Tag Archives: harm reduction

Michigan Hepatitis C Surge Related to Prescription Opioid and Heroin Abuse

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 Michigan Department of Health and Human Services (MDHHS) released its 2016 Hepatitis B and C Annual Surveillance Report, indicating drastic increasing in new Chronic Hepatitis C (HCV) cases in the state, particularly among residents aged 18-29. Two factors posed significant roles in the transmission of these cases – Injection Drug Use (IDU) and Incarceration.

HEAL Blog has consistently reported on HCV transmission as a result of IDU and within incarceration settings, and report is further evidence of those positions. There were 11,883 new Chronic HCV cases reported in 2016 for a rate of 119.78 out of every 100,000 people. 69% of those cases were followed up on and epidemiological profiles were made; of those IDU was a risk factor in 64% of cases, while incarceration was a risk factor in 63% (MDHHS, 2017).

More striking, however, was the vast increase in Chronic HCV in people aged 18-29 between 2005-2016 – an alarming 473%, of which 84.2% were reportedly related to IDU in that same age group. This trend is replicated all over the country, especially in areas where prescription opioid and heroin abuse levels are more prevalent.

Logo for the Michigan Department of Health & Human Services

Photo Source: MDHHS

MDHHS reported that viral hepatitis-related hospitalizations, liver cancer incidence, liver transplants, and viral hepatitis deaths have all increased over the last decade, largely driven by the impact of Chronic HCV infections (Mack, 2017). With so many of these cases ostensibly linked to opioid and heroin abuse, a robust response to the addiction epidemics is needed, as well as compulsory “Opt-Out” screening at clinics, emergency rooms, hospitals, and correctional settings.

The Lansing City Council recently voted to allow Syringe Services Programs (Syringe/Needle Exchanges), a proactive Harm Reduction measure that studies indicate reduces the rate of transmission amongst both People Who Inject Drugs (PWIDs), as well as the general population (Cook, 2017). Selling these programs to citizens who are unfamiliar with the programs, staunchly opposed to drug use, or believe that the exchanges encourage drug use remains a difficult proposition. Proponents argue that PWIDs are going to use drugs, regardless of whether or not there are exchanges; that being the case, it makes logical sense to prevent the spread of disease.

Michigan’s increase in Viral Hepatitis (VH) follows a national trend that will be replicated – possibly with farther reaching, deadlier impact – in other states.

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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Compulsory Viral Hepatitis Screening is a Pathway to Elimination

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

At the International AIDS Society’s (IAS’) 4th Annual HIV/Viral Hepatitis Co-Infection Meeting in Paris, France, aside from all of the various data regarding rates of infection around the globe and various approaches to eradicating Hepatitis B and C (HBV/HCV, respectively) by the World Health Organization’s (WHO’s) target year of 2030, one assertion rang true throughout: all of these projections and approaches will require robust Harm Reduction measures to be put in place.

For the uninitiated, Harm Reduction measures are various laws, regulations, and statutes put into place in order to reduce injury or death from a specific cause; a good example of this would be a Seat Belt Law. As they relate to Viral Hepatitis (VH), Harm Reduction statutes include various methods of reducing the likelihood of infection (and thereby death), such as the mandatory use of Prescription Drug Monitoring Programs (PDMPs), ID requirements for the purchase of prescription opioid drugs, and prescriber education about the risks of prescribing opioids and proper opioid usage. One set of measures, however, would serve several purposes: mandatory or compulsory screening requirements for HIV, Hepatitis B, and Hepatitis C.

"Hepatitis" on a screen, with a stethoscope

Photo Source: CTV News

A handful of states (CT, FL, MA, NY, and PA) have considered or passed mandatory screening guidelines for the Birth Cohort (people born between 1945-1965). These guidelines are largely inefficient, because they rely upon an “Opt-In” method of screening, meaning that patients are offered screening, and must accept – it’s optional. Additionally, these measures focus only on the Birth Cohort, and understandably so, as they represent the largest percentage of existing HCV cases. These approaches, while well-intentioned, must be amended and updated on a national level, in order to effectively combat the spread of both HBV and HCV.

