Tag Archives: opioids

Opioids Drive Hepatitis C Infections in New CDC Data

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) has released new data that estimate that approximately 2.4 million adults are living with Hepatitis C (HCV) in the United States (Hofmeister, et al., 2018). This estimate was reached by analyzing 2013-2016 data from the National Health and Nutrition Examination Survey to estimate the prevalence of HCV in the non-institutionalized population in combination with literature reviews and population size estimation approaches to estimate the HCV prevalence and population sizes for incarcerated people, unsheltered homeless people, active-duty military personnel, and nursing home residents (Hofmeister).

Photo of the CDC Headquarters

Source: George Mason University

These data represent the latest effort by the CDC to more accurately reflect the severity of the HCV epidemic in the United States. The accuracy of this estimate has been significantly hampered by the failure of the CDC to classify HCV as a mandatorily reportable condition (like HIV). Instead, the CDC has left up to individual states whether or not they consider HCV a reportable condition, which has led to a range of wildly varying approaches from no reporting whatsoever, to incredibly detailed reporting that goes down to the county and/or jurisdictional level. These variations have led to certain states providing no functional data about the incidence or prevalence of this deadly virus in their states.

One of the primary drivers of new HCV infections has been the prescription opioid and heroin epidemic that extends into virtually every corner of the U.S.:

Earlier CDC research found that new hepatitis C cases tripled between 2010 and 2016. Most were traced to injection-drug use among younger adults addicted to heroin and other opioids. Adults under 40 have the highest rate of new infections (Norton, 2018).

In states where Injection Drug Use (IDU) is highly prevalent (suburban and rural areas of New England, the Midwest, and Appalachia), IDU accounts for a significant percentage of new HCV infections – in West Virginia and Massachusetts – the states with the second- and first-highest rates of HCV infection respectively – evidence suggests that it is the leading risk factor identified in HCV incidence reporting.

The recent news that Medicaid was expanded by voter ballot initiatives in Idaho, Nebraska, and Utah brings some hope that people living with HCV in those states will gain access to curative treatment. That said, even with Medicaid programs paying for treatment, it is both far cheaper, and more effective to prevent infection, rather than to play “Recovery Medic.” This can be effectively accomplished by establishing (and adequately funding) Syringe Services Programs (SSPs) which have been shown to reduce the number of new infectious disease infections and increase access to and utilization of drug abuse recovery services. Unfortunately, according to a 2017 CDC study, only three U.S. states have laws that “support full access” to both SSPs and HCV treatment (Norton).

For those of us in the HCV data game, these data are of little surprise. While this latest CDC estimate is down from the previous one, there are factors to consider when looking at this decrease: the introduction of HCV Direct-Acting Antivirals has decreased the number of people living with HCV as access to these medications has increase and people who wereliving with HCV have died in greater number as their disease ravaged their livers and other bodily organs. Essentially, people either got cured, or they died (Norton).

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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Rural America Continue to Struggle with Opioid Addiction

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 1999, the Centers for Disease Control and Prevention (CDC) reported that drug overdose deaths were higher in metropolitan (urban) areas than in non-metropolitan (suburban/rural) areas – a rate of 6.4 vs. 4.0 (per 100,000). In 2015, that trend has reversed, with non-metropolitan overdose deaths more than quadrupled in number with a rate of 17.0, while metropolitan areas had a rate of 16.2 (CDC, 2017).

From these data we can surmise a few things:

  1. The population in the U.S. did not decrease from 1999 (279 million) to 2015 (321 million);
  2. Despite this population increase (+42 million), the total number of drug overdose deaths has increased exponentially;
Medical technician counting needles.

Photo Source: Daily Beast

So, what changed during this period? According to the American Society of Addiction Medicine, from 1999 to 2008, overdose death rates, sales and substance use disorder treatment admissions related to prescription pain relievers increased in parallel:

  • The overdose death rate in 2008 was nearly four times the 1999 rate;
  • Sales of prescription pain relievers in 2010 were four times those in 1999;
  • Substance use disorder treatment admission rate in 2009 was six times the 1999 rate
  • In 2012, 259 million prescriptions were written for opioids – more than enough to give every American adult their own bottle

Along with these sobering (as it were) statistics, four out of five heroin users started out abusing prescription painkillers. Also, 276,000 adolescents aged 12-17-years-old were current non-medical users (abusers) of prescription pain relievers, with 122,000 having an addition to prescription pain relievers. 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users (American Society of Addiction Medicine, 2016)

Essentially, as the rate of prescribing opioids increased over time, so too have the rates of addiction and overdose deaths. That said, the opioid prescribing rate has declined from 2012-2017 and is currently at the lowest level in ten years, from 259 million in 2012 to 191 million in 2017.

