Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws

“Opioid overdose is typically reversible through the timely administration of the drug naloxone and the provision of emergency care. However, access to naloxone and other emergency treatment is often limited by laws and that pre-date the overdose epidemic. In an attempt to reverse this unprecedented increase in preventable overdose deaths, a number of states have recently amended those laws to increase access to emergency care and treatment for opiate overdose.”

The Network for Public Health Law has published an update on access to naloxone by state and Good Samaritan laws.

http://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf

Source: Network for Public Health Law – May, 2013

How to Make Drug Courts Work

Pg8_law“Drug courts have made a surprisingly small contribution to the crime reduction that has occurred over the past twenty years. They process only a small fraction of drug-involved offenders within the criminal justice system, and an even smaller fraction of offenders who commit serious crimes. Most chronic cocaine, heroin and methamphetamine users who reach court will end up in jail or prison, often for minor crimes.

Drug courts could be more helpful in reducing crime and incarceration, but only if they become more ambitious and less risk-averse by taking in populations likely to serve real time.”

http://www.washingtonpost.com/blogs/wonkblog/wp/2013/04/26/how-to-make-drug-courts-work/

Source: WashingtonPost.com – April 26, 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:
http://www.eurekalert.org/pub_releases/2013-03/jhm-sak030413.php

Free access to the articles is available for a limited time at: http://annals.org/onlineFirst.aspx

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.”

http://online.wsj.com/article/SB10001424127887323293704578330712442353712.html

Source: – WallStreetJournal.com – 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.

http://www.ox.ac.uk/media/news_stories/2013/130201.html

Source: University of Oxford – February 1, 2013

The December 2012 issue of Heroin Addiction and Related Clinical Problems is Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. Articles in this issue include:

  • Quality of Care Provided to Patients Receiving Opioid Maintenance Treatment in Europe: Results from the EQUATOR analysis
  • Outcomes of opioid-dependence treatment across Europe: identifying opportunities for improvement
  • Assessing the current state of public-health-related outcomes in opioid dependence across Europe: data from the EQUATOR analysis
  • Barriers to treatment access and informed patient choice in the treatment of opioid
    dependence in Europe
  • Aggressive behaviour and heroin addiction
  • Post-traumatic stress spectrum and maladaptive behaviour (drug abuse included) after catastrophic events: L’Aquila 2009 earthquake as case study

The PDF file is available for download at: http://atforum.com/documents/HeroinDecember2012.pdf

Hearing Bad Things about Methadone Treatment? Thank “Dr. Drew”

Why is it that most opioid-dependent patients aren’t enrolled in medication-assisted treatment (MAT), despite its proven effectiveness?

One reason is the link between so-called reality television and negative perceptions about methadone and buprenorphine. That’s the thinking of the authors of “Messages About Methadone and Buprenorphine in Reality Television: A Content Analysis of Celebrity Rehab with Dr. Drew.” Published online in Substance Use & Misuse, January 8, 2012, the article analyzes all episodes in the first four seasons of Celebrity Rehab with Dr. Drew.

First aired in January 2008, the show features Dr. Drew’s interactions with celebrities being treated at the Pasadena Recovery Center, a residential facility in California. One wonders what motivates patients to go “on camera”—such as the woman who allowed her withdrawal convulsions to be shown to hundreds of thousands of viewers.

Linking reality TV and attitudes toward MAT seems logical. TV exposes us to nuances—tone of voice, facial expression. When a fatherly “Dr. Drew” softly confides, “methadone just takes your soul away. It’s no way to live,” people listen intently, and many take it to heart.

Study Design

Researchers analyzed the quantity and slant of the show’s messages about treating opioid dependence with methadone and buprenorphine. They watched all 39 episodes of the first four seasons of Celebrity Rehab with Dr. Drew, and coded the data using scientifically accepted methods.

Results

Of the 33 patients portrayed, 13—about 40 percent—were using or had used opioids. Of these, 4—about 30 percent—used methadone or buprenorphine.

The two main messages: methadone and buprenorphine are primarily drugs of abuse, and are not acceptable treatment options.

References to Methadone and Buprenorphine

 
Methadone
Buprenorphine
Times referred to
20
8
As a drug of abuse
17 (85)*
7 (87.5)
Rejected as a treatment option
13 (15)
1
Endorsed as treatment option for opioid dependence
0
0
*times (%)
   

 
Mentions of methadone and buprenorphine in Dr. Drew’s show “highlighted harmful effects and focused on how and why patients should stop using them,” the authors found.

For example, Dr. Drew advised a patient trying to cope with opioid withdrawal symptoms that methadone can create another addiction. Thus he “reaffirmed a negative perception that has been cited as a reason for forgoing enrollment in medication-assisted treatment,” the authors noted. Dr. Drew also said some patients develop severe methadone withdrawal that “leads to medical and psychiatric complications that require hospitalizations.”

Authors’ Comments

The authors found that Celebrity Rehab with Dr. Drew reinforces negative stereotypes, presents misinformation, may perpetuate existing stigma toward addiction and its treatment, and undercuts support for its expansion.

