Hep C World News - Week of May 12, 2024

Study finds big jump in addiction treatment at community health clinics

Portland, OR - The number of health care professionals able to write a prescription for a key medication to treat addiction quadrupled at community health clinics from 2016 to 2021, according to a new study by researchers at Oregon Health & Science University. The findings, published online today in the journal JAMA Health Forum, provides a glimmer of hope amid a national overdose epidemic that has claimed more than 100,000 lives in the United States in each of the past few years. The study examined community health centers serving low-income people primarily in West Coast states. Researchers found the number of health care professionals prescribing buprenorphine increased from 8.9% to 37.5% from 2016 to 2021—a substantial increase that researchers attribute to increased state and federal efforts to ease the ability of clinicians to prescribe medication to treat addiction. Buprenorphine, approved by the Food and Drug Administration in 2002, relieves withdrawal symptoms, cravings and pain. It normalizes brain function by acting on the same target in the brain as opioids or heroin. It's one of three medicines approved by the FDA for treatment of opioid dependence, along with methadone and naltrexone. "It's heartening," said lead author Daniel Hartung, Pharm.D., M.P.H., associate professor in the OHSU-Oregon State University College of Pharmacy. "Over a third of the providers in these community health centers are writing prescriptions for buprenorphine." Researchers examined data from 166 clinics in the network supported by Portland-based OCHIN, Inc. The study included more than 1,300 health care professionals that provided care for some 570,000 people in 2021. In clinics in rural areas, the proportion of health care professionals able to prescribe buprenorphine was even greater, growing from 20.3% to 52.7% in five years. "There's still a lot of work to be done," Hartung said. "But it's a step in the right direction when more providers have the capacity to write prescriptions to treat patients who want to be treated." In addition to Hartung, co-authors included Robert W. Voss, M.S., of OCHIN, Inc.; Steffani R. Bailey, Ph.D., and Nathalie Huguet, Ph.D., associate professors of family medicine in the OHSU School of Medicine; and John Muench, M.D., M.P.H., professor emeritus of family medicine in the OHSU School of Medicine. 

For more information: https://tinyurl.com/yey9arkn

Hep C World News - Week of May 5, 2024

The harm-reduction movement has lost sight of what truly matters

Vancouver, BC - Earlier this year the federal government delayed an extension of medical assistance in dying (MAID) to include those suffering solely from mental illness, which could have included people with substance use disorder. At the same time, British Columbia’s provincial officer of health called for the province’s “safe supply” program to be expanded. Both policies should be rejected outright, according to an opinion piece recently published in the National Post. Recovery from addiction is real, it works and it’s the only humane policy for people with a substance use disorder. Canada has fully embraced extreme harm reduction, a primarily activist-driven approach to drug policy that aims to promote “safe” or “regulated” drug use, rather than discouraging it and encouraging people to seek treatment. The harm-reduction only strategy includes policies that fully decriminalize drugs like fentanyl and meth and provides potentially deadly prescription drugs to users. Now, as the drug crisis has further spiraled out of control, some people want to double down on these policies, including decriminalization, expanding safe supply and allowing MAID for drug users. Harm-reduction advocates made inroads by arguing that individuals should be kept alive so that they can ultimately enter treatment and be given a second chance at life. Now, the movement has been hyper-extended to a grim point, where some seem to have given up on the prospect of a better tomorrow. Harm reduction is not inherently bad. For those on the far end of the use spectrum — the hard to reach, hard to engage with population — it can be a way to bring them into services and get them into recovery. Meeting people where they are at can be valuable to get them the help they need. But it is only one of many tools, reserved for those who really need it. Millions of people in recovery in North America are testament to the fact that treatment works, even if people take different paths to get there. Harm reduction should be just one part of a broader strategy to prevent drug use before it starts, treat substance use disorder, shut down open-air drug markets and increase international co-operation to reduce drug flows. The harm-reduction movement has drifted from its founding values and disregarded the lives of drug users. It is extremely discouraging to hear Dr. Bonnie Henry, B.C.’s provincial health officer, state that, “Abstinence … just doesn’t work for people who have a dependency on opioids.” This statement is unprecedented, wrong, and without scientific merit. Policymakers should learn from and celebrate the millions of individuals who have overcome their substance use disorders and achieved recovery. These individuals illustrate that recovery is possible and provide hope to those who are currently struggling with addiction. To get people into recovery, of course, we need more and better treatment options. That places like Vancouver’s Downtown Eastside have little quality treatment available — but plenty of cheap drugs — shows how far we have to go. Treatment varies from traditional 12-step programs to medication-assisted treatment, such as methadone and buprenorphine for opioid use disorder. 

