Methadone Programs Can be Key in Educating, Treating Hepatitis C Patients

liver“People who inject drugs and are enrolled in a drug treatment program are receptive to education about, and treatment for, hepatitis C virus, according to a study by researchers at several institutions, including the University at Buffalo.

That finding, published online this week in the Journal of Addiction Medicine will be welcome news to health care providers. “One of the most important findings of this work is that people who inject drugs do want to be educated about the disease and that education is associated with willingness to be treated,” says senior author Andrew H. Talal, MD, professor of medicine in the Division of Gastroenterology, Hepatology and Nutrition at UB and adjunct associate professor of medicine at Weill Cornell Medical College. research assistant professor of medicine at UB.”

Source: -May 16, 2014

Fewer Opioid Treatment Programs Offer HIV Testing

“According to a study, fewer opioid treatment programs are offering onsite testing for HIV and sexually transmitted infections (STIs), despite guidelines from the Centers for Disease Control and Prevention (CDC) recommending routine HIV testing in all health care settings.

The absolute number of programs offering testing for HIV, STIs, and HCV increased from 2000 to 2011. However, the percentage of programs offering HIV testing decreased significantly, by 18%, and the percentage of those offering testing for STIs fell by 13% throughout the study. Testing for each infection did not change over time in public programs, but HIV testing dropped by 20% among for-profit programs and 11% in nonprofit programs.

Source: - February 19, 2014

Open Access Journal Article: Advancing Service Integration in Opioid Treatment Programs for the Care and Treatment of Hepatitis C Infection


It is estimated that approximately 200 million people globally are infected with the hepatitis C virus and that roughly half of these people live in Asia. Without treatment, it is estimated that roughly twenty percent of those infected with hepatitis C virus progress to chronic liver disease, then subsequently, end-stage liver disease. Thus, access to hepatitis C testing and subsequent care and treatment of chronic hepatitis C infection are essential to address the global burden of disease.

In the United States, the Center for Disease Control and Prevention estimates that 60% of new cases of hepatitis infection are due to injection drug use. Opioid Treatment Programs (OTP’s) dispense methadone and buprenorphine under specific federal regulations to injection drug users diagnosed with opioid dependence. OTPs are developing comprehensive care and treatment model programs that integrate general medical and infectious disease-related medical care with substance abuse and mental health services. Integrating hepatitis care services and treatment in the substance abuse treatment settings fosters access to care for patients with hepatitis C infection, many who otherwise would not receive needed care and treatment.

This may serve as a national model for highly cost-efficient healthcare that has a measurable outcome of improved public health with reduced hepatitis C prevalence.

Source: International Journal of Clinical Medicine – January 2014

International Journal of Drug Policy Celebrates its 25th Anniversary – 25 Free Downloads Available from Past Issues

Articles of interest related to opioid dependence and addiction include:

  • Gender sameness and difference in recovery from heroin dependence: A qualitative exploration – September 2013
  • Interventions to prevent HIV and Hepatitis C in people who inject drugs: A review of reviews to assess evidence of effectiveness – August 2013
  • What has been achieved in HIV prevention, treatment and care for people who inject drugs, 2010–2012? A review of the six highest burden countries – October 2013
  • Syringe access, syringe sharing, and police encounters among people who inject drugs in New York City: A community-level perspective – August 2013
  • “I felt like a superhero”: The experience of responding to drug overdose among individuals trained in overdose prevention – August 2013
  • Brief overdose education can significantly increase accurate recognition of opioid overdose among heroin users – June 2013
  • Does informing people who inject drugs of their hepatitis C status influence their injecting behaviour? Analysis of the Networks II study – December 2013

Source: International Journal of Drug Policy – January 2014

Proportion of Opioid Treatment Programs Offering On-Site Testing For HIV and STIs Declines

technology“A survey of opioid treatment programs finds that the proportion offering on-site testing for human immunodeficiency virus (HIV) and sexually transmitted infections (STIs) declined substantially between 2000 and 2011, despite guidelines recommending routine opt-out HIV testing in all health care settings, according to a study appearing in the December 25 issue of the Journal of the American Medical Association (JAMA).

From 2000 to 2011, the absolute number of programs offering testing for HIV, STIs, and the Hepatitis C virus (HCV) increased but the percentage offering on-site testing for HIV declined by 18 percent and for STIs by 13 percent. There was no change for HCV testing. More than 75 percent of public programs offered on-site testing for each infection, with no change over time.

