funds from Emergency Medical Services programs.

Prescription drug diversion has led to tragic repercussions for many living in Appalachia who are now struggling with both addiction and comorbid infectious diseases. But, this problem doesn’t just exist in rural Appalachia, the Midwest, and New England – these issues are manifesting all around the U.S., and if we don’t take drastic measures to deal with drastic consequences, we’ll find ourselves faced with expensive outcomes.

References:

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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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Who Funds the Opioid Epidemic (and the Subsequent HCV Epidemic)

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

Senator Claire McCaskill (D-MO) is planning to introduce a bill into the Senate that would require drug makers to report payments that are made to nonprofit organizations and patient advocacy groups (Silverman, 2018). This is an issue that HEAL Blog, as well as the Community Access National Network’s HIV/HCV Co-Infection Watch publication, has repeatedly brought up in our reporting.

Sen. Claire McCaskill

Photo Source: The Washington Free Beacon

State and Federal lawmakers have been attempting to place prescribing and use restrictions on prescription opioid drugs for the better part of two decades. There is a natural opposition that state and Federal lawmakers face from opioid manufacturing pharmaceutical companies, such as Purdue Pharma, maker of OxyContin, the first prescription opioid drug made available and marketed to average consumers rather than for use in palliative care and severe injury. But, that’s not where the pressure on lawmakers ends.

Purdue Pharma logo

Photo Source: Purdue Pharma

Where McCaskill’s proposal comes into play goes back much further, with pharmaceutical companies creating and funding nonprofit organizations to advocate for a single issue: Pain. Pain Advocates, since the late-1980s, have been actively lobbying Congress, the U.S. Food & Drug Administration (FDA), and state legislatures to push for easier access to these powerful drugs. Every time a legislator or the FDA attempts to reign in what was once virtually unfettered access to

Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body and reducing the sending of pain messages to the brain, thereby reducing the feeling of pain. For Pain Advocates who claim to represent patients whose levels of daily or regular pain leave them unable to function normally, these drugs have been seen as necessary for their survival. What drug manufacturers who fought for easy access to these drugs failed to mention (despite knowing from their own research) is that opioid drugs are highly addictive.

I’ve personally encountered several pain advocates whose opposition to my advocacy for opioid prescribing restrictions in the state of West Virginia has been boiled down to this line of thinking: “How am I supposed to be a functional human being without these prescriptions?” In a state like West Virginia, which has the highest rate of drug overdose deaths in the nation (52 per 100,000) and potentially the highest rate of Hepatitis C (HCV) in the nation (7.2 per 100,000), this comes across to me as them really saying, “My pain is more important than the preventable spread of disease or others’ lives.”

As the rate of new HCV infections continues to rise, in some states like WV, exponentially, is that opioid drug abuse is directly tied to this meteoric increase. In a report from the National Institutes of Health’s (NIH’s) National Institute on Drug Abuse, data indicate that the incidence of heroin initiation (beginning to use) was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not. Further, a separate study cited by the NIH found that 86% of young, urban heroin injectors had used opioid pain relievers nonmedically prior to using heroin, and that their introduction into nonmedical use was characterized by three main sources of opioids: family, friends, and personal prescriptions (National Institute on Drug Abuse, 2018).

Next week, we’ll take a deeper look at how opioid diversion from legitimate prescriptions can potentially lead to addictions that can increase the risk of acquiring Hepatitis and HIV as a result of Injection Drug Use.

References:

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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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