For more information: https://tinyurl.com/2k99zmxf

Hep C World News - Week of April 28, 2024

Urgent action needed to achieve viral hepatitis elimination

Lisbon, Portugal - The headline figures from WHO's 2024 Global Hepatitis Report, released at the World Hepatitis Summit in Lisbon, Portugal, on April 9, make for stark reading. 1·3 million people died from viral hepatitis in 2022: the same number as killed by tuberculosis, second only to COVID-19 as the leading communicable cause of death, and an increase on the 2019 estimate of 1·1 million. There were 1·2 million new hepatitis B infections and almost 1 million new hepatitis C infections in 2022—marginally lower than 2019 estimates, but not substantially so. The report, which gathers data from 187 countries, estimates that around 254 million people were living with hepatitis B and 50 million were living with hepatitis C in 2022. In terms of diagnosis and treatment, only 13% of people living with chronic hepatitis B had been diagnosed and around 3% had received antiviral therapy at the end of 2022. And, between 2015 and 2022, only 36% of individuals living with hepatitis C had been diagnosed and 20% had received curative treatment by the end of 2022. These represent small improvements against 2019 data but fall well short of the goal to treat 80% of those living with hepatitis B and C by 2030. Although many countries have now developed national plans to tackle viral hepatitis, implementation has been variable, with limited decentralization being a key constraint on scaling up testing and treatment. Access to rapid diagnostic testing at the primary care or community levels is limited, as is the availability of affordable, simplified treatment regimens. Considerable emphasis must be placed on the simplification and decentralization of care, with integration of viral hepatitis into existing services. The report rightly calls for a shift to a public health approach to tackling viral hepatitis, the success of which has been amply demonstrated by Egypt's strides towards elimination of hepatitis C. Access to the tools needed to eliminate viral hepatitis—diagnostics, treatment, and, in the case of hepatitis B, preventive vaccination—remains a major hurdle. For instance, 63% of new hepatitis B infections occur in the WHO African Region, where only 18% of newborn children receive hepatitis B birth-dose vaccination. The resumption of Gavi, the Vaccine Alliance's support for the roll-out of hepatitis B birth-dose vaccination from June, 2024, will thus be crucial. Major disparities exist in the price paid for treatment, despite the availability of generic versions or their inclusion in voluntary licensing agreements—the report notes, for instance, that, although tenofovir disoproxil fumarate is off-patent and has a global benchmark price of US$2·4 a month, only seven of 26 countries surveyed paid this price or less for the drug. Similarly, only four of 24 countries reported paying the benchmark price of $60 or less for a 12-week course of sofosbuvir–daclatasvir. Efforts must be directed at ensuring the affordability of treatment through pricing policies and procurement strategies. Such efforts are all the more important given that funding for the viral hepatitis response remains limited, despite ample evidence that the elimination of viral hepatitis would be rapidly cost-saving. 

For more information: https://tinyurl.com/2k99zmxf

Hep C World News - Week of April 21, 2024

Rates and causes of death after release from incarceration

Sydney, Australia - Formerly incarcerated people have exceptionally poor health profiles and are at increased risk of preventable mortality when compared with their general population peers. However, not enough is known about the epidemiology of mortality in this population—specifically the rates, causes, and timing of death in specific subgroups and regions—to inform the development of targeted, evidence-based responses. Researchers in Australia aimed to document the incidence, timing, causes, and risk factors for mortality after release from incarceration. They analysed linked administrative data from the multi-national Mortality After Release from Incarceration Consortium (MARIC) study. We examined mortality outcomes for 1 471 526 people released from incarceration in eight countries (Australia, Brazil, Canada, New Zealand, Norway, Scotland, Sweden, and the USA) from 1980 to 2018, across 10 534 441 person-years of follow-up (range 0–24 years per person). We combined data from 18 cohort studies using two-step individual participant data meta-analyses to estimate pooled all-cause and cause-specific crude mortality rates (CMRs) per 100 000 person-years, for specific time periods (first, daily from days 1–14; second, weekly from weeks 3–12; third, weeks 13–52 combined; fourth, weeks 53 and over combined; and fifth, total follow-up) after release, overall and stratified by age, sex, and region. They found that  75 427 deaths were recorded. The all-cause CMR during the first week following release (1612 [95% CI 1048–2287]) was higher than during all other time periods (incidence rate ratio [IRR] compared with week 2: 1·5 [95% CI 1·2–1·8], I2=26·0%, weeks 3–4: 2·0 [1·5–2·6], I2=53·0%, and weeks 9–12: 2·2 [1·6–3·0], I2=70·5%). The highest cause-specific mortality rates during the first week were due to alcohol and other drug poisoning (CMR 657 [95% CI 332–1076]), suicide (135 [36–277]), and cardiovascular disease (71 [16–153]). We observed considerable variation in cause-specific CMRs over time since release and across regions. Pooled all-cause CMRs were similar between males (731 [95% CI 630–839]) and females (660 [560–767]) and were higher in older age groups. The markedly elevated rate of death in the first week post-release underscores an urgent need for investment in evidence-based, coordinated transitional healthcare, including treatment for mental illness and substance use disorders to prevent post-release deaths due to suicide and overdose. Temporal variations in rates and causes of death highlight the need for routine monitoring of post-release mortality. The study was funded by Australia's National Health and Medical Research Council. 

For more information: https://tinyurl.com/5a3ktzsy

Hep C World News - Week of April 14, 2024

Start of a New Trend? Hepatitis C Cases Drop in the U.S.

Atlanta, GA -  New U.S. hepatitis C infections dropped slightly in 2022, a surprising improvement after more than a decade of steady increases, federal health officials said Wednesday. Experts are not sure whether the 6% decline is a statistical blip or the start of a downward trend. Seeing 2023 and 2024 data, when it's available, will help public health officials understand what's going on, said Daniel Raymond, director of policy at the National Viral Hepatitis Roundtable, an advocacy organization. "We've had a decade of bad news ... I am cautiously encouraged," he said. "You always want to hope something like this is real, and a potential sign that the tide has turned." Drops in infection rates did not occur across the board. They declined for white Americans, but continued to rise in Black, Latino, and Native American communities, according to Neil Gupta, MD, MPH, who oversees the branch of the CDC that tracks viral hepatitis. The hepatitis C virus is spread through contact with blood from an infected person. The virus does most of its damage by infecting the liver, and, if left untreated, can lead to cirrhosis or liver cancer. Infections are driven mainly by people injecting illicit drugs. Data released by the CDC for 2022opens in a new tab or window show 4,848 new infections, down from 5,023 reported the year before. actually, estimates about 67,000 new hepatitis C infections actually occurred in 2022, because many people who become infected don't realize it, meaning most new infections are not diagnosed and reported. But that too is down, from 70,000 estimated for 2021. The new infection rate -- used to better compare data from one year to another -- dropped 6%. Though the decline is encouraging, Gupta said, the 2022 statistics are still twice as high as what the nation saw in 2015. Cases had consistently gone up since 2013 during the longstanding opioid epidemic due to drug users shooting heroin and fentanyl. Experts say a couple of factors could have contributed to a decline in 2022, including successful prevention efforts and needle exchanges. The North American Syringe Exchange Network (NASEN) keeps a directory of U.S. programs, and listings have grown from about 300 to nearly 500 in the last several years, said Paul LaKosky, PhD, NASEN's executive director. Many programs also have boosted hepatitis C testing and found ways to get infected people to treatment, he noted. But LaKosky and others think something else may be at play, too: Drug users are shifting from injecting to smoking. A recent CDC report found that between early 2020 and late 2022, the percentage of overdose deaths with evidence of smoking rose 74%, while the percentage of deaths with evidence of injection fell 29%. Fewer people injecting drugs like fentanyl means fewer opportunities for the spread of hepatitis C, experts noted. "There has been a tremendous shift in the way people are consuming their drugs. There's been a decrease in demand for syringes. We've seen this nationwide," said LaKosky, who added there is more demand for supplies to snort or smoke drugs. More than 2 million Americans are infected with hepatitis C, some of them having lived with infections for many years, the CDC estimates. About 12,700 Americans died in 2022 of hepatitis C-related causes, according to the CDC. 