Even with this decline, reversing the damage already done is going to take at least a generation to fix, particularly when it comes to adequately addressing opioid and heroin addiction (inclusive of treatment, recovery, and relapses). Moreover, there are vast disagreements in how we, as communities, counties, states, and a nation, should best go about dealing with these issues.

Despite the fact that we have hard scientific data and evidence that certain measures work better than others (e.g. – Harm Reduction measures like Syringe Services Programs (SSPs) and Medication-Assisted Treatment (MAT)), it is difficult to convince elected officials to legalize, authorize, and fund these measures. This is largely due to long-standing, albeit factually inaccurate, objections that SSPs are essentially “enabling” or “condoning” drug use and abuse.

One small town in Washington state – Stanwood – has decided to approach their burgeoning opioid addiction problem like they would a natural disaster, the same way they would mobilize and respond to a landslide or flu epidemic:

…the response to the opioid epidemic is run out of a special emergency operations center, a lot like during the Oso landslide, where representatives from across local government meet every two weeks, including people in charge of everything from firetrucks to the dump (Boiko-Weyrauch, 2018).

The name of this group is the Multi-Agency Coordination group (MAC group), and has seven big, overarching goals which are broken up into manageable steps, like distributing needle cleanup kits and training schoolteachers to recognize trauma and addiction. Police officers enter illegal homeless encampments in wooded areas not to arrest them, but to help link them to drug treatment and housing resources, as well as to provide other assistance, such as food, coffee, and transportation to and from appointments (Boike-Weyrauch).

This approach to policing the opioid epidemic is slowly becoming more popular, but again, convincing states, counties, and local municipalities to adopt this strategy is incredibly difficult due to the long-standing opposition against the use of public resources for these purposes. The concept of treating addiction as a disease, rather than as a crime to be punished isn’t an easy pill to swallow for those who believe that only the individual is responsible for dealing with their health issues; who have abandoned the concept that addressing the welfare, health, and safety of all citizens will lead to greater results than leaving people to their own devices.

As part of the Community Access National Network’s ongoing research, we provide state-by-state analysis of various Harm Reduction measures (e.g. – SSPs, Naloxone Access, and Provider Education Requirements) in our monthly publication, the HIV/HCV Co-Infection Watch. Our October edition can be found here: http://www.tiicann.org/co-infection-watch.html

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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Research Indicates Nearly 30% of Opioid Prescriptions Lack Medical Justification

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

HEAL Blog posts frequently discuss the impact the opioid epidemic has upon the spread of HIV, Hepatitis B (HBV), and Hepatitis C (HCV). One aspect that we’ve discussed – prescribing habits – has recently received further study. According to new research published in Annals of Internal Medicine, 28.5% of opioid prescriptions have no record of either pain symptoms or pain-related conditions justifying their prescription (Scutti, 2018).

The study authors go out of their way to suggest that various causes may contribute to this lack of justification – failure to submit documentation, time constraints, clinic workflows, or complicated documentation systems (Scutti). In recent decades, doctors and nurses, alike, have complained about the complicated and seemingly never-ending amount of paperwork involved in providing even the most basic of care. Much of this is related to the Electronic Medical Record (E.M.R.) – software programs that are designed to account for virtually everything that can, does, or should occur with a patient. Recent studies indicate that doctors spend a little more than half of their work hours doing administrative work, rather than in face-to-face time with patients (Ofri, 2017).

Rx bottle with medicine on top of an Rx order

Photo Source: MedScape

Essentially, any time an insurer, new law, regulation, or threat of legal action appears, new field (or more) pops up in E.M.R. software that requires input on behalf of the doctor. So, realistically, it is possible that the justifications for at least some of the 28.5% of unjustified opioid prescriptions could just have been lost in the shuffle. Doctors are, after all, only human. Very well-trained, highly educated humans, but humans, nonetheless.