Declines were most pronounced in for-profit programs.”

Source: – December 24, 2013

Barriers to HCV Care Include Lack of Physical Symptoms, Treatment Side Effects

“Barriers to hepatitis C care for patients enrolled in opioid substitution treatment included the perception of being physically well and concerns about adverse effects associated with interferon-based hepatitis C virus treatment, according to results from the ETHOS study.

“Integrating treatment for hepatitis C within settings that provide treatment for drug dependence minimizes some of the barriers for clients wishing to undertake hepatitis C treatment,” study researcher Carla Treloar, PhD, deputy director of the Centre for Social Research in Health at the University of New South Wales, Australia, told Infectious Disease News. “However, treatment remains an unattractive option for some patients. Providing ways for those without hepatitis C symptoms to be assessed for liver damage may be important to open up alternative conversations about hepatitis C care.”

Source: – December 11, 2013

New Resources Available From SAMHSA

Based on TIP 53: Addressing Viral Hepatitis in People with Substance Use Disorders – A Quick Guide for Clinicians and Administrators

Offers clinicians information to address viral hepatitis when working with people with substance use disorders. Covers hepatitis prevention, screening, treatment, and service coordination, and guides administrators on how to add or improve hepatitis services.

Based on TIP 54: Managing Chronic Pain in Adults With or in Recovery from Substance Use Disorders – A Quick Guide for Clinicians and Administrators

Summarizes guidelines for clinicians treating chronic pain in adults with a history of substance abuse. Covers patient assessment, chronic pain management, managing addiction risk in patients treated with opioids, and patient education.

Source: Substance Abuse Mental Health Services Administration – November 2013

Hepatitis C, a Silent Killer, Meets Its Match

“Medicine may be on the brink of an enormous public health achievement: turning the tide against hepatitis C, a silent plague that kills more Americans annually than AIDS and is the leading cause of liver transplants. If the effort succeeds, it will be an unusual conquest of a viral epidemic without using a vaccine.

“There is no doubt we are on the verge of wiping out hepatitis C,” said Dr. Mitchell L. Shiffman, the director of the Bon Secours Liver Institute of Virginia and a consultant to many drug companies.

Over the next three years, starting within the next few weeks, new drugs are expected to come to market that will cure most patients with the virus, in some cases with a once-a-day pill taken for as little as eight weeks, and with only minimal side effects.

That would be a vast improvement over current therapies, which cure about 70 percent of newly treated patients but require six to 12 months of injections that can bring horrible side effects.”

Source: – November 4, 2013

Studies – Advance Knowledge of HIV Impact on Hepatitis C Infection and Genes That May Thwart HCV

Infectious disease experts at Johns Hopkins have found that among people infected with the hepatitis C virus (HCV), co-infection with HIV, speeds damage and scarring of liver tissue by almost a decade.

In a second study of HCV infection, the Johns Hopkins research team participated in the discovery of two genetic mutations that make it more likely that patients’ immune systems can rid the body of HCV. Both studies are described in articles published online in February ahead of print in the journal Annals of Internal Medicine.

“Our latest study results suggest that HIV might promote aging and disease progression in people with HCV,” says infectious disease specialist and senior investigator, David L. Thomas, M.D., M.P.H. Thomas, who is the Stanhope Bayne-Jones Professor and director of infectious diseases at the Johns Hopkins University School of Medicine and a professor at the university’s Bloomberg School of Public Health, says that among 1,176 study participants, those co-infected with HCV and HIV showed the same severity of liver fibrosis and cirrhosis as those who were infected only with HCV but were 9.2 years older. All study participants were current and former intravenous drug users from Baltimore whose health and disease progression were being monitored with bi-monthly check-ups and liver tissue samples taken from 2006 to 2011.

The United States Centers for Disease Control and Prevention estimates that a quarter of the 3.2 million Americans chronically infected with HCV are also infected with HIV.

Thomas says the findings may help physicians predict the people who are most likely to self-recover from exposure to HCV, and those who will most likely require aggressive treatment right away.

The press release can be accessed at:

Free access to the articles is available for a limited time at:

Source: – John Hopkins Medicine – March 4, 2013

Patient Dilemma: Treat Hepatitis C Now or Hold Out?