For more information: https://tinyurl.com/297syuy7

Hep C World News - Week of April 7, 2024

WHO sounds alarm on viral hepatitis infections claiming 3500 lives each day

Geneva, Switzerland - According to the World Health Organization (WHO) 2024 Global Hepatitis Report, the number of lives lost due to viral hepatitis is increasing. The disease is the second leading infectious cause of death globally -- with 1.3 million deaths per year, the same as tuberculosis, a top infectious killer. The report, released at the World Hepatitis Summit, highlights that despite better tools for diagnosis and treatment, and decreasing product prices, testing and treatment coverage rates have stalled. But, reaching the WHO elimination goal by 2030 should still be achievable, if swift actions are taken now. New data from 187 countries show that the estimated number of deaths from viral hepatitis increased from 1.1 million in 2019 to 1.3 million in 2022. Of these, 83% were caused by hepatitis B, and 17% by hepatitis C. Every day, there are 3500 people dying globally due to hepatitis B and C infections. “This report paints a troubling picture: despite progress globally in preventing hepatitis infections, deaths are rising because far too few people with hepatitis are being diagnosed and treated,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “WHO is committed to supporting countries to use all the tools at their disposal - at access prices - to save lives and turn this trend around.” Updated WHO estimates indicate that 254 million people live with hepatitis B and 50 million with hepatitis C in 2022. Half the burden of chronic hepatitis B and C infections is among people 30–54 years old, with 12% among children under 18 years of age. Men account for 58% of all cases. New incidence estimates indicate a slight decrease compared to 2019, but the overall incidence of viral hepatitis remains high. In 2022, there were 2.2 million new infections, down from 2.5 million in 2019.  These include 1.2 million new hepatitis B infections and nearly 1 million new hepatitis C infections. More than 6000 people are getting newly infected with viral hepatitis each day. The revised estimates are derived from enhanced data from national prevalence surveys. They also indicate that prevention measures such as immunization and safe injections, along with the expansion of hepatitis C treatment, have contributed to reducing the incidence.  Across all regions, only 13% of people living with chronic hepatitis B infection had been diagnosed and approximately 3% (7 million) had received antiviral therapy at the end of 2022. Regarding hepatitis C, 36% had been diagnosed and 20% (12.5 million) had received curative treatment. These results fall well below the global targets to treat 80% of people living with chronic hepatitis B and hepatitis C by 2030. However, they do indicate slight but consistent improvement in diagnosis and treatment coverage since the last reported estimates in 2019. Specifically, hepatitis B diagnosis increased from 10% to 13% and treatment from 2% to 3%, and hepatitis C diagnosis from 21% to 36% and treatment from 13% to 20%. The burden of viral hepatitis varies regionally. The WHO African Region bears 63% of new hepatitis B infections, yet despite this burden, only 18% of newborns in the region receive the hepatitis B birth-dose vaccination. In the Western Pacific Region, which accounts for 47% of hepatitis B deaths, treatment coverage stands at 23% among people diagnosed, which is far too low to reduce mortality.  Bangladesh, China, Ethiopia, India, Indonesia, Nigeria, Pakistan, the Philippines, the Russian Federation and Viet Nam, collectively shoulder nearly two-thirds of the global burden of hepatitis B and C. Achieving universal access to prevention, diagnosis, and treatment in these ten countries by 2025, alongside intensified efforts in the African Region, is essential to get the global response back on track to meet the Sustainable Development Goals. 

For more information: https://tinyurl.com/pwhep7yj

Advocate doctors criticize safer supply programs

Vancouver, BC - A group of 72 doctors in B.C., including several of the province’s leading physicians, have signed a letter criticizing Canada’s experimental “safer supply” programs. The letter argues that, not only are these programs unscientific, but they are also being widely defrauded and seriously harming youth. “Safer supply” refers to the distribution of free recreational drugs, typically through prescription, as an alternative to potentially tainted street substances. While advocates claim that these programs save lives, there is widespread evidence that clients regularly resell (“divert”) their safer supply on the black market to purchase stronger illicit drugs, which then floods communities with cheap opioids and fuels new addictions, particularly among youth. Dozens of addiction experts have also argued that there is no evidence that safer supply works. Most studies which support the strategy use low-quality research methodologies that are considered unacceptable in most healthcare studies – for example: simply asking drug users if they benefit from safer supply, or if they resell their drugs, and then treating their answers as objective fact. The new 72-doctor letter, which was originally published in February as an op-ed in the Times Colonist, reiterated many of these concerns and expressed frustration with the B.C. NDP’s inconsistent claims about safer supply. Lead author Dr. Mark Mallet, a hospitalist at Victoria General Hospital, wrote that, although the provincial government spent nearly a year dismissing safer supply diversion as an “urban myth,” it was gratifying to see top officials recently admit that it is actually a common occurrence. However, he said that it is “unsettling” that such officials, including Provincial Health Officer Bonnie Henry, repeatedly assured the public that diversion was being closely monitored when, evidently, it was not. Dr. Mallet also expressed frustration with the government’s tendency to vilify doctors who criticize safer supply. Until very recently, such experts often stood accused of “politicizing” the issue and inciting a “moral panic” through “anecdotes” – but their concerns, by the provincial government’s own admission, turned out to be entirely justified. The doctor said that it is shocking that, almost four years after safer supply was expanded across Canada, there are still almost no credible studies into these programs or their unintended consequences. “We should be drowning in evidence by now,” he wrote, noting that, in light of this gap, it is “not surprising” that harm reduction advocates have been able to dismiss signs of diversion as merely anecdotal. “It is impossible for anecdotes to rise to the level of evidence if no one is systematically collecting data.”

