Tag Archives: IDU

Generational Stigmata and HCV

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

When it comes to Hepatitis C (HCV), people in America have long assumed that it was (and is) a Baby Boomer problem. Recent statistics, however, indicate that a rapidly increasing number of new HCV diagnoses are linked to Injection Drug Use (IDU), and that IDUs will likely lead to an exponential explosion of new infections compared to previous years. With that reporting, however, a stigma has arisen amongst the Baby Boomer population (the Birth Cohort), leading some in the cohort to avoid screening for the disease. Research published in March 2016 (Joy, 2016), however, indicates that HCV infections within the Birth Cohort is much more likely to have arisen from unsafe medical practices on behalf of doctors and hospitals, rather than any lifestyle choices made on the part of patients.

The research, published in The Lancet Infectious Diseases journal, was conducted by scouring over 45,000 documents and records, examining 45,316 sequences of HCV Genotype 1a – the most common strain – and then used a technique called “phylogentic analysis” to focus on five HCV genes and trace the dynamics of the HCV epidemic. The results suggest that the initial peak of the HCV epidemic – the time when initial infection and introduction of the disease in the Birth Cohort – occurred between 1948 and 1963, far earlier than many had suggested.

These infections are most likely related to the techniques and equipment that medical professionals used in the post-World War II (WWII) era, prior to the establishment of safer technologies, equipment, blood screening, and techniques that came about in the wake of the initial HIV crisis of the 1980s and 1990s. Strict blood screening techniques were not, in fact, common place until the U.S. government mandated the practice in 1992. As such, anyone who received a blood transfusion or underwent invasive medical procedures prior to that year may have been exposed to HCV, and should be screened for the virus.

Stigmata are nothing new, however, for the Birth Cohort. This is a group who helped to push the sexual revolution and drug use of the 1960s and 70s, and began having children in the 1980s. During this time, reports of sexually transmitted diseases and viruses, as well as transmission via IDU, began gaining more media exposure, both of which gained a level of ignominy in the 1980s in relation to HIV. We must remember that many media reports indicated that HIV only impacted those in the “4 ‘H’ Club” – Heroin users, Hookers, Haitians, and Homosexuals. When this type of branding in the media and in government conversations occurs, stigmata arise that leads to people avoiding testing and treatment.

Since that time, however, infectious diseases have undergone something of facelift, with multi-million-dollar ad campaigns and outreach programs on the part of pharmaceutical companies and governments trying to spread the word about getting tested. These efforts are part of a concerted effort to reduce the stigma associated with chronic illnesses and infectious diseases that are both costly to treat and incredibly harmful to those living with them if they go untreated.

For the Birth Cohort, however, to feel as if they should be lumped in with what many view as an unsavory crowd simply goes counter to the reality of the epidemic. Screening for HCV isn’t just something that applies to those who practice risky behavioral patterns; rather, it should be something that is routine within the Birth Cohort, so that they can cure HCV and live their waning years without the concern of HCV-related illnesses and co-morbidities.

References:

  • Joy, J., McCloskey, R., Nguyen, T., Liang, R., Khudyakov, Y., & Olmstead, A., et al. (2016, March 30). The spread of hepatitis C virus genotype 1a in North America: a retrospective phylogenetic study. The Lancet Infectious Diseases16(6), 698-702. doi:10.1016/s1473-3099(16)00124-9. Retrieved from: http://dx.doi.org/10.1016/S1473-3099(16)00124-9

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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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A Case of Northern Overexposure

By: Marcus J. Hopkins, Blogger

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

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

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

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

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

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

 

References

 

 

 

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Appalachian Syringe

By: Marcus J. Hopkins, Blogger

If the heroin epidemic of the 1970s taught us anything, it’s that heroin use mostly affects the inner city minority communities, so white people who live outside of those cities don’t have anything to worry about, right?

Wrong. Much to the chagrin of anti-drug propagandists, this narrative was then, and is now, entirely false. One of the biggest fallacies of America’s drug policy is the fact that most of the prevention-based legislative efforts have been based off of similar false narratives, shoddy “science (most of which is relegated to stereotyping drug users), and a desire to punish, rather than prevent.

The latter – punishment over prevention – is a recurring theme in American drug politics, and that is arguably best reflected in how our states approach the issue of syringe exchanges. Despite the Appalachian Region (including AL, GA, KY, MD, MS, NY, NC, OH, PA, SC, TN, VA, & WV) having some of the highest rates of opioid prescriptions per 100 people, the highest rates of Hepatitis B and C, and some of the highest opioid-related overdoses in the nation, there has been little political will to enter into the scientifically uncontroversial, but politically controversial, business of syringe exchanges.

droppedimage

Photo Source: Bathroom Sketch

The premise behind syringe exchanges is this – we understand that people are going to use injection drugs; providing them with a safe way and place to exchange used needles for clean ones helps to stem the spread of virulent diseases that often run rampant within these communities. Sadly, the punishment-based approach to dealing with drug abuse operates off the premise that drug abusers know the risks of their bad habits, and if they’re stupid enough to use injection drugs, they deserve whatever health consequences come their way. Not only is that premise callous, it is also costly.

In the past few years, some states have begun to learn this lesson the hard way – Scott County, Indiana’s 2015 epidemic of IDU-related HIV and HCV, for example – and have begun to recognize that the conventional approach to dealing with the opioid and heroin epidemics has been largely unsuccessful. Rather than quelling the epidemic, the punitive approach to coping with addiction has simply driven it underground where it cannot be effectively monitored, diagnosed, or treated. This has helped to create a dangerous breeding ground for the spread of disease as a result of IDU that was largely thought to have ended in the 1990s.

Thankfully, several states’ law enforcement communities and local governments have recognized that the punitive approach to this problem has not brought about satisfactory results, and have come to be some of the most ardent supporters of both syringe exchange programs and rehabilitative and recovery services – two measures that research indicates as being the most effective tools in stemming the spread of preventable IDU-related disease exposure. These programs also offer support staff who are there to engage participants in confronting their problems with addiction, as well as helping to provide linkage to other important social services, such as housing and healthcare.

While we clearly have a long way to go in providing addiction and recovery services to the underserved communities in Appalachia, there are positive strides being made and steps being taken, although this is happening mostly on the local level. The best way to extend these programs to hard to reach communities is to advocate for their inclusion in state-level legislative initiatives, and doing that will require advocates to demonstrate how these programs help to save states money in these times of economic uncertainty. When faced with empirical and quantitative evidence, even the most fiscally conservative debt hawk can’t deny that these measure save not only lives, but precious resources.
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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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