“Being diagnosed with a potentially fatal disease usually triggers immediate treatment. But a growing number of people infected with hepatitis C are putting off therapy, choosing instead to roll the dice and wait for a new generation of drugs to become available.

The new drugs, which could begin hitting pharmacies in a year or two, promise to cure hepatitis C more effectively and with far fewer harsh side effects than the current regimen of medications. The disease, which attacks the liver, often progresses slowly, giving certain patients leeway in when to seek treatment. And doctors regularly monitor these patients to check if the disease has significantly worsened. Up to four million Americans are estimated to be infected with the hepatitis C virus.”

Source: – – March 4, 2013

Target ‘Super-spreaders’ to Stop Hepatitis C

Each intravenous drug user contracting Hepatitis C is likely to infect around 20 other people with the virus, half of these transmissions occurring in the first two years after the user is first infected, a new study estimates.

The work, led by researchers from Oxford University, suggests that early diagnosis and treatment of Hepatitis C in intravenous drug users could prevent many transmissions by limiting the impact of these ‘super-spreaders’ (a highly infectious person who spreads a disease to many other people).

Working out ‘who has infected who’ in fast-spreading diseases such as influenza is often relatively straightforward, but in slow-spreading diseases such as Hepatitis C and HIV, where instances of transmission are spread over months or years, it is extremely difficult. The new approach, developed by a team from Oxford University, University of Athens and Imperial College London, combines epidemiological surveillance and molecular data to describe in detail, for the first time, how Hepatitis C spreads in a population.

Source: University of Oxford – February 1, 2013

Research: Availability of Viral Hepatitis Services in U.S. Drug Treatment Programs

The prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) is disproportionately high among individuals in U.S. drug treatment programs. Therefore, such programs are ideal settings for the provision of services targeting viral hepatitis, including screening, education, vaccine prevention, and treatment. This National Institute of Drug Abuse Clinical Trials Network (NIDA-CTN) study assessed the availability and comprehensiveness of viral hepatitis services within US drug treatment programs. Administrators from 319 drug treatment programs within the NIDA-CTN were invited to participate via survey, and 84% responded. Data were compared between programs that provided methadone (n=89) and those that did not (n=180). Most programs were private, not-for-profit, free-standing facilities but varied in most other aspects (e.g., geographic location, program size, and medical versus nonmedical staffing).

Testing for HCV-antibody was performed in 28% of programs and was more likely to be offered at methadone programs (55%) compared with programs that did not provide methadone (15%).

Vaccination for hepatitis A virus and HBV were offered either on-site or through contractual agreement with another provider in 68% of programs.

For all substance abuse treatment programs, HCV-related treatment was provided either on-site or through contractual agreement at 29% of programs and was more common in programs providing methadone than in programs that did not provide methadone (48% versus 22%, respectively). Fifteen percent of programs offered on-site HCV treatment, 3.5% offered treatment through contractual agreement with another provider, 67% referred patients to a community resource, and 15% did not offer treatment at all.

Comments: Less than one-third of drug treatment facilities offered HCV-antibody testing or HCV treatment either on-site or through contractual agreement with another provider. Programs that provided methadone were more likely to provide these services than programs that did not provide methadone. These data are likely biased in that they reflect programs enrolled in the NIDA-CTN, a group of programs that may be more likely to provide such services, and are limited by their self-report nature. The findings suggest a need to improve access to HBV and HCV screening and treatment at drug treatment programs to address this public health agenda.

Source: Alcohol, Other Drugs, and Health: Current Evidence – May/June 2012, Jeanette M. Tetrault, MD

Original Source: Bini EJ, Kritz S, Brown LS Jr, et al. Hepatitis B virus and hepatitis C virus services offered by substance abuse treatment programs in the United States. J Subst Abuse Treat. 2012;42(4):438–445.

Hepatitis C Lurks Inside Baby Boomers

The Centers for Disease Control and Prevention recently issued draft guidelines that all U.S. baby boomers should get a one-time hepatitis C test. More than 2 million U.S. baby boomers are infected with hepatitis C, many of whom don’t know they have it.

The CDC predicts that testing all baby boomers could identify more than 800,000 new cases and save more than 120,000 lives. Current CDC guidelines only call for testing of baby boomers that have known risk factors for infection, however, studies have shown that many baby boomers don’t perceive themselves to be at high risk for infection.

