Tag Archives: Centers for Disease Control & Prevention

Viral Hepatitis Funding Lowest in States Most at Risk

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

The Centers for Disease Control and Prevention (CDC) recently released the data related to Viral Hepatitis (VH) surveillance in the U.S. for 2015, and the picture is…grim. While many states saw relatively stable rates of new Acute Hepatitis C (HCV) infections, two states – AL and PA – experienced 100% increases from 2014 (CDC, 2017). CDC funding for states’ respective Viral Hepatitis programs, however, tends to fall short in states where rates of infection are high relative to the population (The AIDS Institute, 2017).

Infection rates are generally calculated by taking the number of total infections, dividing that by a state’s total population, and multiplying that result by 100,000 to calculate how many people, on average, will be infected for every 100,000 residents. For example:

The state of West Virginia reported 63 new cases in 2015; the state has a population of 1,844,000, so 63/1,844,000 = 0.00003416 x 100,000 = 3.416 rate of infection.

West Virginia, despite being the 14th least populous state (including the District of Columbia), has the second highest rate of new HCV infections in the U.S., second only to Massachusetts, which has a rate of 3.7. The following chart lists the top ten states in order of highest infection rate, their respective populations, and the amount of funding in those states for VH:

Chart showing 10 states with highest viral hepatitis infections also having lowest state budgets to combat the disease, including MA, WV, KY, TN, ME, IN, NM, MT, NJ, NC

The above chart seems to be indicative of two things irrespective of a state’s population: (1.) certain states make VH funding a priority, while others do not; (2.) states are simply not receiving enough funding from the Federal government and the CDC to bring their VH programs up to funding levels adequate enough to effectively combat VH.

Each of these states has a number of factors contributing to their respective rates of infection: (1.) Aging populations (Baby Boomers born between 1945-1965); (2.) High rate of Injection Drug Use related to opioid drugs, heroin, or stimulants; (3.) Sharp increase in the number of tests administered, resulting in higher rates of positive results.

What is clear is that funding for VH is woefully inadequate if the U.S. intends to eradicate HCV from the U.S. by 2030.

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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Hepatitis Policy Project Releases Report on HCV Monitoring in the U.S.

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

Report Cover: "Monitoring the Hepatitis C Epidemic in the United States"

Source: Hepatitis Policy Project

The Hepatitis Policy Project (HPP), a project of the O’Neill Institute for National & Global Health Law at Georgetown Law in Washington, D.C., released in June 2017 their latest report, “Monitoring the Hepatitis C Epidemic in the United States: What Tools Are Needed to Achieve Elimination?” The report highlights five key recommendations that the institute believes need to be implemented in order to ensure the elimination of Hepatitis C (HCV) in the United States.

It is important to note that these recommendations fall in line with what HCV advocates and organizations have been stating for years: state and Federal governments are failing to adequately address the lack of concrete reporting data for the disease that kills more Americans each year than the total combined number of deaths from 60 other infectious diseases, including HIV, tuberculosis (TB), and pneumococcal disease (CDC, 2016). The primary reason for this failure on the part of all parties: financial resources – neither the Federal, nor state governments are allocating adequate funds in order to make mandatory the reporting of HCV infections in every state, and as a result, the Centers for Disease Control and Prevention (CDC) and other research and reporting bodies must rely on inaccurate, passive, and/or outdated data reporting that is simply inefficient and unacceptable.

HEAL Blog, in May 2017, wrote about this data issue when the CDC and Emory University revealed its Hepatitis monitoring tool, HepVu, that contains data that is seven years out of date (Hopkins, 2017). Our argument contends that seven-year-old data is an ineffective tool for helping lawmakers and government agencies to craft data-driven policies and regulations. If the data is not current within one or two years, policymakers have little use for it. The HPP report makes five key recommendations designed to eliminate these data collection issues:

  • Expand and standardize reporting to the CDC: The CDC’s Department of Viral Hepatitis (DVH) is only now expanding funding efforts from 7 jurisdictions to 14 – an unacceptably (but expanded) low number. The DVH should work with Congressional appropriators to create a five-year plan to expand and build the capacity to conduct active surveillance to the great majority of states. This should include the development of a standardized reporting rubric that details the specific patient information that must be provided by clinicians and subsequently passed on to the states – a strategy that has been in place for HIV since the 1990s, and has helped to create more accurate data reporting and craft data-drive policies to address the epidemic. This will require more money.
  • Utilize electronic medical records to collect data on HCV cases and the cure cascade: Modern medicine makes great use of technology, including the collection and retention of medical records; what is lacking is a system to centralize and analyze these data. Better use of electronic medical records information could improve the consistency, quality, and accuracy of case reports made by states by lessening the burden on providers and laboratories to report new cases to state health authorities that is required under the current scheme. The current requirement for providers and labs to le reports strains their already limited time and personnel resources, and often leads to incomplete reporting. This data could instead be pulled together by state epidemiologists using an integrated electronic medical records database, which would also provide matching metrics with cases, such as race, age, gender, sex, and progress of treatment.
  • Fund epidemiological research using clinical data sets: Clinical care data are a largely untapped resource that relies on data that already exist. As such, greater efforts are needed to fund analyses of such data. This recommendation also suggests that several agencies across the Federal Health and Human Services department be directed to fund epidemiological research on HCV.
  • Integrate improved monitoring of HCV with responses to the opioid epidemic: With most new cases of HCV being related to Injection Drug Use (IDU), largely driven by the nation’s out-of-control opioid addiction epidemic, it is imperative that we tie HCV prevention and treatment efforts to substance abuse prevention and treatment measures, elevating HCV as a signature component of the national response to opioid abuse.
  • Establish and monitor HCV elimination plans across major U.S. health systems: The U.S. has several large established health systems – Medicaid, Medicare, the V.A., and various correctional systems. It is, therefore, imperative that we focus HCV elimination efforts on these major systems in order to adequately approach the elimination of HCV across all health systems. Starting with government-funded health systems allows for better monitoring of patients and patient outcomes.

The HPP report is an excellent document that outlines several real-world solutions that could (and should) be implemented across local, state, and Federal governments in order to achieve the elimination of HCV in the United States. Download the full 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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Emory University and CDC Reveal HepVu

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

The latest tool in Viral Hepatitis advocacy has arrived: HepVu (www.hepvu.org). A project of Emory University’s Coalition for Applied Modeling for Prevention (CAMP) – supported by the Centers for Disease Control and Prevention (CDC) – HepVu is an interactive website that provides various data related to Viral Hepatitis (VH), with the greatest emphasis being placed upon Hepatitis C (HCV), the least accurately reported variant in the U.S.

The website features interactive maps detailing estimated prevalence data, rates of infection, mortality data, and regional impacts and comparisons on both the national and state levels. While HCV data released by the annual National Health and Nutrition Examination Survey (NHANES) conducted by the CDC produces national estimates, HepVu is the first analysis that uses a more nuanced formula that includes NHANES data, but also examines state-level reporting and statistics that includes electronic medical records (EMRs), insurance claims, and HCV-related mortality.

Other site features include infographics, explanations about the various types of VH, and the ability to print and download maps and data for use in advocacy efforts and reports. Dr. Patrick Sullivan, one of the researchers associated with creating the project, stated that making the site a resource for HCV-related advocacy and reporting efforts was an essential step in creating HepVu. This is the first HCV-related website (of which I am aware) that makes these data easily available for reprinting and citation purposes.

The contributing researchers to the website admit that this reporting is likely well below the actual prevalence and rates of infection, because screening, reporting, and tracking vary in quality and amount of data from state to state, in no small part because of a lack of Federal and state funding for HCV reporting, as well as adequate and standardized reporting requirements set by the CDC. Part of what makes this data so important is that it serves as a great starting point for advocating for increased funding for reporting and tracking – something that Congress has been slow to address, despite large increases in funding to address America’s opioid and heroin abuse crisis, the leading contributor to the rise in new HCV infections.

The primary limitation of the data presented on HepVu (and in general) is age: the vast majority of the data centers on 2010 and 2014 – seven and three years old, respectively. This complaint has been a sticking point for advocates and HCV-related organizations for several years, particularly because of the release of easily tolerated and highly effective Direct Acting Agents (DAAs) that serve as a curative treatment for HCV. Now that we have these tools to eradicate HCV, it is imperative that we begin operating on current information, rather than relying upon data that predates two presidential elections. This means that both Federal and state governments are going to have to step up to the plate and begin adequately funding screening, reporting, and tracking efforts, regardless of the high cost of these drugs.

HepVu is an excellent starting point, despite the data limitations, and so long as the statistics and information are regularly updated with more current information, it has the potential to become an invaluable tool in combating HCV and hopefully eradicating the virus from the U.S., entirely.

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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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Rural Americans Still Lack Access to Syringe Exchange Programs

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

The HEAL Blog  covers the expansion of Syringe Exchange programs as an effective and proven method of Harm Reduction to prevent the spread of HIV and Hepatitis C (HCV). While there have been some notable successes over the past few years, especially in states where rural transmission of both HIV and HCV is increasing, the stark reality is that these areas largely lack access to the Syringe Exchange programs that could help to stanch the spread of deadly diseases that are easily spread through sharing and reusing needles.

