Tag Archives: opioid

The Kids Aren’t Alright

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

For nearly three years, healthcare officials and epidemiologists have been sounding the alarm: the face of the Hepatitis C (HCV) epidemic is changing – it’s getting younger by the minute. We, here at HEAL Blog, have been beating that drum alongside them, and yet, the U.S. Centers for Disease Control and Prevention (CDC) has yet to formally change the screening recommendations to reflect the new reality. As more evidence piles up that new Acute HCV infections are largely being driven by prescription opioid and heroin Injection Drug Use (IDU) among Americans aged 15-45.

A piece written by the Digestive Health Team out of the Cleveland Clinic – Why Is Hepatitis C on the Rise in 20- to 29-Year-Olds? – explicitly says as much. In addition, while African-Americans share a disproportionate burden in the epidemic (as a percentage of the population), these issues are particularly pronounced in white, non-urban (suburban and rural) populations living primarily in Appalachia, the Midwest, and New England.

So, what is it about these areas that drives people to abuse prescription opioids, heroin, and/or other illicit drugs? There isn’t just one answer. A lot of the areas where these outbreaks and epidemics are so pronounced share several similarities – struggling economic circumstances; higher-than-average unemployment; less access to and utilization of healthcare services; high rates of Social Security Disability Insurance utilization; economies driven by high-intensity labor industries (mining, for example). Any combination of these factors can lead people to develop substance addictions; that these areas are more remote with fewer outlets and opportunities for employment, entertainment, or social engagement essentially creates enclaves where people can all but disappear into a considerably isolated world of addiction.

Where the kids come in often has to do with the friends, relatives, and other adults whose legitimate opioid prescriptions get unknowingly diverted by experimenting teens who inadvertently become addicted to the highly addictive substances. As a young adult living in a small city in Tennessee in the 2000s, virtually all any of my friends and co-workers wanted to do was find “pills” (primarily OxyContin). Whereas I grew up in the cocaine-fueled 80s and ecstasy-addled 90s, parties in the 2000s were, for my generation, comparatively somber affairs, with everyone pilled out on opioids and barely able to function. Once the U.S. Food & Drug Administration (FDA) started to catch on and legislators began tightening prescribing guidelines, they turned to cheaper and more readily available heroin.

With IDU comes a whole host of risks that, for much of the 80s and 90s – particularly as it related to HIV/AIDS – were made explicitly known. Every health and D.A.R.E. (Drug Abuse Resistance Education) I was made to attend as a child, pre-teen, and teenager included a very graphic section on the dangers of injecting drugs. Almost every school in the 90s had a rumor going around about some random person who was dancing at a nearby club and got stabbed with a used needle and got AIDS. While a lot of hyperbole was involved in these stories, the sense of horror we were expected to evince – “WHAT?!?! A DIRTY NEEDLE?!?!” – led a lot of us to become more risk averse, particularly in our younger years.

Twenty years later? A lot of those fears have been forgotten. We no longer see horrific images of people dying from AIDS – the treatments are amazing, tolerable, and don’t kill you. We aren’t afraid of diseases like HIV or viral hepatitis, anymore, because…well, HIV isn’t a death sentence, and HCV is curable. Hepatitis B is still a huge problem, as it has no cure. But, the reality is that neither the fear of becoming addicted, nor the fear of becoming infected are presently palpable enough to prevent people from even starting. What starts out as a way to kick back with your friends and loosen up can quickly turn into a daily habit and morph into a physical dependency. Once you’re dependent and addicted, the risks become less frightening.

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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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Appalachia’s Opioid Addiction Continues Wreaking Health Havoc

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 Northern Kentucky Health Department (NKHD) has reported a 48% increase in new HIV infections in the region in 2017, with 37 new cases compared to 25 in 2016. In 18 of those 37 cases (48.6%), Injection Drug Use (IDU) was listed as a primary risk factor, compared to just 5 of the 25 cases in 2016 (20%). Further analysis of these data show that the IDU-related new infections were concentrated in just two of the region’s four counties – Campbell and Kenton (Northern Kentucky Health Department, 2018).

Whenever a jump in new HIV infections occurs in Appalachia, I say to myself, “THIS! THIS will be our teachable moment! THIS will be the one that forces [state] to take action!” And, a lot of the time, I’m partially correct. The most common refrain I hear when asking state and local healthcare officials about potential HIV outbreaks is, “We don’t want this to be another Scott County, Indiana.”

Sihe HIV outbreak in Scott County, IN in 2015 (Hopkins, 2017) that saw the county’s number of new HIV infections jump from 5 per year to 216 in two years, states all across American and even the Federal government began taking actions to prevent a similar outbreak. In 2016, Congress partially lifted the ban on Federal funding for Syringe Services Programs (SSPs) – a move once thought virtually impossible given the political climate (All Things Considered, 2016). The Scott County outbreak served as a cautionary tale in state run by Conservatives – “It’s time to get with the times.”