The other side of this argument, however, is that “doctors are human.” Doctors, like every human, are susceptible to poor influences – deals made with pharmaceutical companies to prescribe certain medications that highly addictive in lieu of other medications, for example. Or addiction; manipulation by patients; under the table dealing. At least once a week, I read an article about a doctor whose license is being suspended or revoked because they’ve been illicitly prescribing opioids or other narcotics in exchange for [x], or they’ve been selling them on the side. But, even those instances can’t account for all of 28.5%.

Yet another angle is that these drugs have become increasingly regulated since 2006 (the scope of the Annals study is 2006-2015). Since 2015, even more restrictions have been placed upon opioid prescribing, and in most states, this has resulted in dramatic decreases in the number of prescription per capita. In 2017, the opioid prescribing rate had fallen to the lowest it had been in 10 years (Centers for Disease Control and Prevent, 2017). But, even that comes with additional problems: patients turning to “street” sources for prescription opioids; patients moving off of opioids to heroin (often cut with fentanyl or carfentanil), because heroin is easier and cheaper to obtain; the resultant overdoses and increased risk of infection with HIV, HBV, and HCV.

There is no single solution to curbing the opioid epidemic. Doing so is going to require multiple approaches working in conjunction to defeat the problems. Outside of just prescriber education about opioid addiction and increase prescribing restrictions, we must also include and incorporate patient-focused harm reduction measures, such as increasing access to legal Syringe Services Programs (needle exchanges that also provide screening and testing for diseases and linkage to treatment programs for disease and addiction) and increasing access to addiction treatment programs by expanding the number of available beds.

For far too long, we have attempted to deal with these problems with siloed responses – just syringe exchanges; just prescribing restrictions; just prescriber education. This strategy is not working, and moreover, it is more expensive, in the long-run, to continue funding multiple single-focus initiatives that don’t work in tandem with one another, than it would be bring all of these resources and initiatives into one large effort. But, that will require cooperation and a lot of money up front; it’s far more palatable to fund smaller, less effective initiatives because the “ask” is lower on up-front costs. Realistically, though, it needs to be done.

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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Who Funds the Opioid Epidemic (and the Subsequent HCV Epidemic)

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

Senator Claire McCaskill (D-MO) is planning to introduce a bill into the Senate that would require drug makers to report payments that are made to nonprofit organizations and patient advocacy groups (Silverman, 2018). This is an issue that HEAL Blog, as well as the Community Access National Network’s HIV/HCV Co-Infection Watch publication, has repeatedly brought up in our reporting.

Sen. Claire McCaskill

Photo Source: The Washington Free Beacon

State and Federal lawmakers have been attempting to place prescribing and use restrictions on prescription opioid drugs for the better part of two decades. There is a natural opposition that state and Federal lawmakers face from opioid manufacturing pharmaceutical companies, such as Purdue Pharma, maker of OxyContin, the first prescription opioid drug made available and marketed to average consumers rather than for use in palliative care and severe injury. But, that’s not where the pressure on lawmakers ends.

Purdue Pharma logo

Photo Source: Purdue Pharma

Where McCaskill’s proposal comes into play goes back much further, with pharmaceutical companies creating and funding nonprofit organizations to advocate for a single issue: Pain. Pain Advocates, since the late-1980s, have been actively lobbying Congress, the U.S. Food & Drug Administration (FDA), and state legislatures to push for easier access to these powerful drugs. Every time a legislator or the FDA attempts to reign in what was once virtually unfettered access to

Opioid drugs work by binding to opioid receptors in the brain, spinal cord, and other areas of the body and reducing the sending of pain messages to the brain, thereby reducing the feeling of pain. For Pain Advocates who claim to represent patients whose levels of daily or regular pain leave them unable to function normally, these drugs have been seen as necessary for their survival. What drug manufacturers who fought for easy access to these drugs failed to mention (despite knowing from their own research) is that opioid drugs are highly addictive.

I’ve personally encountered several pain advocates whose opposition to my advocacy for opioid prescribing restrictions in the state of West Virginia has been boiled down to this line of thinking: “How am I supposed to be a functional human being without these prescriptions?” In a state like West Virginia, which has the highest rate of drug overdose deaths in the nation (52 per 100,000) and potentially the highest rate of Hepatitis C (HCV) in the nation (7.2 per 100,000), this comes across to me as them really saying, “My pain is more important than the preventable spread of disease or others’ lives.”