Source: – May 23, 2012

AATOD Conference a Resounding Success

More than 1,350 people attended the American Association for the Treatment of Opioid Dependence (AATOD) meeting held in Las Vegas April 21-25 at the Venetian/Palazzo Hotel. Among the more than 60 attendees from other countries was a large delegation from Vietnam, reporting on that nation’s successful expansion of methadone treatment.

Under the theme “Recovery for Patients, Families, and Communities,” the conference was co-hosted by the Substance Abuse Prevention and Treatment Agency (SAPTA) of the Nevada Department of Health and Human Services/Division of Mental Health and Developmental Services.

Plenary Highlights

The conference opened with Gov. Brian Sandoval endorsing the work of Nevada’s opioid treatment programs (OTPs).  The governor remained to listen to Deborah A. McBride, MBA, SAPTA director, make her opening remarks. There are 11 OTPs in Nevada, and Ms. McBride expressed unwavering support for their valuable contribution in the wake of epidemic prescription-drug abuse in Nevada. AATOD president Mark Parrino, MPA, reported on AATOD’s national work. Gilberto Gerra, MD, director of the Drug Prevention and Health Branch of the United Nations Office on Drugs and Crime, Vienna, Austria, emphasized the international need for medication-assisted treatment (MAT). 

The second plenary session, dedicated to Lisa Mojer-Torres, lawyer, methadone patient, and tireless advocate, who died last year, focused on methadone as a valid pathway to recovery. The session was led by Carol McDaid, co-founder and principal of Capitol Decisions, and William L. White, MA, senior research consultant, Chestnut Health Systems, both in recovery themselves.

“The whole issue of methadone as part of recovery is critical,” remarked Mr. Parrino, noting the negative attitude in many states among legislators and judges who simply don’t think methadone maintenance treatment constitutes recovery.

Timothy P. Condon, PhD, visiting research professor at the Center for Alcoholism, Substance Abuse, and Addictions at the University of New Mexico, did an excellent job of highlighting the science and policy aspects of MAT during the closing plenary. There was also a presentation on MAT as part of health care reform, provided by Paul Samuels of the Legal Action Center.

And during the closing plenary, Justice Michael Cherry, now Chief Justice of the Nevada Supreme Court, expressed strong support for methadone and buprenorphine in the courts and criminal justice system. It is rare to have the highest judge in the state participate throughout an entire AATOD conference, said Mr. Parrino.

Hot Topics

Buprenorphine and Federal Register Notice

Nicholas Reuter, senior public health advisor with the division of pharmacologic therapies at the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA), talked with AT Forum about hot topics at the conference, including the pending Federal Register notice allowing OTPs to dispense buprenorphine.

Mr. Reuter said the final rule is now in the Office of Management and Budget (OMB) regulatory review process, where it has been since March 8. The final rule will allow OTPs to prescribe buprenorphine under the same rules as DATA 2000-waived physicians, with some additional requirements.  Now, OTPs can dispense buprenorphine only with the same take-home and treatment rules that apply to methadone in 42 CFR Part 8.

This final rule has taken years to reach this point. The approval may be slowed by the interagency review, speculated Mr. Parrino, with one or two agencies expressing concern about diversion. Ironically, when the proposed rule was first published three years ago, comments expressed concern about OTPs causing buprenorphine diversion. Diversion of buprenorphine is now a major issue, without the final rule. Many OTPs feel that is due to the lack of counseling and other services in the office-based system.

Hepatitis C—A SAMHSA Priority

Robert Lubran, director of the division of pharmacologic therapies at CSAT, talked about the public health implications of hepatitis C virus (HCV) in the U.S., noting that SAMHSA will shift emphasis to screening and treatment for HCV. (See related article in this issue.)

Mr. Reuter added that CSAT has had a focus on HCV at many AATOD conferences: “We emphasize screening and treatment. This is the same situation we had with HIV,” he said. Programs are concerned that if widespread testing is undertaken, funds for treatment must be available.  Most states cover the medical treatment for HCV, but stigma against opioid dependence and OTP patients makes it harder for them to access care.  Mr. Parrino added that AATOD has trained over 700 clinical staff in hepatitis C testing and counseling, but few programs offer on-site treatment.