For more information: https://tinyurl.com/ew479du8

Hep C World News - Week of March 31, 2024

Researchers encourage simultaneous testing for three viruses – HIV, HBV and HCV

Toronto, ON - Due to shared routes of infection, some populations are vulnerable to coinfection with HIV and/or hepatitis B virus and/or hepatitis C virus. Testing for all three viruses is not always done. This can allow some infections to go undiagnosed, cause harm and spread. Coinfection with these blood-borne viruses can accelerate the course of illness caused by each one. HBV and HCV are collectively referred to as viral hepatitis. These viruses infect the liver and gradually injure this vital organ, leading to persistent fatigue, the formation of scarred liver tissue, serious infections, liver failure and increased risk of liver cancer and death. Treatment for HBV is available to help manage the infection and allow people to live long, healthy lives. Treatment for HCV can cure this viral infection. Treatment for HIV (antiretroviral therapy, ART) can make a person healthier and, in many cases, allow for near-normal life expectancy. Furthermore, a person with HIV who is on effective treatment cannot pass on the virus to their sexual partners. However, if left untreated, HIV can severely damage the immune system. Testing for all three viruses could help uncover previously undiagnosed infections and allow healthcare personnel to offer treatment.  Worldwide, it is estimated that collectively there are more than four million infections of HBV, HCV and HIV each year. What’s more, annual deaths from all three viruses are estimated to be 1.7 million. A team of researchers in the UK notes that without systemic intervention HBV and HCV will cause “more deaths [globally] annually than HIV, malaria and tuberculosis combined” by 2040. Although much progress has been made against HIV, with many people being tested and offered treatment when a positive test occurs, in contrast, progress against viral hepatitis (hepatitis B and C viruses) is lagging.  A major barrier to progress against infection with all three viruses is access to testing. To begin to remedy this, in 2022 the World Health Organization (WHO) released guidelines on the care and treatment of HIV and viral hepatitis. The WHO guidelines recommended testing for these three viruses in the following populations: people who use drugs (PWUD), gay, bisexual, men who have sex with men (gbMSM) and incarcerated people. They note that the three viruses are not limited to these populations.

For more information: https://tinyurl.com/muhtu4r9

Hep C World News - Week of March 24, 2024

How to motivate liver disease candidates to make lifestyle changes

Copenhagen, Denmark - New research reveals that screening for liver fibrosis is linked to improved alcohol consumption, diet, weight and exercise in people at risk for liver disease. Scientists supported in part by the EU-funded LiverScreen project have found that when people are screened for liver fibrosis, they are more motivated to make improvements in their alcohol intake, diet, exercise and weight. This suggests that a screening programme could serve as a tool for the prevention, early detection and treatment of advanced fibrosis. As part of the study, researchers investigated 4 796 people living in Denmark at risk of alcohol-related or non-alcoholic fatty liver disease. They found that participation in a liver fibrosis screening programme leads to sustained improvements in lifestyle among individuals at risk for these diseases. Of the 4 796 participants, 1 850 were at risk for alcohol-related liver disease (ALD) and 2 946 for metabolic dysfunction-associated steatotic liver disease (MASLD). A total of 383 individuals – 10 % of the ALD group and 7 % of the MASLD group – screened positive for fibrosis. Having received lifestyle advice, participants completed questionnaires evaluating lifestyle changes at 1 week and 6 months, and a subgroup was re-examined at 2 years. In the ALD group, excessive drinking decreased from 46 % to 32 % at the 6-month mark. Only a small percentage – 15 % – reported increased drinking, without any differences between individuals who screened positive and those who screened negative. For participants with a high-risk alcohol use at baseline, a positive screening test predicted abstinence or decreased alcohol use after 6 months. After 2 years, excessive drinking dropped from 52 % to 41 % in a subgroup of 752 individuals and a positive screening test again predicted abstinence or decreased alcohol use. MASLD participants showed similar improvements in lifestyle at 6 months. An estimated 35 % improved their diet, 22 % exercised more, and 13 % reported a weight loss of 5 % or greater. Improvements in the MASLD group were most pronounced in participants who had screened positive. “This is to our knowledge the first study investigating global lifestyle changes after targeted, population-based screening for liver fibrosis across the spectrum of steatotic liver disease. Our study is unique, because we investigated 4796 at-risk individuals from the general population, have an 84% response rate, evaluate both short- and long-term changes, and assessed lifestyle risk factors …,” report the authors in their paper. “Our results indicate that screening for liver disease may act as an added motivation for patients to achieve better health,” the study authors supported by LiverScreen (Screening for liver fibrosis - population-based study across European countries) conclude. “The act of attending a screening program for liver fibrosis can therefore be seen as a catalyst for behavioural change, boosting existing motivation for lifestyle improvements.” 