An estimated 70% of new Acute HCV infections are related to Injection Drug Use (IDU) by People Who Inject Drugs (PWIDs). That none of these screening guidelines make mention of these facts is indicative of our inability to accurately capture the data we need in order to adequately assess the scope and scale of the epidemic. Statistics at the state and national levels are largely reached using modeling that projects an estimated number that ostensibly accounts for underreporting. PWIDs are, however, notoriously difficult patients from whom to capture data, in no small part because we see them consistently in only a handful of healthcare settings: Hospitals for overdoses, Prisons, Jails, and Juvenile Detention Centers for incarceration, and Rehabilitation facilities. In addition, Syringe Services Programs (SSPs) are another excellent point of data collection, but it must be handled differently than those previously listed.

The most effective method of screening is to make it compulsory (mandatory) on an “Opt-Out” basis in which patients are informed that screening for HIV, HBV, and HCV are part of a required set of screenings, and they must provide “informed refusal” of the test. This requires that all hospitals, clinics, justice/incarceration settings, and rehabilitation facilities adopt this method of screening in order for the most effective use of time and money that will result in the most accurate data captures. When opioid and heroin users overdose and are the recipient of emergent care services, this is the prime location to capture data from PWIDs. The same holds true for those who are moved into justice settings, as well as those who enter rehabilitation services. Additionally, with the use of rapid HCV antibody testing, this can be accomplished in a relatively short period of time. The important part is ensuring that each Positive test result is followed up with an immediate secondary confirmatory screening, rather than scheduling a second appointment.

These types of compulsory screening requirements are paramount to achieving the WHO’s goal of eradication of HBV and HCV by 2030. Once patients know their status, with proper linkage to care services, they can be cured of HCV and treated for HBV with relative ease. This will, of course, require an investment on the part of state, Federal, public, and private partners, and until we have Federal movement on these issues, the best location to start is at the state-level. Personally, I am working on an endeavor with one of West Virginia’s delegates to work on building a workable and FUNDED compulsory screening requirement as close to the one I suggested above, given the complex nature of WV’s budgetary constraints. We at HEAL Blog invite you to do the same, in order to ensure that compulsory screening becomes a reality.

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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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Heroin and Hepatitis Go Hand in Hand

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

Over the past year, HEAL Blog has paid a lot of attention to heroin, particularly in relation to the massive increase in heroin and prescription opioid overdoses in Appalachia, the Midwest, and the Northeast. While the purpose of HEAL – “HEAL” standing for “Hepatitis: Education, Advocacy, and Leadership” – is to specifically address issues related to Viral Hepatitis, and particularly Hepatitis C (HCV), when we cover issues related to prescription opioid abuse and heroin, we sometimes fail to connect the dots between the two topics. There is, in fact, a very high correlation between Injection Drug Use (IDU), People Who Inject Drugs (PWIDs), and the transmission of HCV: most new HCV infections in the three previously listed regions are related to IDU.

Sources of Infection for Persons with Hepatitis C

Photo Source: Pinterest

HCV and HCV-related co-morbidities (e.g. – Cirrhosis, Advanced Liver Disease) kill more Americans each year than any other infectious disease (Centers for Disease Control and Prevention, 2016). It is also one of the most expensive diseases to treat, with Direct Acting Agent (DAA) drug Wholesale Acquisition Costs (WACs) ranging between $50,000 and $100,000 for twelve weeks of treatment. This makes preventing the spread of HCV not only a matter of physical health, but one of fiscal health.

Despite pharmaceutical manufacturers’ arguments that the one-time cost of a regimen to achieve a Sustained Virologic Response (SVR – “cure”) is far cheaper than the long-term costs of other diseases, not to mention the long-term costs that arise if HCV goes untreated, state and Federal healthcare budget departments remain unconvinced. Budgeting processes generally focus on a single year, rather than accounting for multi-year spending, so arguing that long-term expenditures “cost” more hasn’t been an effective argument. Even with the clandestine pricing agreements and rebates – clandestine, because they are not made public due to “trade secrets” laws – states have yet to begin treating every HCV-infected client on their government-funded rosters. To do so would blow through entire pharmacy budgets several times over, in many states.

With PWIDs representing the highest number of new HCV infections between the ages of 18-35, state legislatures are starting to come around to the realization that the best way to avoid spending that money on expensive treatments is to put into place Harm Reduction measures that are shown to prevent the spread of blood borne illnesses. As it is very difficult and unfeasible to stop IDU, syringe exchanges can be put into place that allow PWIDs to inject using clean needles, rather than sharing them.