Roose R, Fuentes L, Cheema M. Messages about methadone and buprenorphine in reality television: A content analysis of celebrity rehab with Dr. Drew [published online ahead of print, 2012]. Substance Use & Misuse. doi: 10.3109/10826084.2012.680172.

http://www.vh1.com/search/?q=dr+drew

________________________________________________________________

AT Forum Opinion: What’s Behind Dr. Drew’s Attitude

What’s behind Dr. Drew’s attitude? Surfing the Web and watching him in action provides clues. The folksy “Dr. Drew” (“Dr. Drew Pinsky”) is at times a showman, at times a controlling father-figure, and at times seemingly a friend—but always an authority who is not to be questioned.

Dr. Drew is fully credentialed: board-certified by the American Board of Internal Medicine and American Board of Addiction Medicine, licensed private practitioner, assistant clinical professor of psychiatry at the University of Southern California.

In his 2009 book, The Mirror Effect, Dr. Drew admits that he has some traits of a “closet narcissist,” having scored a 16 on the Narcissistic Personality Inventory. He has been a TV series actor. Has starred on several reality shows, including Sex . . . With Mom and Dad. The New York Times has described Dr. Drew’s combined career in medicine and mass media as requiring him to navigate “a precarious balance of professionalism and salaciousness.” In a 2009 interview, the Times questioned Dr. Drew about his practice of paying addicts to attend rehab—asking if luring cast members with promises of money and exposure didn’t cast doubt on their commitment to sobriety. “My whole thing is bait and switch,” Dr. Drew explained. “Whatever motivates them to come in, that’s fine. Then we can get them involved with the process.”

But where are the data for his methods? Dr. Drew doesn’t cite any studies in the huge body of evidence matching patients with treatment. Nor does he mention the ASAM criteria, which list methadone and buprenorphine as treatments of choice for opioid addiction.

There’s a big difference between obtaining exposure and publicity, and providing treatment for substance use disorders. We shouldn’t confuse them, as Dr. Drew does—buying exposure in the guise of treatment.

If there’s a place for the methods and opinions of the Dr. Drews of this world, it’s not in the realm of evidence-based addiction medicine.

September 2012 Issue of Heroin Addiction and Related Clinical Problems is Now Available Online

Heroin Addiction and Related Clinical Problems, the official journal of EUROPAD (European Opiate Addiction Treatment Association), is a peer-reviewed publication for professionals wanting to stay informed of research and opinion on opioid misuse treatment in Europe and around the world. A particular emphasis is on medication-assisted treatments for opioid addiction. Articles in this issue include:

  •  Assessing the current state of opioid-dependence treatment across Europe: methodology of the European Quality Audit of Opioid Treatment (EQUATOR) project
  • Is substance use disorder with comorbid adult attention deficit hyperactivity disorder and bipolar disorder a distinct clinical phenotype?
  • Economic evaluation of opioid substitution treatment in Greece
  •  The journey into injecting heroin use
  • Cognitive behavioural coping skills therapy in cocaine using methadone maintained patients: a pilot randomised controlled trial

The September issue can be accessed at: Heroin Addiction and Related Clinical Problems September 2012 (2.12 MB, 116pp)

New Report: The U.S. Drug Policy Landscape Insights and Opportunities for Improving the View

This new report from RAND Corporation provides a nonpartisan primer that should be of interest to those who are new to the field of drug policy, as well as those who have been working in the trenches. It begins with an overview of problems and policies related to illegal drugs in the United States, including the nonmedical use of prescription drugs. It then discusses the efficacy of U.S. drug policies and programs, including long-standing issues that deserve additional attention. Next, the paper lists the major funders of research and analysis in the area and describes their priorities. By highlighting the issues that receive most of the funding, this discussion identifies where gaps remain.

The press release can be accessed at: http://www.rand.org/news/press/2012/09/18.html

The report can be accessed at: http://www.rand.org/pubs/occasional_papers/OP393.html

Source: RAND Corporation – September 18, 2012

U.S. Health Panel Likely to Make HIV Tests Routine

Reuters reported on August 19 that the United States Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

http://www.reuters.com/article/2012/08/19/us-usa-health-hiv-idUSBRE87I04J20120819

Source: Reuters.com – August 19, 2012

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.

Injecting Someone Who ODs Called a Homicide in Maryland

There’s a difference between a drug overdose and a homicide, even if the drug was heroin and the person who died was injected by a friend. At least, that is the view of Maryland’s chief medical examiner, David R. Fowler, MD, as reported in The Baltimore Sun this spring. But now, Dr. Fowler has done just that: declared a homicide in which a person was injected by someone—a friend, as it turned out—and then died. Amber Brown and her girlfriend drank alcohol and injected each other with heroin in Baltimore one night. Amber Brown fell asleep and didn’t wake up.

Typically, Dr. Fowler calls the hundreds of drug overdoses that occur in his state each year “undetermined,” because he doesn’t believe in labeling a death a homicide—or labeling it with any cause at all—unless there is evidence, notably from witnesses.