For more information: http://tinyurl.com/22bxedbk

Hep C World News - Week of March 17, 2024

Mike Tyson urges Biden to free thousands locked up over cannabis

Washington, DC - The former heavyweight boxing champion Mike Tyson has urged Joe Biden to follow through on his commitment to “correct our country’s failed approach to marijuana” and give clemency to the thousands of nonviolent cannabis offenders still languishing in federal lockups. “President Biden has the power to effect real change – he can right these wrongs and grant clemency to those who are sitting in prison for cannabis offenses,” Tyson told the Guardian. “We know the failed war on drugs was wrong and no one should be sitting in jail for cannabis. It’s time our country moves forward and end cannabis prohibition once and for all.” Legal cannabis sales in the US could soon reach $40bn annually. And campaigners say it is an injustice that more than 2,000 people – overwhelmingly people of color – are in federal jails sentenced for conduct that today is essentially legal in almost half of the country, with recreational cannabis legal in 24 states. About 30,000 more are in state penitentiaries for non-violent cannabis offenses, activists say, with data patchy. Biden doesn’t have the power to pardon those offenders, but Tyson pleaded with the president to pressure those states to do so. Biden has been accused of misleading voters in his messaging over his pardon for people convicted of simple marijuana possession offenses, in line with his campaign promise to decriminalize cannabis. “No one should be in jail just for using or possessing marijuana,” he said in October 2022. However, as of nine months earlier, “no offenders sentenced solely for simple possession of marijuana remained in the custody of the Federal Bureau of Prisons”, according to the US Sentencing Commission. (Those who remain in prison face charges including drug trafficking.) In a video for Reeform, a campaigning cannabis brand founded by Weldon Angelos, who served a 13-year prison sentence for selling less than $1,000 worth of cannabis before he was granted clemency in 2016, Tyson said it beggared belief that people were doing “murderers’ time” for trafficking a “mild medicine”. The White House will receive a letter on Tuesday penned by Tyson, a cannabis advocate and entrepreneur, which says it is high time the authorities reconcile with communities, including poor people and people of color, who have paid the heavy cost of the US’s so-called drug war.  

For more information: http://tinyurl.com/yjvn2f5n

Hep C World News - Week of March 10, 2024

There's a new boogeyman in town - Nitazenes 

Cleveland, OH - Move over fentanyl! There's a new boogeyman in town. At least that's what you might be hearing from the news. And if you haven't already heard the word "nitazenes" then you can expect to soon. Nitazenes are a class of synthetic opioids, also known as the benzimidazole opioids, which have received more and more attention as they are being detected with increasing frequency in street drugs and overdoses. Media coverage has primarily focused on nitazenes being "more potent than fentanyl," and a cause for concern in our ongoing overdose crisis. Make no mistake, fentanyl continues to drive the overwhelming majority of overdose deaths in the U.S. and the rest of North America, and so far, nitazenes have primarily been detected in drug samples with fentanyl. While detection seems to be increasing, it remains unclear what their true prevalence is in the drug supply because testing for nitazenes is limited and they are still not routinely tested for in overdose deaths. As detection capabilities are expanded, we can expect to see an increase in overdoses involving nitazenes, and we can prepare for this drug class in the supply without reinventing the wheel. Nitazenes themselves are not entirely new. They were developed in the 1950sopens in a new tab or window as potential pain medications, but they were never approved or used medically. They are also not used in veterinary medicine. Because of this, there is limited human data on their effects, not to mention that many of the nitazenes now being detected are completely novel drugs. However, the potency across the class is highly variable opens in a new tab or window: they can be significantly more potent than fentanyl and can have significantly longer-lasting effects. Meanwhile, other nitazenes are less potent than fentanyl. Isotonitazene -- a member of the nitazene class -- was first detected in drugs in the U.S and overdose victims in Canada and Europe in 2019opens in a new tab or window. Since then, 20 total nitazenes have been identified in street drugs with increasing frequency. They are Schedule I drugs in the U.S., meaning any possession or use is considered illegal. In areas of North America where drug sample testing is more widely employed and available, the prevalence of nitazene-positive samples actually seems to be low, and they seem to have possibly decreased over time in much the same way that many fentanyl analogues (which had also previously showed up in the drug supply) were ultimately replaced once more with fentanyl. This is not necessarily reassuring given limitations in testing, increases in fentanyl purity, and presence of other unpredictable substances like benzodiazepines and xylazine. In Europe, where fentanyl has not been widespread, there is more concern that nitazenes are on the rise as they have recently been detected in multiple countries and multiple different drug products. While fentanyl doesn't seem to be going away anytime soon in North America, Europe has the potential for nitazenes to become more widespread and cause more problems. This is because their appearance in the European drug market coincides with reduced supply of heroin, which had still been the primary street opioid there -- this situation is similar to the conditions that led to the rise of fentanyl in North America. With action already taken against Europe's heroin supply, the demand for opioids will most likely lead to replacement with synthetic alternative(s). Given the singular focus on supply-side interventions, any success at destroying the fentanyl supply should also be expected to carry similar risk for replacement with something new and something potentially worse.