Syringe exchanges have, for much of the past forty years, been largely reviled by politically conservative politicians and states; many Republican politicians have repeatedly argued that state-sponsored syringe exchanges will only encourage bad behavior, serving as a tacit endorsement of IDU. Now that prescription opioid and heroin abuse has moved outside of the urban areas and into the suburban and rural areas that serve as bastions of the Conservative ideal, suddenly, these politicians are coming around to the idea.

Medical technician counting needles.

Photo Source: Daily Beast

In the past two years, several considerably conservative states have passed laws allowing syringe exchanges to be established – Indiana, North Carolina, Ohio, and Virginia, to name a few – largely in response to a relative explosion of new HIV and HCV infections related to IDU. The problems that politicians and their constituents once relegated to the big cities have come to their quiet towns, and have done so right under their noses. The lessons out of Scott County, Indiana, where nearly 200 people tested positive for HIV near the end of 2015 and into 2016, are still reverberating throughout the region, and people are starting to look at ways to prevent the spread of disease, rather than punish the behavior.

It is clear that the opioid and heroin abuse epidemic is not going away, anytime soon. Since we aren’t likely to stop currently addicted people from injecting drugs, the smartest path forward is to at least make certain they can do so safely.

References:

  • Centers for Disease Control and Prevention (CDC). (2016, May 04). Hepatitis C Kills More Americans than Any Other Infectious Disease. Atlanta, GA: Centers for Disease Control and Prevention: Newsroom Home: Press Materials: CDC Newsroom Releases. Retrieved from: https://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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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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An Argument Against “Pain”

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

Last week, I posted a link from The Week, about John Oliver’s take on the prescription opioid epidemic. In his NSFW video, he does a largely comprehensive retrospective of how America became quickly addicted to opioid painkillers as the “go to” pain remedy beginning in the late-1990s, of course with his trademark British fire, ire, and expletive-laden delivery. Generally, this type of post generates a few laughs from my friends and agreeing comments from healthcare professionals who understand the scope of the epidemic. This time, however, I was surprised by a treatise on the perils of this type of video.

When it comes to issues where someone clearly feels “wronged” by legal prescribing guidelines, I often take a logical approach. Prescribing guidelines for opioids aren’t written to punish “responsible” patients who adhere to the dosage instructions listed on the label for medically necessary prescriptions. But, the argument that was made, in this case, was that, “…like anabolic steroids,” the risks associated with these drugs has been blown way out of proportion, and videos like these instill in physicians a sense of fear that prevents them from prescribing medically necessary drugs.

For whatever reason, friends of mine who know I work in research related to HIV, HCV, and Harm Reduction frequently come to me with their gripes about opioid prescribing guidelines. In this example, my friend had undergone oral surgery, and his physician refused to prescribe a three-day prescription for an opioid pain reliever in the state of California. My friend said that he was “forced” to get his medications on the “black market,” because his physician was “afraid to prescribe” him the drugs. Mind you, this person is not, in fact, a physician; he is, however, a bodybuilder who openly admits to taking anabolic steroids to get bigger (as per his earlier reference).

What frustrates me about this type of argument is that it presupposes that whatever type or level of “pain” someone is in requires the use of prescribed opioid painkillers; that, regardless of the prescribing guidelines, or even best practices or medical advice, their pain makes an opioid prescription “medically necessary.” It is an unfortunate consequence of living in a society with a U.S. Food and Drug Administration and prescribing guidelines that what one person, who is not a physician, believes to be medically necessary may not, in fact, be.

In a similar vein, another friend of mine, knowing that a segment of my research has to do with opioid prescribing guidelines, asked me if I knew a physician who would prescribe them to her, against her current physician’s recommendations. She believes that the pain management alternative he suggests is not long enough lasting, and that, because she doesn’t have an “addictive personality,” she should be prescribed opioids on a continuing basis to deal with her chronic pain.

For the record: I am not a physician, nor am I in touch with physicians who would violate their respective states’ Doctor Shopping laws or Lock-In regulations. I do not know where to get opioids on the “black market,” nor do I have any connections who can “hook you up” with some illegal prescription drugs. For whatever reason, my well-meaning friends, who may or may not have “addictive personalities,” have it in their heads that they know better about what drugs they should be taking than the licensed professionals who spent several years and hundreds-of-thousands of dollars to obtain their advanced medical degrees.