A new report from the Centers for Disease Control and Prevention (CDC), decreases in HIV diagnoses in People Who Inject Drugs (PWIDs) indicate success in HIV prevention. However, emerging behavioral and demographic trends could reverse this success (Wejner, et al, 2016). In terms of demographics of PWIDs, both African-Americans and Hispanic populations have seen consistent and rapid downward trends in all three areas: HIV diagnoses among PWIDs, those who shared syringes to inject drugs, and people who reported injecting drugs for the first time. Whites, but urban and non-urban, however, did not fare well in these measures.

In both Urban and Non-Urban settings, new HIV diagnoses amongst white PWIDs saw a slight increase; the same is true of whites who shared syringes to inject drugs; whites made up over 50% of people who reporting injecting drugs for the first time. This shouldn’t come as a big shock to those who have been following drug usage trends – the abuse of opioid prescription drugs and heroin in rural and suburban areas has spiked significantly, over the past twenty years, as we have covered in previous posts – areas where the population tends to skew heavily to the White.

Sign reading, "HIV Needle Exchange"

Indiana Needle Exchange

While Syringe Exchange Programs (SEPs) have grown more common in urban areas, people living in largely rural states, rural areas, and suburban areas have again fared poorly in this regard. A 2015 report from the CDC surveyed 153 SEP directors (out of the then 204, in March 2014), and found that only 9% of SEPs were in Suburban areas and only 20% in Rural areas (Des Jarlais, et al., 2015). The areas hardest hit by the increase in PWIDs – the Northeast, South, and Midwest – had a total of 11 SEPs in Rural areas; the West, by comparison, had 18 in Rural areas. While this data is from 2013, and more SEPs have been opened, it is difficult to get a definitive count of the number of operative SEPs.

From a health emergency perspective, we have a White HIV crisis brewing in rural and suburban America. Beyond the issues related to PWIDs, there is also the increase risk of sexual transmission from PWIDs to those who do not inject drugs. Whites have consistently represented the largest number of new infections, since the beginning of the epidemic (not to be confused with the disproportionate rate of infection amongst minority groups), and for the first time in 2014, White PWIDs had more HIV diagnoses than any other racial or ethnic population in the country (Sun, 2016). State and Federal laws – especially in rural states – continue to present barriers to establishing and funding SEPs in areas that are the hardest hit.

One of the most frustrating aspects of reporting healthcare statistics is the reporting lag; the references used in this post present data that is at least two years old. This problem exists because of the time it takes for states to finalize data, in addition to the time it takes for peer reviewing before publication. While there were 204 operating SEPs in the U.S. in 2013/2014, it’s now 2016, and we could use some updated numbers.

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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Hepatitis C and Aging

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

While we, here at HEAL Blog, have spent much of the year focusing on the vast increase in new Hepatitis C (HCV) infections amongst the Injection Drug User (IDU) population, what often gets left out of that picture is the effect that Chronic HCV has upon the aging Baby Boomer population. According to the U.S. Centers for Disease Control and Prevention (CDC), of the estimated 3.2 million people chronically infected with HCV in the U.S., approximately 75% were born between 1945–1965 – Baby Boomers (CDC, 2015). As such, the Community Access National Network (CANN) will be hosting a panel on HCV and Aging this December 08, 2016, in Washington, D.C.

BORN 1945-1965? CDC recommends you get a blood test for Hepatitis C

Photo Source: Examiner

Baby Boomers have faced significant risks that make them more likely to have been infected with HCV, not the least of which includes blood transfusions received prior to 1990, when routine screening for HCV became the norm. Additionally, because HCV may take many years to manifest, many people are unaware that they are infected, with estimates ranging from 45% – 85% (CDC, 2015). Additionally, recent CDC reports indicate that HCV kills more Americans than any other infectious disease (CDC, 2016), despite being a curable condition. Roughly half HCV-infected patients often fail to receive appropriate treatment, because they are unaware that they are infected.