For more information: http://tinyurl.com/3fda3psc

Hep C World News - Week of March 3, 2024

WHO hepatitis C elimination targets: the global equity challenge

Geneva, Switzerland - In 2016, the WHO Global Health Sector Strategy on Viral Hepatitis targeted an 80% reduction in new hepatitis C virus (HCV) infections by 2030, from 2015 levels. Currently, there are 58 million people living with HCV, a reduction of 18% from the 71·1 million people that were living with HCV in 2015. Only 11 countries are currently on track to reach HCV elimination targets by 2030. HCV elimination targets will not be realised globally at present treatment rates. Currently, for every person treated, two more people are infected. We estimated that the global number of people treated would need to increase from 754 000 per year to 7·2 million per year for WHO elimination targets to be achieved. Identifying and addressing barriers to HCV treatment is an issue of global health equity. Of the 111 countries with available data, high-income countries had diagnosed 45% of people with HCV in 2020, but only 5% of these people were treated. Low-income countries had diagnosed 16%, and treated less than 1% of people with HCV. The consequence of inequality in access to HCV treatment is that, while some countries have been successful in managing their local epidemics, the global HCV epidemic is not being adequately addressed. According to the 2022 WHO Global Health Sector Strategies global targets, by 2025, 60% of people with HCV should be diagnosed, and 50% should be treated. These targets might be achievable in high-income countries where 45% of people already know their HCV status; however, such targets are challenging for low-income and middle-income countries where testing and treatment are not readily available. In 2014, direct-acting antivirals (DAAs) advanced the efficacy and safety of HCV treatment, but their cost remains a barrier to universal HCV treatment access. Initial 12-week courses of DAAs ranged between US$66 400 and $84 000, with sofosbuvir making a record $2·3 billion in sales within the first quarter of 2014. The cumulative revenue for pharmaceutical companies for HCV drugs between 2009 and 2022 was approximately $109 billion. DAA costs have since decreased due to factors such as patent opposition, joint procurement, and voluntary licenses.  Achieving HCV elimination will require a substantial increase in treatment rates. If all 58 million people with HCV were treated with generic sofosbuvir–daclatasvir for US$40, HCV could be eliminated globally for $2·3 billion, preventing 263 000 deaths annually. This $2·3 billion equates to 2% of the $109 billion in HCV drug sales between 2009 and 2022. However, DAA price reductions are a necessary, but insufficient, component of HCV elimination. Coordinated test and treat strategies are critical to improve retention in care, and sociocultural and judicial barriers must be addressed. The future challenges will be to upscale screening programs and mobilize price reductions in a globalized way to achieve widespread and equitable HCV treatment access that is not isolated to high-income countries.

For more information: http://tinyurl.com/26mkpyx8

Hep C World News - Week of February 25, 2024

Women with concurrent MASLD, alcohol-related liver disease have 83% higher risk for death

Los Angeles, CA - Women with concurrent metabolic dysfunction-associated steatotic liver disease and alcohol-related liver disease had an 83% greater risk for all-cause mortality than men and those with ALD alone had 160% greater risk, data showed. “Steatotic liver disease is a major and increasingly prevalent condition that is likely an underlying precursor to many conditions, including those involving the heart,” Susan Cheng, MD, MPH, lead study author and director of the Institute for Research on Healthy Aging at Smidt Heart Institute, said in a Cedars-Sinai press release. “We are paying even more attention to steatotic liver disease because we are seeing how it tracks closely with established cardiovascular risk factors such as hypertension, high cholesterol and diabetes.” Using the National Health and Nutrition Examination Survey III (1988-1994), Cheng and colleagues analyzed data from 10,007 adults (mean age, 42 years; 50.3% women) to investigate the prevalence, risks and mechanisms of steatotic liver disease among women vs. men. Of those included, 1,461 had MASLD, 225 had MASLD and ALD (MetALD) and 105 had ALD. Data included ultrasonographic measures of hepatic steatosis, cardiometabolic risk factors and self-reported alcohol intake. According to results published in the Journal of Hepatology, there were significant differences in MASLD, MetALD and ALD prevalence among men (18.5%, 3.2% and 1.7%, respectively) vs. women (10.3%, 1.2% and 0.3%). Over a median follow-up of 26.7 years, there were 2,496 deaths. Multivariable-adjusted survival analysis showed MASLD was not significantly linked with all-cause mortality among men or women; however, MetALD was associated with a 83% higher risk for all-cause mortality among women (HR = 1.83; 95% CI, 1.29-2.57) but not men. Further, ALD was significantly associated with all-cause mortality among both sexes, with a higher magnitude among women (HR = 3.49; 95% CI, 1.86-6.52) compared with men (HR = 1.89; 95% CI, 1.42-2.51). “These findings are especially concerning in the context of the COVID-19 pandemic, during which alcohol use and related death, particularly in women, has increased,” Alan Kwan, MD, a research instructor in the department of cardiology at Cedars-Sinai who also worked on the study, said in the release. 

For more information: http://tinyurl.com/jjpjxk64

Hep C World News - Week of February 18, 2024

Why is the opioid addiction problem getting worse?

New York, NY - Opioid addiction doesn’t get as many headlines as it used to, but the crisis is as bad as ever. It doesn’t have to be. Decades into the deadliest drug overdose epidemic in American history, people are dying at higher rates than ever. Between 2017 and 2021, the number of overdose deaths involving opioids jumped from 47,600 to 80,411 — many more Americans than are killed each year by guns or cars. The surge has been largely driven by powerful synthetics like fentanyl, an opioid 50 times more potent than heroin.  Provisional data from the Centers for Disease Control and Prevention show nearly as many opioid-involved overdose deaths in 2022, at 79,770. Overdoses in Black, American Indian, and Latinx communities have been rising even faster, widening the mortality gap between white people and people of color. In 2020, Black men 65 and older died of overdoses at seven times the rate of white men in the same age range.  Meanwhile, the number of Americans struggling with opioid addiction remains staggering. In 2022, 6.1 million people 12 and older had an opioid use disorder, according to the Substance Abuse and Mental Health Services Administration’s most recent annual survey, while 8.9 million reported misusing opioids within the past year.  

