Tag Archives: Ohio

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

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

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

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

Medical Benefits Claim Form with the word, "REJECTED"

Photo Source: NPR

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

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

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

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

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

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

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

References:

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

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

 

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Are Hepatitis C “intentional exposure” Criminalization Laws on the Horizon?

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

One of my favorite things about growing up in the 1980s/90s was hearing all about how “…this guy spit on someone, and it turned out…he had HIV.”

Inevitably, the “guy” they were talking about was supposedly arrested and charged with a felony for trying to infect someone with AIDS, and everyone would gasp in horror – how DARE someone try to spread AIDS by spitting on an innocent bystander?! If I happened to be in or around the group talking about this, I would always (not so calmly) explain to them that it is a scientific improbability that one could transmit the HIV virus by way of spit, because the concentration of the virus in spit is so low that there is almost a 0% chance that it can be transmitted outside of incredibly extreme circumstances and a concerted effort. Mind you, this was back in the late-80s/early-90s, when the AIDS panic was still in full swing. Even THEN, I wasn’t stupid enough to believe this kind of nonsense.

States that criminalize biting, spitting, or throwing of bodily fluids by people who have HIV

Little did I know, at the time, that these kinds of arrests were an actual thing. In 2017, there were 16 states that criminalize spitting, biting, and blood exposure for HIV-infected citizens (The Center for HIV Law & Policy, 2017).

I mean…

It’s 2018. These laws aren’t even based on good science!

So, because everything is awful, and America is totally known for basing their laws on good data and research, of course these fatuous laws would be extended to Hepatitis C (HCV) – one of the least effectively externally transmitted viruses.

Photo of a 27-year old man with Hepatitis C charged with spitting at Cleveland police officers.In Cleveland, OH, for example, a 27-year-old man who was drunk has been charged with First Degree Felonious Assault…for spitting on a police officer. He’s being held on $75,000 bond in the Cuyahoga County Jail, because he was drunk and spat in a police officer’s face while being put into an ambulance (Jankowski, 2018). Matthew Wenzler, the accused, has been called a “carrier” of HCV, and Cleveland Police reports state that they were “told” he is a “heroin addict.”

This isn’t even the first time Ohio has prosecuted someone for Spitting While HCV – in both State v. Price (2005) and State v. Bailey (1992), Ohio courts have upheld convictions for assault for spitting in an officer’s mouth. The neighboring state, Indiana, classifies Spitting While HCV as Class 5 or 6 felony battery…but only:

…if the accused in a rude, angry, or insolent manner places bodily fluid/waste on another person AND knew or recklessly failed to know that his or her bodily waste or fluid was infected with hepatitis [for Class 6].

…if the accused in a rude, angry, or insolent manner places bodily fluid/waste on another person AND knew or recklessly failed to know that his or her bodily waste or fluid was infected with hepatitis AND places the bodily fluid/waste on a public safety official [for Class 5] (Paukstis, 2017).

In South Dakota, a (Republican) state lawmaker has introduced legislation to make the transmission of HCV a Class 3 Felony punishable by up to 15 years in a state penitentiary and a $30,000 fine (Mercer, 2018). What makes this trouble is that this legislation is for “intentional exposure” which applies to “…transferring, donating or providing blood, tissue, organs or other infectious body parts or fluids” (Mercer). For anyone who’s paid attention over the past two years, the transplantation of HCV-infected organs has been repeatedly done, because there is now a functional cure for the disease. These organs are desperately needed at a time when the disease can be cured, and this legislation would making numerous people criminally liable for completing these procedures – the donor and anyone who approved or performed the transplant.

It should go without saying that criminalization of Viral Hepatitis (of any variety) and HIV is based not on good data or science, but upon efforts to shame and stigmatize those with the disease. It’s time for this nonsense to stop.

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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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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The Negative Impact of Opioid Drugs Upon Children and Young Adults

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

In early November 2016, a conference held at Xavier University in Ohio drawing hundreds of doctors, nurses, social workers, and addiction specialists began releasing shocking (though unsurprising) data related to the prescription opioid and heroin epidemic’s negative impact on children and teenagers. The findings indicate what many in healthcare already knew: we are at risk of creating a generation of children whose lives are fundamentally altered for the worse by addiction.

In the past few months, HEAL Blog has doggedly followed the unrelenting opioid-fueled devastation in the state of Ohio, and we have frequently brought to the fore the plight of children whose lives are have been put at risk due to their caretakers’ substance addiction and abuse. What we haven’t yet really covered has been the growing risk posed to children and teens whose access to opioids is made possible by their caretakers.

A study released in the Journal of the American Medical Association (JAMA) Pediatrics showed a 165% increase in opioid poisonings in children from 1997 to 2012 (Luthra, 2016). The rate of toddlers hospitalized more than doubled, and teens were found to be increasingly at risk of overdose (both intentional and unintentional) because they gained access to their parents’ prescription opioids without their knowledge. Both of these issues point to the need to better address overprescribing of opioid drugs, as well as to better stress the need for safer storage of prescription drugs.

