Tag Archives: Maine

Increase in HCV Cases Calls for Updated Screening Protocols

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

We, here at HEAL Blog, attempt to provide coverage of local outbreaks of Viral Hepatitis (VH), as well as to investigate and report them using evidence-based data to accurately characterize the issues at play. What consistently comes to the forefront of Hepatitis C (HCV) infection is the issue of Injection Drug Use (IDU) and the People Who Inject Drugs (PWID). More than any other risk factor, IDU in consistent across Hepatitis A (HAV), Hepatitis B (HBV), and HCV. According to the Centers for Disease Control and Prevention (CDC), in 2015, IDU was reported as a risk factor in 36.1% of all Acute HAV cases, ~34.3% of all Acute HBV cases, and 64.2% of all Acute HCV cases (CDC, 2017).

Hepatitis Screening

Photo Source: JAMA

In the five of the states with the highest rates of HCV – Massachusetts (MA), West Virginia (WV), Kentucky (KY), Tennessee (TN), Maine (ME), and Indiana (IN) – these data are undeniable:

And yet, none of these states have amended their HCV screening protocols to include compulsory “Opt-Out” screening in every healthcare setting. This is folly, at best, and dereliction of duty, at worst. If a state’s responsibility is to ensure the health and welfare of its citizens, it is incumbent upon them to take non-extraordinary steps to expand screening protocols. Moreover, they must begin regularly surveilling and reporting, including detailed risk-factor reporting.

If this sounds “revolutionary,” it’s simply not. Given the high rates of infection, mortality, co-morbidities, and the fact that there is a functional cure for the disease, there is simply no excuse for failing to expand testing to include compulsory “Opt-Out” screening for HCV, particularly in states where IDU is high. Is it expensive? Yes. But, again, when it comes to the health and welfare of people, sometimes short-term expenditures outweigh long-term costs of care. This is why there are grants; this is why people pay taxes.

Some of the most successful screening efforts are being conducted not in traditional healthcare settings, but at Syringe Services Programs (SSPs), which remain controversial among those who say that they promote and encourage drug use. These services are, however, vital to stemming the spread of disease. Perhaps the least successful screening efforts are conducted in incarceration settings, despite having essentially a captive demographic. These efforts are hampered, again, by cost concerns, as, if the results come back “Positive,” they are required by law to treat.

While expanding screening may be initially costly, it is the best way for us to go about eliminating HCV in the U.S.

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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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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Taking a LePage from an Outdated Book

By: Marcus J. Hopkins, Blogger

Naloxone does not truly save lives; it merely extends them until the next overdose,” Gov. Paul LePage (Miller, 2016).

Maine’s very own Republican Governor Paul LePage, is renown for his ability to say just the wrong thing in the absolutely worst way possible, and his above quote is an example. LePage’s comment is a part of his veto the Maine legislature’s attempt to expand the ability of pharmacies to provide naloxone – a non-habit forming drug used to counteract the effects of opioid and heroin overdoses – without the need for a prescription.

Photo of Maine Governor Paul LePage

Photo Source: Business Insider

This type of legislation is nothing unusual – roughly 30 states have similar Harm Reduction laws on the books. Maine, in fact, has already increased access to naloxone by making it readily available to emergency personnel, nurses, and other healthcare professionals, and bill LD 1547 would’ve brought Maine in line with a majority of states. The bill came about after national pharmacy, CVS, requested the bill in response to a letter from U.S. Senator Angus King (I-ME) asking the chain to expand the availability of the antidote (Mistler, 2016a). For the most part, LD 1547 enjoyed broad bi-partisan support from legislators, community members, healthcare professionals, medical associations, and public employees and servants. So well-received was the bill, that it was passed “under the hammer” – unanimously without a roll call. LePage was not one of its fans.

Maine, like most other rural areas in the U.S., is in the throes of a growing opioid and heroin abuse epidemic, and this isn’t the first time that LePage has taken a stab (pun intended) at the problem. Earlier, this year, LePage made similarly troubling comments:

“These are guys by the name D-Money, Smoothie, Shifty. These type of guys that come from Connecticut and New York. They come up here, they sell their heroin, then they go back home. Incidentally, half the time they impregnate a young, white girl before they leave. Which is the real sad thing, because then we have another issue that we have to deal with down the road” (Fuller, 2016).

The unfortunate result of this type of verbiage is that it tends to lead to further stigmatization, rather than creating any substantive solutions or net positive results. What’s sadder is that the stigma associated with opioid and heroin abuse is so pervasive in our society that those who are also unwilling or unable to read, research, or understand existing research about opioid addiction and abuse have these stereotypes of substance abusers further reinforced in their minds.

Of further concern for LePage is that his veto is likely to be overridden by Maine’s legislature. It is this author’s hope that, along with an overridden veto, the citizens of Maine are treated with a more accurate portrayal of the fight against opioid and heroin abuse and addiction; one that doesn’t portray them as “…addict[s] [with] a heroin needle in one hand and a shot of naloxone in the other.”

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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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