Read the complete article, published by VOX: http://tinyurl.com/2y9uwt52

Hep C World News - Week of February 11, 2024

Overdose mortality incidence and supervised consumption services in Toronto

Toronto, ON - Supervised consumption services (SCS) prevent overdose deaths onsite; however, less is known about their effect on population-level overdose mortality found a study that was that was recently published in The Lancet. Researchers here aimed to characterize overdose mortality in Toronto, ON, Canada, and to establish the spatial association between SCS locations and overdose mortality events. For this ecological study and spatial analysis, we compared crude overdose mortality rates before and after the implementation of nine SCS in Toronto in 2017. Data were obtained from the Office of the Chief Coroner of Ontario on cases of accidental death within the City of Toronto for which the cause of death involved the use of an opiate, synthetic or semi-synthetic opioid, or other psychoactive substance. We assessed overdose incident data for global spatial auto-correlation and local clustering, then used geographically weighted regression to model the association between SCS proximity and overdose mortality incidence in 2018 and 2019. The researchers included 787 overdose mortality events in Toronto between May 1, 2017, and Dec 31, 2019. The overdose mortality rate decreased significantly in neighborhoods that implemented SCS (8·10 deaths per 100 000 people for May 1–July 31, 2017, vs 2·70 deaths per 100 000 people for May 1–July 31, 2019; p=0·037), but not in other neighborhoods. In a geographically weighted regression analysis that adjusted for the availability of substance-use-related services and overdose-related sociodemographic factors by neighborhood, the strongest local regression coefficients of the association between SCS and overdose mortality location ranged from −0·60 to −0·64 per mile in 2018 and from −1·68 to −1·96 per mile in 2019, suggesting an inverse association. They found that the period during which SCS were implemented in Toronto was associated with a reduced overdose mortality in surrounding neighborhoods. The magnitude of this inverse association increased from 2018 to 2019, equaling approximately two overdose fatalities per 100 000 people averted in the square mile surrounding SCS in 2019. Policy makers should consider implementing and sustaining SCS across neighborhoods where overdose mortality is high. 

For more information: http://tinyurl.com/3ex8zsdj

Hep C World News - Week of February 4, 2024

Alcohol, opioids most common causes of substance use-related heart disease deaths

Redlands, CA - Substance use-related CVD deaths increased at an average of 4% per year from 1999 to 2019, with alcohol and opioids the most common contributors, despite an overall reduction in CVD mortality in the U.S. during the same period, data show. In a large database analysis of CDC death data published in the Journal of the American Heart Association, researchers also found that the increase in substance use-related CVD age-adjusted mortality rate has particularly accelerated since 2012. “Despite drops in overall CVD disease deaths from 1999 to 2019, CVD deaths in which substance use was cited as a contributing factor increased an average of 4% per year, with the death rate accelerating to 6.2% from 2012 through 2019,” Dmitry Abramov, MD, a cardiologist and associate professor of medicine at Loma Linda University Health in Redlands, California, told Healio. “Prominent increases in CVD deaths associated with substance use were most notable among women, American Indian or Alaskan individuals, younger individuals, rural area residents, and users of cannabis and psychostimulants. However, increases were seen across the board among all of the studied substances and among all studied demographics, which highlights the significant public health burden of substance use as a contributor to CVD death.” Abramov and colleagues analyzed deaths occurring within the U.S. related to CVD and substance use (excluding smoking or tobacco use) from the CDC WONDER database. Researchers calculated crude, age-adjusted mortality rates per 100,000 population, annual percent change, and average annual percent changes from 1999 to 2019. From 1999 to 2019, there were 51,998,560 deaths in the U.S., of which 29,455,193 deaths were related to CVD in people aged 25 years and older. Of those deaths, 2.2% listed substance use as a concomitant cause of death. Of the deaths attributed to substance use and CVD, 75.6% were men; 70.6% were white and 65% were related to alcohol use. Researchers found that the age-adjusted mortality rates per 100,000 population were more pronounced among men (22.5; 95% CI, 22.5-22.6) than women, more pronounced among American Indian or Alaska Native people (37.7; 95% CI, 37-38.4) than other races or ethnicities and more pronounced among those living in rural areas (15.2; 95% CI, 15.1-15.3) than those living in urban areas. Assessing substance use category, age-adjusted mortality rate per 100,000 population was highest for alcohol-related CVD death (9.09; 95% CI, 9.07-9.12), followed by opioids (2.04; 95% CI, 2.03-2.06), cocaine (1.45; 95% CI, 1.44-1.46) and stimulants (0.95; 95% CI, 0.94-0.96). The overall substance use-related CVD age-adjusted mortality rates increased from 9.9 (95% CI, 9.8-10.1) in 1999 to 21.4 (95% CI, 21.2-21.6) in 2019, with an average annual percent change of 4% (95% CI, 3.7-4.3).  The increases in substance use-related CVD average annual percent change were greatest among women (4.8%; 95% CI, 4.5-5.1), American Indian or Alaska Native people (5.4%; 95% CI, 4.4-6.4), younger adults aged 25 to 39 years (5.3%; 95% CI, 3.9-6.6), those living in rural areas (5%; 95% CI, 4.6-5.4) and people who used cannabis and psychostimulants (12.7%; 95% CI, 10.9-14.5). “Rising rates of CVD mortality associated with substance use should lead to additional public health efforts to support comprehensive evaluation and management of substance use in the U.S.,” Abramov told Healio. “That includes clinician and patient education, as well as attention to socioeconomic factors that contribute to substance use. Additional public health efforts are important to both reduce substance use and to reverse the trends in CVD deaths associated with substance use and will hopefully lead to further reduction in the overall burden of CVD.” 