Methadone Mortality Form Becomes Optional

Surprising AATOD, CSAT announced the suspension of their methadone mortality form, introduced only about three years ago.  CSAT will do a “more formal information collection and analysis,” Mr. Lubran told the AATOD Board. “Instead of a voluntary form, we thought we would work with our colleagues in the Center for Behavioral Health Statistics and Quality to do something more official,” he said. “Right now we’re trying to come up with the best analytic procedure, and pursue a pilot. The idea is to do this in a way that is consistent.”  A Dear Colleague letter to the field about the change is dated April 3, but Mr. Parrino wasn’t given it until April 30. (For a copy of the letter, go to

Benzodiazepine Use in OTP Patients

The use of benzodiazepines in OTP patients was again a hot topic. Ron Jackson, MSW, LICSW, conducted an excellent, well-attended roundtable discussion about how to handle benzodiazepine use in OTP patients. The long-awaited benzodiazepine guidelines are expected to be part of a set of guidelines that cover the use of many different psychoactive substances in an OTP, instead of just benzodiazepines, Mr. Reuter said after the meeting. “We decided to broaden it, to talk about psychoactive medications in general,” confirmed Mr. Parrino. “But it’s really about benzodiazepines.” (See related article in this issue.)

Awards Banquet

Beny J. Primm, MD, executive director, Addiction Research and Treatment Corporation, presented the Nyswander/Dole “Marie” Awards to nine recipients.

Joseph V. Brady, PhD, Maryland

Otto C. Feliu, MS, New York

Hilary Jacobs, MSW, Massachusetts

Edward J. Johnson, MA, South Carolina

Barbara Schlichting, LCSW, New Jersey

Stacy Seikel, MD, Florida

Steve Tapscott, MA, Texas

Stephan Walcher, MD, Germany

William C. Wilson, California

Banquet honorees also included William L. White, MA, who received the prestigious Friend of the Field Award, and Roxanne Baker, CMA, recipient of the Richard Lane/Robert Holden Patient Advocacy Award for her work on behalf of methadone and recovery.

The next AATOD National Conference will convene in November 2013 in Philadelphia.

Hepatitis C: Good News—and Challenges

“Twelve weeks into treatment they checked my viral count and it was undetectable. I knew I was going to make it through this.” 

— a patient, quoted in Tip 53: Addressing Viral Hepatitis in People With Substance Use Disorders

Tip 53—the new publication from the Substance Abuse and Mental Health Services Administration (SAMHSA)—is full of great information about hepatitis C virus (HCV)—the new rapid diagnostic test, the two new drugs that have advanced the treatment of HCV infection, and everything staffers and patients at opioid treatment programs (OTPs) need to know. (See Resources to find out about a free download or paper copy.)

Why Hepatitis C Is So Important to OTPs

The prevalence of HCV infections in the U.S. is about 3 million to more than 5 million, and at least half are related to injection drug use. Because HCV afflicts between 67 percent and 96 percent of methadone patients, those who aren’t infected need to know how to prevent it, and those who already have it need to know about tests and treatment options, and how to avoid spreading the infection.

Hepatitis C begins as a silent disease. It goes away in about 15 percent to 25 percent of people; otherwise it can persist for decades, without symptoms, until there is severe liver damage that can lead to liver failure or cancer, a liver transplant, or death.

A New Test and New Treatment Options

The new 20-minute screening test can detect HCV antibodies in a blood sample while the patient is waiting. If a patient tests positive on screening and follow-up testing, further workup entails finding out which of six types of HCV—called genotypes—the patient has. Most methadone patients have genotype 1. Workup could also include a liver panel, other blood tests, a viral load test to determine the amount of virus present, and maybe a liver biopsy.

If a caregiver and patient decide treatment is best, two newly approved oral drugs greatly improve the odds for those with genotype 1: telaprevir (Incivek) or boceprevir (Victrelis). When either—never both—is added to the current two-drug therapy—weekly peg-interferon injections, plus daily oral ribavirin, 68 percent to 80 percent of patients respond, vs. 40 percent to 55 percent that responded to the previous two-drug therapy. Treatment time for many patients has been cut in half, to about six months. (The methadone dose may need to be modified, because of interactions with the new drugs.) Patients with genotype 2 or 3 tend to respond well to the earlier two-drug treatment.

When the virus can no longer be detected in the blood for six months, the patient is said to have a “sustained viral response”—an SVR. The virus doesn’t return in up to 99 percent of patients, but reinfection can occur, so preventive steps are important.