As the rate of new HCV infections continues to rise, in some states like WV, exponentially, is that opioid drug abuse is directly tied to this meteoric increase. In a report from the National Institutes of Health’s (NIH’s) National Institute on Drug Abuse, data indicate that the incidence of heroin initiation (beginning to use) was 19 times higher among those who reported prior nonmedical pain reliever use than among those who did not. Further, a separate study cited by the NIH found that 86% of young, urban heroin injectors had used opioid pain relievers nonmedically prior to using heroin, and that their introduction into nonmedical use was characterized by three main sources of opioids: family, friends, and personal prescriptions (National Institute on Drug Abuse, 2018).

Next week, we’ll take a deeper look at how opioid diversion from legitimate prescriptions can potentially lead to addictions that can increase the risk of acquiring Hepatitis and HIV as a result of Injection Drug Use.

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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Young Adults Most at Risk of Hepatitis C Infection Via Injection Drug Use

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

Statistical analyses from around the country don’t lie: our nation’s young adults are driving the Hepatitis C (HCV) epidemic in the United States, and prescription opioids and heroin are the primary risk factor. These data, released by the U.S. Centers for Disease Control and Prevention (CDC) in December 2017, indicate that adults aged 18-39 saw a 400% increase in HCV, 817% increase in admissions for injection of prescription opioids, and a 600% increase in admissions for heroin injection (CDC, 2017). This analysis was made by compiling data from the CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states from 2004 to 2014.

Photo of the CDC Headquarters

Source: George Mason University

The findings “…indicate a more widespread problem than previous studies have shown,” researchers led by the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) wrote (Connor Roche, 2018). The largest increases were among persons aged 18-29 and 30-39 (400% and 325%, respectively), non-Hispanic Whites, and Hispanics (Zibbell, et al, 2018). Admissions for both men and women attributed to Any Opioid Injection Drug Use (IDU) increased significantly, as did admissions for heroin IDU, and Prescription Opioid Analgesics (POA). Amontg non-Hispanic Whites, admissions for Any Opioid IDU increased 134% over the 11-year period (Zibbell).

What makes this frustrating as an advocate for both HCV and for Harm Reduction measures is the pushback from Conservative and Libertarian organizations and “think tanks” who consistently claim that there is no “opioid epidemic;” that the only real problem we have is heroin and fentanyl (Singer, 2018). The Cato Institute – one such Libertarian organization (founded as the Charles Koch Foundation in 1974) – has consistently misrepresented data about the opioid epidemic in America by focusing only on overdose statistics. Even the statistics they cite – “Digging deeper into that number shows over 20,000 of those deaths were due to the powerful drug fentanyl, more than 15,000 were caused by heroin, and roughly 14,500 were caused by prescription opioids” – come with some caveat that portends to excuse their galling lack of accuracy.

The purpose of the Cato Institute and Mr. Singer’s positions is to attempt to persuade “rational” people that prescription opioids aren’t the real problem, and any efforts to restrict or regulate the dosages, supply days, or “well-meaning, hardworking” healthcare providers who prescribe prescription opioids is obviously absurd. Why, any rational human being would never abuse prescription opioids, and the people who do are the ones at fault; not those innocent physicians who prescribe the highly addictive substances. (/sarcasm)

Counter to the alternate reality created by Mr. Singer, where addiction to the effects of opioids just magically appears, and can’t possibly be related to prescription drugs, that isn’t how addiction works, nor do any of the surrounded data – drug abuse statistics, treatment facility admission records, and HIV/HCV infection data – support his nonsensical claim.

These findings from the CDC should be concerning to Americans. These problems are going to get far worse, before they get better, particularly if people who are addicted lose access to government-, employer-based, and/or privately-funded healthcare coverage. With the removal of the Individual Mandate from the Affordable Care Act in 2017, analysts consistently predict that chaos will ensure within the health insurance marketplaces, which will inevitably result in fewer people having access to affordable healthcare, an increase in unpaid medical and emergent care expenses, and increased prices for everyone.