In fact, using toxicology records alone to determine cause of death is not scientifically accurate. Someone who is opioid tolerant, for example, might have a high level in the body—enough to kill an opioid-naïve user—but may have died of something else. That’s why chief medical examiners look for other signs related to the death. Was the deceased jogging at the time, and fell over clutching the chest? Perhaps the death was a heart attack. In fact, Ms. Brown had complained of chest pains before she and her friend took alcohol and heroin, according to The Baltimore Sun.

Assuming that drugs caused a death is difficult enough—not to mention assuming that someone else was responsible for administering the drugs.

A few years ago the Substance Abuse and Mental Health Services Administration (SAMHSA) was obsessed with the idea that methadone overdoses were related to methadone diverted from opioid treatment programs. Finally, when all the data were in, the truth was clear: the methadone that was responsible for overdoses was coming from pain prescriptions—and in many cases, the person taking the methadone was opioid naïve, or actually taking it for pain, but unaware that the medication has a very long half-life (is eliminated from the body very slowly, thus additional doses can build up to dangerous levels). Not getting high or feeling pain relief immediately, a person may take another pill.

And in what was a very sad series of unintended consequences over the course of a decade, it was the crackdown on oxycodone (OxyContin), combined with the low cost of methadone, that led to an increased use of methadone for pain, and in turn the entire prescription opioid abuse and overdose crisis has wound up with a crackdown on pain prescribing altogether. Some people who legitimately need pain prescriptions are being denied them, as physicians, wary of being investigated, cut down on their prescribing. At the same time, people who are addicted will need someplace to go for treatment, or will find some other way to avoid withdrawal. They may buy buprenorphine on the street—that buprenorphine/naloxone (Suboxone) is being diverted is already well known—or they may just turn to heroin. Will there be fewer overdoses, or more?

In the case of Amber Brown, whose family has not been located, the autopsy concluded the cause of death was heroin intoxication, and the reason it was easy to call her death a homicide was that the police knew someone else had injected her.

Whether or not there will be criminal charges against the friend, whose name has not been released by police, has not yet been decided. Maryland has one of the nation’s strongest substance abuse treatment programs, especially in medication-assisted treatment for opioid addiction, and there’s a movement in the state to have fewer “undetermined” drug overdose deaths and more identified causes and more people to blame. Kudos to Dr. Fowler for his adherence to medical evidence over the course of his 20 years as the state’s chief medical examiner. Let’s hope he can continue to stand firm as the calls for someone to blame—and punish—for overdoses inevitably mount.

War on Drugs Fuelling Spread of HIV, Report Concludes

The worldwide war on drugs has been a “remarkable failure,” only serving to drive the spread of HIV among drug users and their sexual partners, suggests a new report published by The Global Commission on Drug Policy.

According to the report, injection drug use now accounts for about one-third of new HIV infections outside sub-Saharan Africa. Tough drug law enforcement policies around the world are driving that spread in a number of ways, including:

  • Forcing drug users underground to avoid arrest, away from HIV testing and HIV prevention services
  • Spreading the HIV pandemic in prisons, where drug use in often rampant, by needlessly incarcerating non-violent drug offenders
  • Encouraging syringe sharing by restricting groups from offering sterile syringes to drug users
  • Wasting funding on ineffective drug law enforcement efforts instead of investing it in proven HIV prevention strategies.

http://www.ctvnews.ca/health/war-on-drugs-fuelling-spread-of-hiv-report-concludes-1.854231#axzz1z1Ctxfkq

Source: CTV News.com - June 26, 2012

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.

Resources

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.  http://store.samhsa.gov/shin/content//SMA11-4656/SMA11-4656.pdf

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. http://www.vocal-ny.org/wp-content/uploads/2011/10/Methadone-Report-Cover1.jpg

 

L.A. Moves the Needle – The City’s Early Action in AIDS/HIV Prevention by Providing a Needle Exchange Program Proved to be Prescient. Now is no Time to Back Off

In 1992 in Los Angeles, where needle exchanges were already in effect, the rate of HIV among those who injected drugs was 8.4%. In 1993, the HIV rate in Miami for that population was the highest in the country: 48%. Although Miami put into place HIV-prevention programs, there has never been a large-scale needle exchange program there. Today the rate of HIV among injection drug users in Miami is 16%. In Los Angeles, the rate stayed low, and as of 2009, the most recent data available, it was 5%.

These facts have important consequences. Extrapolating from county data, it’s believed that about 34,000 Los Angeles residents are injection drug users. The California Department of Public Health calculates the lifetime costs of treating one person with HIV at $385,200. If those 34,000 Angelenos had an HIV rate of 16% rather than 5%, we’d be spending an additional $1.4 billion in treatment costs.

http://www.latimes.com/news/opinion/commentary/la-oe-scholar-hiv-needle-exchange-20120410,0,4371176.story

Source:  Los Angeles Times – April 10, 2012

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