These prescribing guidelines aren’t just made to make individuals’ lives more complicated; they are designed to address very serious addiction issues that are leading people to their literal graves. I get it: you think your pain is great enough that you deserve special treatment. Well, you don’t. At some point, it became an issue of grave importance that no one, ever, feel any sort of pain, and that all pain needed to be treated with drugs meant to be reserved for people who were in severely unbearable pain. That is simply not the case, regardless of what your black market drug dealer tells you. Suck it up, a bit, and you will live, just as humans have managed to survive with a modicum of pain for tens of thousands of years.
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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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New Harm Reduction Focus Helps Bring Light

By: Marcus J. Hopkins, Blogger

The HIV/HCV Co-Infection Watch — published by the Community Access National Network (CANN) — recently added two new sections to its monthly report: the first focuses on the coverage offered by the Veterans Administration (VA); the second, and perhaps more involved research, focuses on Harm Reduction efforts.

HIV/HCV Co-Infection Watch

HIV/HCV Co-Infection Watch

The VA section is extremely cut and dry; they recently announced that they will effectively cover all veterans who are currently eligible for benefits for HCV treatment using Direct Acting Agent (DAA) HCV therapies. The Harm Reduction section, however, requires a more nuanced approach, as each state has its own interpretation of how they implement each aspect of Harm Reduction.

For those unfamiliar with the term, “Harm Reduction” is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use, as well as for expanding, protecting, and respecting the rights of drug users. The specifics, again, vary from state to state in their implementation, but there are overarching ideals that are used to shape these programs. In our research, we’re focusing on several very important Harm Reduction strategies:

  • Syringe Exchanges;
  • Expanded Naloxone Access;
  • Good Samaritan Laws;
  • Mandatory Prescription Drug Monitoring Programs;
  • Doctor Shopping Laws;
  • Physical Examination Requirements;
  • ID Requirements for Purchase;
  • Required/Recommended Prescriber Education; and
  • Lock-In Programs.

If this list seems exhaustive, it’s really only the tip of the iceberg. Harm Reduction strategies have a consistent track record of bringing about positive health outcomes, but little attention gets paid to them, unless there is a well-publicized health crisis – a sudden explosion of new HIV infections resulting from injection drug use, for example – that essentially forces the hand of state legislators to act. The most recent example of legislative Harm Reduction publicity came from Maine, which we covered two weeks ago, when Republican Governor Paul LePage vetoed a bill that provided expanded access to Naloxone by allowing it to be purchased from pharmacies without a prescription; his veto was quickly overturned by both Maine’s House and Senate on April 29th.

While Harm Reduction strategies have a proven record of net positive outcomes, there are always unintended consequences to any well-intentioned law. The U.S. has been in the throes of a prescription opioid addiction problem since the late 1990s, and state and federal governmental intervention is desperately needed and vitally important to help quell the ever-increasing addiction and overdose rates, HIV and HCV infection rates, and the unfortunate increase in criminal activities (such as varies classifications of theft) that tend to accompany an increase in opioid drug use. One such unintended consequence is the reduced access to prescription opioid drugs for patients whose healthcare needs truly necessitate their occasional use of a validly prescribed opioid.

I was recently asked by a very good friend if I knew of any doctors who would prescribe opioid pain relievers. This person knows the type of research I conduct, and his question stemmed from the fact that his doctor has repeatedly tried the same methods of pain relief that provide only short-term results to a chronic issue despite repeated requests to move past the less effective approach to a longer-lasting solution. My friend’s predicament is that any doctors outside of West Virginia University’s healthcare system are outside of his insurance plan’s network, which leaves him with few good options on a fixed income.

While I understand my friend’s predicament, I was unable to provide him with the answer he was seeking. What makes this problem difficult to address is that WV has one of the most vigorous legislative approaches to Harm Reduction strategies, largely because the state has been coping with a massive opioid addiction problem for at least two decades that has all but ravaged the state. It is my belief that this doctor properly using the context of WV’s opioid addiction problem to inform his overall approach to pain relief, and rightly so. For my friend, I suggested the use of a healthcare mediator or advocate during their next appointment; someone to speak on his behalf, and to try to come to a pain management approach that will allow him to better address his needs and to help the doctor understand his patient’s position – that the regimen he’s prescribing may not be the best solution for his patient.

My position, however, remains unchanged – Harm Reduction strategies are the most effective way to achieve net positive healthcare outcomes related to prescription opioid use, abuse, and addiction. While there will always be unintended consequences for some, the good of the many outweighs the complications that can arise from more stringent prescribing requirements. There is little doubt that we are facing a crisis of unprecedented scale; how we choose to deal with that, as a nation, will be of the utmost importance.

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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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