Two hands, with one hold a needle

Photo Source: TheBody.com

Of the 18 IDU-related HIV infections, 78% were co-infected with Hepatitis C (Monks, 2018). Increases in new cases of Hepatitis C (HCV) are often the “canary in the coal mine) that leads healthcare professionals to begin more rigorous screening for HIV, particularly in areas of the country where the incidences of prescription opioid and/or heroin abuse are particularly rampant. Unlike the heroin epidemic of the 1970s, the new opioid epidemic of the modern millennium is set in rural and suburban areas of the country. Of the 220 counties identified by the Centers for Disease Control and Prevention (CDC) as being vulnerable to HIV or HCV outbreaks, 56% are in Kentucky, Tennessee, and West Virginia – the states that rank in the top four rates of Hepatitis B and HCV infections in the U.S. (Whalen & Campo-Flores, 2018).

Across the Ohio River from the Northern Kentucky Independent District, in Cincinnati, the city saw a 40% increase in new HIV infections over 2016, with a total of 129 new infections, 28 of which (22%) were IDU-related (Whalen & Campo-Flores).

HEAL Blog will continue to monitor the situation in Northern Kentucky. After all, nobody wants to be the next Scott County, Indiana

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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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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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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Voluntary Involuntary Opioid Abuse Treatment

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

Kicking an opioid drug abuse habit is one of the most difficult habits to break. So difficult is the prospect of quitting that reports are coming out of Massachusetts indicating that some people facing opioid-related drug charges are asking judges to lock them up – inside a treatment program center for 90 days from which they cannot leave.

These requests are in response to several issues, not the least of which include overcrowded treatment programs with long waitlists that reject patients whose insurance will not adequately compensate the cost of inpatient treatment, often the only way to ensure that those undergoing treatment cannot gain access to heroin or other opioid drugs while attempting to detox. In 2016, roughly 8,000 people will be committed to substance abuse treatment in MA, up 40% from five years ago (Brown, 2016).

Technically, a patient cannot request their own involuntary committal; it requires a close relative, probation officer, or emergency room doctor (or other official) to petition the court on your behalf. If you agree not to oppose the petition, a judge is likely to approve the petition. If a judge agrees to the involuntary commitment, that’s a bed in an inpatient facility paid for by the state, rather than the patient or private insurance, and for a length of treatment longer than for which most insurance programs are willing to pay.

Vivitrol for Opiod Dependence

Photo Source: Vivitrol.com

Treatment prospects are much less diverse for those already incarcerated. The Federal government recently approved spending more than $23 million to fund treatment projects that include giving monthly injections of Vivitrol (Alkermes, Inc.) – a blocker that attaches to certain opioid receptors in the brain and blocks the pleasurable feelings associated with taking opioids (Alkermes, nd.b) – to inmates in an attempt to break the cycle of opioid addiction. Eight states (Arizona, Colorado, Illinois, North Carolina, Rhode Island, Vermont, Wisconsin, and Wyoming) are the recipients of these grants – $2.8 – $3 million over three years (Associated Press, 2016). Each of these states intends to utilize these services to patients in different ways, and at different points in their respective sentences.

In addition to these states, the West Virginia Division of Corrections (DOC) has started a pilot program where it offers an injection of Vivitrol to its soon-to-be-released inmates struggling with opioid addiction. WV, along with neighboring OH and KY, have been incredibly hard hit by opioid abuse. One drawback of this pilot program is that the DOC does not follow up on offenders after they have served their entire sentence, so no information is available on the recovery efforts of six of the participants. This creates a problem with the program, as there is no evidence of its efficacy outside of the incarceration or parole period (Holdren, 2016). Additionally, there are simply not enough treatment centers who provide Vivitrol injections in WV, and those that exist are inconveniently located to those located in some of the hardest hit counties and locations, requiring patients to make 1.5- to 3-hour roundtrips to treatment receive injections.

The primary issue with Vivitrol is the cost – between $1,000 and $1,300 per injection on a monthly basis (Johnson, 2016). For inmates enrolled in Medicaid, Vivitrol injections cost just $3 (in WV); those not on Medicaid must pay their insurance’s prescription fee or foot the entire $1,300 on their own. Alkermes does offer a Patient Assistance Program, which offers co-pay assistance up to $500 each month (Alkermes, n.d.a). Additionally, because the drug is relatively new, there is little evidence, yet, that use of Vivitrol proves effective in the long-term. What data there is, however, points to excellent results.

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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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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