For those patients who are aware of their condition, there is often fear associated with HCV treatments. HCV treatment has long been considered one of the least tolerated therapies in medicine, with older Pegylated interferon-based treatments requiring long regimens that left patients sick and unable to function. With the introduction of the Direct Acting Agents (DAAs), Sovaldi (Gilead) and Olysio (Janssen), in 2013, these concerns related to the tolerability of drugs were largely mitigated. In 2013, there were two DAAs specifically aimed at treating HCV; in November 2016, there are now nine different drugs on the market to treat various genotypes of HCV – Sovaldi, Olysio, Harvoni (Gilead), Viekira Pak (AbbVie), Daklinza (Bristol-Myers Squibb), Technivie (AbbVie), Zepatier (Merck), Epclusa (Gilead), and Viekira XR (AbbVie). Epclusa, released in July 2016, is also the first pan-genotypic DAA that can treat HCV across all genotypes. These HCV DAAs are not only more easily tolerated, but also have shorter treatment times (between 12-24 weeks, with current testing for 8-week courses).

Though the tolerability of HCV treatments has been largely addressed with these newer DAAs, new concerns have risen regard the cost of the regimens, ranging from $54,000 – $94,500 for twelve weeks of treatment (Zepatier and Harvoni, respectively). In addition, Medicaid, Medicare, Ryan White, and private insurers alike have imposed strict Prior Authorization pre-requisites for approving these treatments, many of which include waiting until liver fibrosis scores (scarring levels) have reached a certain severity before they will approve a patient for these regimens. These pre-requisites often include a daunting amount of paperwork that must be filed, several denials, and abstinence from various activities for extended periods before considerations will even begin to be made. These barriers prevent many Baby Boomers from receiving life-saving treatments that should be routine, but because of cost-related issues are often not.

Despite these concerns, testing for HCV is still not a requirement in emergent care situations, regardless of recommendations by the CDC. With HCV being the leading cause of infectious disease-related deaths, it is imperative that we, as a nation, take better care of our seniors, and all become more aware of the risks posed by Chronic HCV.

 

References:

  • Centers for Disease Control and Prevention. (2015, May 31). Viral Hepatitis – CDC Recommendations for Specific Populations and Settings. Atlanta, GA: Centers for Disease Control and Prevention: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention: Division of Viral Hepatitis. Retrieved from: http://www.cdc.gov/hepatitis/populations/1945-1965.htm
  • Centers for Disease Control and Prevention. (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: Centers for Disease Control and Prevention: Newsroom. Retrieved from: http://www.cdc.gov/media/releases/2016/p0504-hepc-mortality.html

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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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Intersection of Imprisonment and Healthcare

By: Marcus J. Hopkins, Blogger

“Nearly forty years ago, the U.S. Supreme Court ruled in Estelle v. Gamble that ignoring a prisoner’s serious medical needs can amount to cruel and unusual punishment, noting that “[a]n inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical torture or a lingering death[.] … In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose” (American Civil Liberties Union, n.d.)

 

These words put forth in a Supreme Court ruling are vitally important in today’s society – one in which the Centers for Disease Control and Prevention (CDC) released its first ever National Survey of Prison Health Care, the results of which were rosy on the surface, but admittedly (on their part) limited in scope, because they only asked if the service was available, rather than checked to see if the services were actually delivered. In addition, numerous reports at the 2016 International AIDS Conference in Durban, South Africa point to a serious issue brewing in the world’s prisons, as the “War on Drugs,” mass incarceration of drug users, and the failure to provide proven harm reduction and treatment strategies has led to high levels of HIV, tuberculosis, and hepatitis B and C infection among prisoners—far higher than in the general population (Medical Express, 2016).

Two hands holding prison bars

Photo Source: News Limited

The U.S. is exceptional, when it comes to the number of inmates in prison for drug offenses: of the 182,924 inmates currently in Federal prison, 84,746 (46.3%) of them were there for drug-related offenses (Federal Bureau of Prisons, 2016). There are roughly 5 million drug-related arrests each year (Prison Policy Initiative, 2016), all of whom spend some portion of their time going in and out of the jail or prison population, which increases the risk of exposure to blood borne pathogens such a HIV, Hepatitis C (HCV), Hepatitis B (HBV), and Tuberculosis (TB) exponentially over that of the general population. As Injection Drug Users (IDUs) represent an ever-increasing percentage of new HCV infections in the U.S. and around the world, the risk of transmission amongst prison populations is an incredibly serious issue that needs to not only be watched, but addressed.

The unfortunate intersection of imprisonment and healthcare statistics is the reality of the HCV treatment landscape in our nation’s prisons. This has been brought into sharp focus, recently, by a Federal lawsuit against state prison officials in Tennessee, which asks the courts to force the state to start treating all inmates who have HCV (WBIR, 2016).. The Tennessean (part of USA Today) released a report in May 2016 finding that only 8 of the 3,487 inmates known to have HCV were being treated for the disease (Tennessean, 2016) – treatment to which these patients are constitutionally guaranteed, but for which few are ever approved. Further complicating the issue is that the number of HCV-infected inmates is likely much higher, but only a handful are ever tested, because “…acknowledging inmates have the disease means they must treat it.”