In another few years, a new two-drug oral therapy (without peg-interferon injections) may be available. Many oral drugs are in clinical trials, and a regimen now in experimental use in humans has achieved very high cure rates. By then, a hepatitis C vaccine may even be on the horizon.

What OTP Patients Can Do

HCV is highly contagious—much more so than HIV. But it’s a blood-borne disease, rarely spread through sexual contact. Patients need to avoid contact with blood that has been contaminated with the virus. This means not sharing injection needles, or rinse water, even a razor or toothbrush that may harbor invisible traces of blood.

Also, OTP patients should get vaccinated against hepatitis A and B, to help shield the liver from damage caused by those viruses. A damaged liver is less able to withstand hepatitis C infection. OTPs may have these vaccines, or can refer patients elsewhere.

Also important is avoiding alcohol, for it contributes to and often speeds liver damage in people with hepatitis. The same is true of acetaminophen and other drugs that can damage the liver.

Patients’ Views

Focus groups of OTP patients interviewed in Beyond Methadone (see Resources) called for at least one onsite OTP specialist for hepatitis C—but that’s a difficult goal for a small OTP, and trained staff can fill many roles. The survey noted that about one-fourth of OTP patients didn’t know their HCV status, and didn’t recall ever being offered a test. The survey also found that more than half who tested positive said they weren’t referred for follow-up tests or medical care, nor were they aware of any support groups or educational materials at their program. Based on these focus findings, OTPs can provide more HCV education, testing, support, and treatment, either onsite or by referral. 

How OTP Staff Can Help

OTPs are being called upon to help patients deal with a deadly illness. According to the Centers for Disease Control and Prevention (CDC), more people in the U.S. now die each year from hepatitis C than from AIDS—almost 5 per 100,000 from hepatitis C, vs. about 4 per 100,000 from AIDS. Clearly, early diagnosis, treatment, and support services would save much suffering and many lives. This is a great opportunity for OTPs to make a difference in the lives of their patients.

VOCAL-NY and other patient advocacy groups have long urged OTPs to provide better intervention and care for patients with HCV.  Many OTPs—67 percent, according to the National Survey of Substance Abuse Treatment Services—already test patients for HCV infection, and that’s very encouraging, but it leaves a sizeable percentage untested, therefore untreated. Some OTPs that test haven’t the resources to provide follow-up care for patients who test positive—additional tests, education, counseling, and medical care. Those OTPs will need a strong referral system to send patients elsewhere, and to make sure they follow up.

Sometimes the side effects of HCV therapy may feel similar to withdrawal symptoms. Staff can encourage peers and patients in treatment to share experiences, support each other, and help each other access care and adhere to treatment.

Many OTPs offer testing only, but staff can still help immensely by being supportive of patients and providing information about HCV in a nonjudgmental, compassionate way, referring patients to outside sources, and making sure they follow up. VOCAL-NY recommends that OTPs with limited services “establish a concrete referral system for HCV patients, and enter into memoranda of understanding (MOUs) with medical providers for follow-up care.”

Among the many wonderful resources for OTP staff in Tip 53 are leads for patients seeking financial help. Treating hepatitis C is costly and can take many months. Yearly medical expenses can easily top $60,000—and that’s before a liver transplant, which can add $100,000 to $250,000 for the procedure alone.

Hepatitis is inflammation of the liver. It can be caused by viruses, substance or alcohol use, certain diseases, or exposure to toxins. The term viral hepatitis refers to liver inflammation caused by any of several viruses; A, B, and C are the most common in the U.S. Acute hepatitis lasts six months. If acute hepatitis doesn’t go away—through treatment, or on its own—it becomes chronic hepatitis, and can last indefinitely, whether treated or not.


Substance Abuse and Mental Health Services Administration. Addressing Viral Hepatitis in People With Substance Use Disorders. Treatment Improvement Protocol (TIP) Series 53. HHS Publication No. (SMA)11-4546. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2011.

Beyond Methadone: Improving Health and Empowering Patients in Opioid Treatment Programs. VOCAL-NY and Community Development Project of the Urban Justice Center (CDP). ebook. By Alexa Kasdan, Phil Marotta, Alison Hamburg, VOCAL New York; and the Urban Justice Center. Brooklyn, NY. VOCAL New York, New York, N.Y. October 6, 2011.