Roughly 1 in 10 high school students admit to taking prescription opioid drugs for nonmedical reasons (McCabe, West, Boyd, 2013; Luthra, 2016), and roughly 40% say they got those drugs from their own prior prescriptions (Fortuna, Robbins, Caiola, Joynt, Halterman, 2016). This suggests that (1.) parents are not properly securing their own prescriptions and (2.) parents are not properly monitoring their children’s use and disposal of prescriptions. These suppositions raise questions about whether or not parents whose children or teens overdose should (or do) face negligence charges.

Prescribing guidelines continue to be tightened, as the U.S. Centers for Disease Control & Prevention (CDC) and the U.S. Food & Drug Administration (FDA) have both attempted to get physicians to limit prescriptions to shorter periods, and there is little evidence that imposing penalties upon people who fail to properly store or dispose of medications will have any appreciable impact on the adult behaviors. The concern, however, is whether or not those penalties will result in lower levels of abuse and poisoning on the part of children and teens.

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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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Ohio’s Opioid Nightmare Continues

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

Yet again, Ohio’s drug users and first responders are being overwhelmed by heroin laced with a stronger opioid drugs. Seven fatal overdoses occurred in one day in Cleveland on Saturday, September 24 (Kaufman, 2016). The following Tuesday saw 27 heroin overdoses in a 24-hour period in Columbus, including two fatalities. One patient had been released from the hospital after being treated for an earlier overdose just thirty minutes prior to being picked up for a second overdose; there were two such overdose victims that first responders treated twice in the same day for being overdosed (Sullivan, 2016).

With the introduction of the powerful opioids, fentanyl and carfentanil, not only those who are addicted to prescription opioid drugs and heroin face increased risks; first responders, emergency personnel, and law enforcement officers also face increased risks of being sickened by exposure to these drugs during raids and rescue situations. So great are the risks to first responders and SWAT teams that the Drug Enforcement Agency (DEA) released a warning about the dangers of handling these powerful opioids without extreme caution (Jones, 2016).

All over the state of Ohio, first responders and crime labs are taxed to the breaking point responding to opioid and heroin overdoses. Jamie Landrum, a Cincinnati police officer, is quoted: “We were literally going from one heroin overdose, and then being on that one, and hearing someone come over [the radio] and say, ‘I have no more officers left,’” Landrum said. Three more people overdosed soon after that (Harper, 2016). At one overdose scene, a patient required at least four doses of Naloxone to be revived; after the fourth dose, he was still not responding.

Beyond the primary concerns of overdose is the reality that these drugs were never meant for use in humans, and therefore, has no human testing data from which to extrapolate even the most basic information: the lethal dose per kilogram of body weight, or how long carfentanil stays in someone’s system. This makes responding to overdoses more difficult.

Naloxone rescue kit

Photo Source: Yourblogondrugs.com

What this means for local, state, and Federal governments is more: more overdoses, more Naloxone, more time spent on each call, and ultimately more money in areas already strapped for resources. And while there’s great outcry for more resources, there seems to be little appetite for holding the pharmaceutical companies that produce these opioids financially liable for the havoc their products have wreaked upon the populace.

At this point, penalties and criminal charges have been largely reserved for prescribing physicians and individual pharmacists; holding anyone higher up the food chain responsible for the opioid epidemic has proven difficult, as the industry is very active in combating any efforts to either curb prescribing habits or to hold anyone in the industry accountable. What we really need are a few brave politicians who are willing to forego the promises of the industry that supports their reelection campaigns, and who will do what’s best for their constituents.
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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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Ohio’s Opioid Addiction Forces Rethinking

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 rescue teams arrived on the scene, they had to break out two windows in her still-running truck to get to Debra Hyde and her eight-month-old grandson. Hyde’s truck was still in “Drive” in front of a large wall of propane tanks, when rescue workers found her overdosed on heroin in the backseat of her truck.

This is at least the second time in the past month that Ohio authorities have found a grandparent or guardian overdose in a vehicle with a child. Earlier in the month, Ronda Pasek and her boyfriend were found overdosed with a child in the backseat, and she is now sentenced to a 180-day sentence for a misdemeanor charge of “child endangerment.” In both cases, the children involved were remanded to the care of child services.

Woman laying on the ground after overdosing on Heroin, with the needle on the ground nearby

Photo Source: JustThinkTwice

1,424 people died in Ohio, in 2015, as a result of drug overdoses. This has forced first responders to reconsider not only how they prepare for their jobs – Naloxone kits are essentially a “must,” these days – but, how they respond to the burgeoning epidemic that plagues their state. In Marion, OH, and across the nation, heroin has fundamentally altered the work of police and emergency-service workers. Police and paramedics are now expected to play the roles of social workers, drug-treatment specialists, and experts at connecting with kids in drug-prevention programs (as those of us who remember D.A.R.E. can attest).