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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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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amfAR Releases Opioid & Health Indicators Database

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

amfAR, The Foundation for AIDS Research, has published their latest site, “Opioid & Health Indicators Database,” which pulls together, for each state, trends over time in opioid use and related infectious disease mortality, as well as state-by-state levels of Federal funding (Melville, 2017). The site was revealed at last week’s Association of Nurses in AIDS Care (ANAC) 2017 conference by Alana Sharp, MPH, from the Foundation of AIDS Research, a private organization that focuses on the various research and databases that informs their reporting.

AmfAR logo

Photo Source: amfAR

The website pulls together various data from a variety of sources and present this data for every state in the U.S., and puts them in the context of HIV, Hepatitis C (HCV), and the opioid crisis. This unique site is one of the first to actively connect these types of data in a user-friendly manner. They also make use of the supplemental data used to compile a list of 220 counties in the U.S. most at risk of HIV and/or HCV outbreaks due to a variety of similar circumstances that include: Drug Overdose Mortality, Prescription Opioid Sales, Mental Health Services, Insurance Coverage, Urgent Care Facilities, Vehicle Availability, Education, Income, Population Density, Poverty, Race/Ethnicity, Unemployment, Urban/Rural Status, and Buprenorphine Prescription Capacity (Van Handel, et al., 2016b).

Opioids Amplifying Impacts on HIV and HCV

Photo Source: opioid.amfar.org

From the front page, users select their either the state or congressional district from one of two dropdown boxes, and receive a fresh page that provides information. For states, the first page displays information on the Most Vulnerable Counties, taken from the Van Handel report, and after a click-thru, lands on a page that lists a considerably deep level of state statistics, including demographic data, HIV and/or HCV populations, opioid use statistics, healthcare-related statistics, and treatment and prevention services information, all of which are set against national statistics (e.g. – Percentage of People without Health Insurance (2015): West Virginia – 11.5%; National – 13.0%). After the numerical presentation, you can scroll down for more in depth coverage about state opioid policies, graphs of state health trends, Federal funding from various agencies, as well as a data explorer, that provides county-by-county HIV and HCV incidence and prevalence data broken, the same data by congressional districts, and by state for comparison.

If users select their congressional district, they’re asked to provide their zip/postal code, and are provided with a district profile providing numerical data similar to the state profile, and follows with the same graphic representation of data as presented on the state level, but Congressional district-specific.

This database, one of the first of its kind, helps provide a fantastic resource for state-level advocates and policy makers for informing good policy planning and crafting. For more information, please visit amfAR’s website at the following address: http://opioid.amfar.org.

References:

  • Melville, N.A. (2017, November 08). Opioid Crisis Inflaming Hep C, HIV in Hard-Hit Communities. New York, NY: Medscape, LLC: News: Conference News. Retrieved from: https://www.medscape.com/viewarticle/888219
  • Van Handel M.M., Rose C.E., Hallisey E.J., Kolling J.L., Zibbell J.E., Lewis B., Bohm M.K., Jones C.M., Flanagan B.E., Siddiqi A.E., Iqbal K., Dent A.L., Mermin J.H., McCray E., Ward J.W., & Brooks J.T. (2016b, November 01). County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States. JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2016 – Volume 73 – Issue 3 – p 323–331. doi: 10.1097/QAI.0000000000001098. Retrieved from: http://journals.lww.com/jaids/Citation/2016/11010/County_Level_Vulnerability_Assessment_for_Rapid.13.aspx
  • Van Handel M.M., Rose C.E., Hallisey E.J., Kolling J.L., Zibbell J.E., Lewis B., Bohm M.K., Jones C.M., Flanagan B.E., Siddiqi A.E., Iqbal K., Dent A.L., Mermin J.H., McCray E., Ward J.W., & Brooks J.T. (2016b, November 01). County-Level Vulnerability Assessment for Rapid Dissemination of HIV or HCV Infections Among Persons Who Inject Drugs, United States – Supplemental Appendix. JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1st, 2016 – Volume 73 – Issue 3 – p 323–331. doi: 10.1097/QAI.0000000000001098. Retrieved from: http://download.lww.com/wolterskluwer_vitalstream_com/PermaLink/QAI/A/QAI_2016_06_29_VANHANDELM_QAIV16762_SDC1.pdf

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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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