HCV Vaccine Possibly Within Reach

Researchers have identified a possible new target for the development of a vaccine against the hepatitis C virus (HCV).

Such a vaccine — which could help control the growing global problem of HCV infection – has been difficult to come by because the virus’s constant mutations have thwarted previous attempts to attack it.

Link to article abstract:

Source: – April 6, 2012

Q&A: What You Need to Know About Hepatitis C – Hepatitis C Kills More Americans Than HIV. How Does the Virus Spread?

The Centers for Disease Control and Prevention (CDC) reported I February that the hepatitis C virus (HCV) now kills more Americans annually than HIV, the virus that causes AIDS. Most of the deaths occur in middle-aged adults — 3% of baby boomers are infected — and about half of people infected don’t know they have the virus.

Healthland spoke with Dr. John Ward, who heads the CDC’s effort to fight hepatitis C, about who is at risk of infection, how the disease is really spread and why it’s important to know your hepatitis C status now.

Source: – February 23, 2012

SAMHSA Issues New Treatment Improvement Protocols (TIPS) on Hepatitis and Chronic Pain

TIP 53: Addressing Viral Hepatitis in People with Substance Use Disorders

This TIP was developed to assist behavioral health professionals who treat people with substance abuse problems in understanding the implications of a diagnosis of hepatitis. The TIP discusses screening, diagnosis, and referrals and explains how to evaluate a program’s hepatitis practices.

TIP 54: Managing Chronic Pain in Adults With or in Recovery From Substance Use Disorders

TIP 54 was developed to help equips clinicians with practical guidance and tools for treating chronic pain in adults with a history of substance abuse. The document discusses chronic pain management, including treatment with opioids, and offers information about substance abuse assessments and referrals.

Source: The Substance Abuse and Mental Health Services Administration – December 2011 & January 2012

Hepatitis C Deaths Up, Baby Boomers Most At Risk

Deaths from liver-destroying hepatitis C are on the rise, and new data shows baby boomers especially should take heed – they are most at risk.

Federal health officials are considering whether anyone born between 1945 and 1965 should get a one-time blood test to check if their livers harbor this ticking time bomb. The reason: Two-thirds of people with hepatitis C are in this age group, most unaware that a virus that takes a few decades to do its damage has festered since their younger days.

Source: – February 21, 2012

People on Methadone Can Succeed on Hepatitis C Treatment

Opiate users on methadone maintenance therapy can be successfully treated for chronic hepatitis C and can achieve outcomes similar to those of people not on methadone, according to data presented at the 13th European AIDS Conference in Belgrade.

Shared use of injection drug equipment is a major risk factor for both HIV and hepatitis C virus (HCV) infection; an estimated 30% of people with HIV also have hepatitis C. But some clinicians have been reluctant to treat active or former drug users for hepatitis C, largely due to concern about suboptimal adherence and poor outcomes.

Karin Neukam from Hospital Universitario de Valme in Seville, Spain, and colleagues compared treatment response amongst 214 hepatitis C patients – a majority of them injection drug users – who started treatment with pegylated interferon plus ribavirin between January 2003 and May 2010. Just over one-third of participants (38%) were on methadone maintenance while 62% were not.

Most participants were men (88% in the methadone group, 77% in the non-methadone group) and the average age was about 42 years. About 25% in both arms were HIV-positive. Methadone recipients were slightly less likely to have the favorable IL28B “CC” gene pattern and more likely to have liver cirrhosis, but were significantly less likely to have hard-to-treat hepatitis C genotypes 1 or 4.

Almost all participants in both study groups reported 80% or better adherence to hepatitis C therapy. Rates of sustained virological response (SVR) – or continued undetectable HCV viral load 24 weeks after completion of treatment – were similar in the methadone and non-methadone groups.

“The efficacy of HCV therapy in methadone maintenance therapy patients is similar to that found in subjects not taking methadone,” the researchers concluded. “Methadone maintenance therapy patients should be equally considered for treatment with pegylated interferon plus ribavirin.”

These findings indicate that methadone maintenance should not be considered a contraindication to hepatitis C treatment.

Original Source: Neukam K et al. Methadone maintenance therapy does not influence on the outcome of chronic hepatitis C treatment with pegylated interferon and ribavirin. 13th European AIDS Conference, PS7/5, Belgrade, 2011.

Source: NAM AidsMap – October 18, 2011

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