Marion Police Chief, Bill Collins, told his officers to stop charging those who overdosed, while at the same time, he was making connections with religious leaders, healthcare professionals, addition treatment providers, and teachers to find ways to help better address drug addiction within his community. He followed the evidence: many addiction surveys indicate that a large number of opioid addicts became addicted to prescription pain killers after gaining access to their parents’, grandparents’, or guardians’ properly (or improperly) prescribed opioid painkillers and began using them recreationally. In addition, he noticed that many of the people who were being found overdosed had kids in local schools, which further indicated that a great place to start would be within the educational paradigm.

With these things in mind, Collins and his allies helped create the “Too Good for Drugs” campaign, that teaches age-specific strategies that students can use to resist drugs. The program won a $25,000 Ohio Department of Education grant to fund the ten-week program for 6th-12th grade students. Teachers were so passionate about the project that they volunteer to teach it. Officials are still waiting to find out if another grand to extend the program to K-5th grade students is approved.

But, beyond the fact that these functions are becoming unlisted job requirements in these fields, should law enforcement officers and other first responders be expected to fill these roles? What few people contest is that “something” needs to be done; beyond that, there’s little agreement between healthcare professionals, law enforcement organizations, and advocacy groups on exactly what that “something” is.

Do we need more treatment centers for drug addiction, both in- and out-patient? Absolutely. Do we need more qualified social workers and staffing resources to adequately address opioid and other drug addiction? Yep. Do we need to do a better job of providing these recovery and addiction services to people in more rural parts of states – areas where opioid and heroin addiction are currently hitting states hardest? There’s no doubt of that.

But, the reality is that all of these approaches, while both the “right things to do” and the best ways we currently have to address the problem, are costly and require resources that, on the state and local levels, may simply not exist. Further complicating these efforts is the seeming inability of our elected leaders at the Federal level to work together toward accomplishing mutually beneficial goals. For states currently watching their cities turn into drug dens with a body count, it really does seem like the time for them to just get it together, and get to work.
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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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Ohio Opioid Epidemic Grows As Death Toll Mounts

By: Marcus J. Hopkins, Blogger

Two weeks ago, police in East Liverpool, Ohio, made global news after posting an arrest scene photo of a four-year-old child in his car seat, while with his grandmother and her boyfriend sat in the front seats, overdosed on heroin. The image has served as both a poignant reminder of the often overlooked consequences of opioid and heroin addiction and as a point of controversy for addiction and child advocates.

Map of Ohio, showing East Liverpool

Photo Source: Google Maps

The East Liverpool police posted the photo in an effort to bring attention to the havoc that opioid and heroin abuse wreaks on not only the user, but on the lives of the people around them. Both overdose victims received doses of naloxone – a fast acting drug that reverses the effects of opioid drugs – at the scene, an act which very like saved their lives. The driver, James Acord (47), was sentenced to 360 days in jail after pleading ‘No Contest’ to charges of child endangerment and operating a vehicle under the influence. the boy’s grandmother, Rhonda Pesak (50), who was awarded custody of the child on July 25, 2016, was sentenced to 180 days in jail after withdrawing her initial ‘Not Guilty’ plea to a charge of child endangerment, and reentering a plea of ‘No Contest.’

The child has since been relocated to live with his great aunt and uncle in South Carolina. His mother initially lost custody of him in December 2012 – four-and-a-half months before he was birth – as a result of her addiction to crack. Custody had initially been awarded to his great grandparents, and custody battles for the boy have involved his birth parents, a grandmother, two great aunts, and a friend, spanning four different states. Essentially, this boy’s life has been negatively impacted by drug addictions of some sort since before he was born.

Addiction advocates have criticized the East Liverpool police for “shaming” people who use drugs; child advocates have criticized the city for failing to obscure the identity of the child, which was done after the images were posted by news agencies. East Liverpool Service-Safety Director, Brian Allen, responded with the following statement:

If we hadn’t, Rhonda Pasek would have received a slap on the wrist and that little boy would have gone back to her – that’s not going to happen now. I doubt she will see that child again (Gould & Graham, 2016).

In the five days that followed the posting of the photograph, East Liverpool, a city of only 11,000 people, saw seven more overdoses and one death from heroin. But, this is just a small vignette of a much larger portrait. On Friday, September 09, Ohio authorities reported at least 21 overdoses in a single day in Akron, OH, bringing the total number of overdose deaths, this year, to 112 in the city. At least 24 people were hospitalized for overdoses, last month, while attending a music festival in the state (Karimi, 2016). In July, along, Akron police reported more than 90 overdoses and eight deaths (Las Vegas Review-Journal, 2016).

Ohio’s recently enacted Good Samaritan law offers immunity from prosecution to people trying to get help for someone overdosing on drugs or overdose victims, themselves, who seek assistance. The law, which went into effect, this month, covers people calling 911, contacting a police officer, or taking an overdose victim to a medical facility for up to two times; upon the third time, they would become subject to prosecution. This law, sign by current Ohio Governor, John Kasich, was passed in an effort to provide those offering assistance to overdose victims some measure of protection in the face of Ohio’s clear opioid and heroin abuse epidemic.

HEAL Blog will continue covering the epidemic in the coming weeks with more information and updates as they become available.
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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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