The lawsuit in Tennessee is just the latest in a string of Federal and class action lawsuits filed against state and Federal prisons over access to HCV drugs, which similar suits being filed in Pennsylvania, Massachusetts, and other states. Failure to adequately screen and treat all incoming patients for infectious diseases such as HIV and HCV is, in this writer’s opinion, a gross dereliction of duty on the part of prison officials that risks not only prison populations, but to all citizens at large, once those prisoners are released into general population. HIV and HCV that goes untreated is not only likelier to result to much more costly long-term health complications (and potentially death), but is also likely to result in greater overall infection rates, as untreated diseases are more easily spread from person to person.
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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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Prescribing Data Paints a Sobering Picture

By: Marcus J. Hopkins

Whenever I speak to colleagues in the medical profession about my work with Hepatitis C (HCV) and coverage data, I inevitably begin citing some of the grim statistics related to the disease: recent spikes in new HCV diagnoses indicate that poorer people between the ages of 13-35 are the new face of the disease; the most effective drugs to treat the virus cost more for twelve weeks of treatment than most Americans make in a single year; that opioid prescription drug and heroin abusers are likelier than virtually any other population to contract HCV; how the disease is largely un- or under-reported, because states lack the funds to adequately monitor and track the disease.

Bar Chart

Photo Source: kngac.ac.in

That I am familiar with the topic and can speak with some authority on the matter is clear, but what I am consistently asked by physicians, specifically, is why I believe we should make testing compulsory for those who are not Baby Boomers, the conventional wisdom being that this population, because they are likelier to have received blood transfusions prior to 1990, are high on the list o potential candidates for HCV. As I try to explain that, the new face of the disease is quickly becoming Injection Drug Users (IDUs) who are younger, whiter, and poorer, I find myself met with consternation. How can I possibly think that compulsory – and potentially costly – blanket screening would produce a net positive result?

My experience comes from having lived during and through the AIDS epidemic of the 1980s and 90s. As a kid and teenager growing up during the age of Comprehensive Sex Education, the constant mantra was “Get tested, get tested, get tested.” The campaign knew that teenagers and young adults were going to have sex with one another, and getting tested was one of the best ways to prevent the spread of HIV; by knowing your status, you could protect yourself and others with whom you might come in contact. These messages were blasted all over the media, in schools, in health classes, in science classes, on television shows, on the radio, in popular music – and, for the most part, this tactic was effective. New infections have largely plateaued over the past twenty years, or so, at roughly 50k annually in the U.S. That these types of marketing and policies directed toward HCV could produce similar results is, to me, a no-brainer.

Despite our differences on testing policies, a constant refrain I hear, especially from Appalachian physicians, is one detailing the woes of opioid drug abuse. “We see more people in the ER for drug abuse-related issues, than for virtually any other reason,” a nighttime ER nurse relayed to me, while collecting a throat culture to check for flu. “How these people get ahold of so many pills is beyond me!”

I hear that, a lot – doctors and nurses who seem simply flummoxed as to how patients come by these prescription drugs, considering the high number of opioid pain relievers prescribed in WV (137.6 for every 100 West Virginians) (Centers for Disease Control and Prevention, 2014). I’m told stories about how boring and pointless are the mandatory opioid educational courses, when they’re not a part of the problem; why should they have to take them, and waste their time on something that’s not really in their wheelhouse?

This might be the biggest disconnect that I encounter – how the behaviors of medical personal and prescribing physicians as they relate to opioid prescription drugs may be driving the increase in new drug abuse-related HCV infections. When a healthcare professional focuses only on the behaviors of patients, without acknowledging that their own role in providing their patients with access to these highly addictive drugs, it is a reminder of just how vital, and yet seemingly unheeded, those mandatory opioid education courses are. Their tacit assertion that common drug dealers, and not themselves, are the crux of the problem demonstrates how badly they need those courses.

Given the high correlative relationship between prescription drug abuse (and its potential, and perhaps eventual, path to heroin) and HCV infections, one might be led to think that the best place to stem the problem would be with the providers of the vice. Of course, a one-solution course of action will never be enough to effectively, or even adequately, combat the problem; multiple angles must be attacked in order to win the war against HCV, and unless we put forth adequate funding, staffing, and physical resources to fight these battles, we will likely fail to win the war.

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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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