For more information: http://tinyurl.com/4ak8v8xk

Hep C World News - Week of January 28, 2024

ACG publishes new guideline for management of alcohol-associated liver disease

Louisville, KY - A new clinical guideline published in the American Journal of Gastroenterology underscored the need to overcome barriers to alcohol use disorder treatment and expand multidisciplinary care for patients with alcohol-associated liver disease. “I think the most important reason why the American College of Gastroenterology wanted to revise this guideline is there has been impetus and recognition that control of the risk factor of alcohol use disorder seems to be the way forward in managing and controlling the magnitude and burden of this disease,” Ashwani K. Singal, MD, MS, FACG, FAASLD, AGAF, guideline author and professor of medicine at the University of Louisville, told Healio. “The second reason is that we wanted to bring out a stronger recommendation to consider early liver transplantation in these patients.” Singal continued: “Further, although there are no currently approved pharmacological therapies for alcohol-associated liver disease and alcohol-associated hepatitis, there are promising therapies on the horizon with a potential in the management of these patients.” To develop a practice guideline for the management of patients with alcohol-associated liver disease (ALD), ACG experts performed a Grading of Recommendations, Assessment, Development and Evaluation analysis of data based on a patient-intervention-comparison-outcome format. The analysis resulted in 35 key concepts or statements and 22 recommendations, which include the following. Alcohol consumption should be avoided among those with underlying obesity or chronic hepatitis C and hepatitis B virus infection. Those undergoing or with a history of gastric bypass should avoid heavy alcohol use. Given the associated higher risk for cirrhosis, heavy alcohol users should abstain from any tobacco use. Adults with suspected unhealthy alcohol use should undergo screening with tools such as the Alcohol Use Disorders Identification Test-Consumption tool. Among those with compensated ALD and alcohol use disorder (AUD), baclofen is recommended and other treatment options include acamprosate, naltrexone, gabapentin or topiramate. Experts suggest against use of disulfiram for treatment of AUD along any spectrum of ALD. Pentoxifylline should not be used in those with severe alcohol-associated hepatitis (AH), nor should universal administration of prophylactic antibiotics be used in hospitalized patients. Conversely, corticosteroid therapy and adjuvant IV N-acetylcysteine is recommended for those with severe AH. Patients with severe AH and high risk for death who are unresponsive to medical management may undergo early liver transplantation according to regional and institutional protocols. Integrated multidisciplinary care models that incorporate behavioral interventions and/or pharmacotherapy should be offered for those with ALD and AUD. “What gastroenterologists and hepatologists need to recognize is to not only screen these patients for alcohol use disorder but also treat them effectively,” Singal said. “Because these patients have liver disease from alcohol use, they’re struggling not only from liver disease and their complications, but also from another disease of alcohol use disorder. We need to take a multidisciplinary integrated care approach for these patients where patients are seen not only by a liver doctor but also comprehensively by an addiction expert, including a counselor, social worker and psychiatrist.” Singal continued: “Comprehensive holistic approach by both specialists overcomes several barriers to receiving care for alcohol use disorder, with a potential for improving long-term outcomes. Integrated approach is also recommended to design future clinical trials for drug development with evaluation of outcomes targeted at liver disease as well as on alcohol use.” 

For more information: http://tinyurl.com/2s4as4r3

Hep C World News - Week of January 21, 2024

New report to advance global HCV elimination efforts through point-of-care 

Paris, France - The International Network on Health and Hepatitis in Substance Users (INHSU), in collaboration with the Coalition for Global Hepatitis Elimination (CGHE), FIND, The Kirby Institute, UNSW, and Clinton Health Access Initiative (CHAI), announces the release of a comprehensive report stemming from the INHSU Hepatitis C Point-of-Care Testing Forum, held during the Global Hepatitis Summit in Paris in April 2023. Despite advances in treatment, an estimated 57 million people are living with chronic hepatitis C infection globally, with 290,000 people dying from HCV-related cirrhosis and liver cancer each year. Scaling up testing and utilizing innovative testing methods are integral if the World Health Organization’s (WHO) 2030 elimination targets are to be met.  This report, developed in response to the urgent need for effective strategies to combat the global burden of HCV, explores the underutilized promise of point-of-care testing in simplifying diagnosis, improving access to treatment, and ultimately reducing the prevalence of HCV. Emma Day, Executive Director of INHSU, emphasized the critical importance of this collaborative effort, stating, “The insights shared at the INHSU Hepatitis C Point-of-Care Testing Forum highlight the potential of point-of-care testing in transforming the landscape of HCV diagnosis and care. By breaking down barriers, we can significantly enhance our efforts towards achieving global HCV elimination goals.” Following the Forum, the report draws on experience from key stakeholders to outline barriers and solutions for increasing access to point-of-care testing across five key areas within a health systems framework. The report underscores the urgent need for action to address challenges in these five key areas and provides practical solutions for implementation alongside real-world examples of successful Point-of-Care programs from Catalonia, Iran, Denmark and more.  It is a valuable resource for policymakers, healthcare professionals, and organisations committed to advancing global HCV elimination goals. 

For more information: http://tinyurl.com/2ussykv5

Hep C World News - Week of January 14, 2024

Developments in hepatitis care: New CDC recommendations and more

Atlanta, GA - As viral hepatitis continues to be a major health concern in the infectious disease field, recent research has highlighted the importance of testing and treatment. A nationally representative survey revealed that of the more than 2 million people with current hepatitis C virus infection, only 68% are aware of their infection.  In new guidance, the CDC recommended that the two-step testing process for hepatitis C virus be completed in one visit, eliminating the need for multiple visits, which often leads to incomplete testing.  Testing for HIV, hepatitis B, and hepatitis C increased among U.S. Medicaid enrollees initiating treatment for opioid use disorder. However, a recent study showed approximately three-quarters of enrollees were not tested for each condition.  Hepatitis C cure rates ‘jarringly low’ as many lack access to treatment An analysis of data from 2013 to 2022 showed that only 34% of people diagnosed with hepatitis C in the United States were cured or cleared of the virus, with many still lacking access to highly effective treatments.

For more information: http://tinyurl.com/4rf6yz3a

Hep C World News - Week of January 7, 2024

Swiss capital Bern considers legal cocaine project 

Zurich, Switzerland - Switzerland's capital is examining a pilot scheme to allow the sale of cocaine for recreational use - a radical approach to the war on drugs that is not thought to have been tried elsewhere. Parliament in Bern has supported the idea, which still needs to overcome opposition from the city government and will also require a change in national law. Drugs policy around the world is evolving, with the U.S. state of Oregon, for example, decriminalising possession of small amounts of cocaine in 2021 in favour of drug treatment. Many European countries, including Spain, Italy and Portugal, no longer have prison sentences for possession of drugs including cocaine, although nowhere has gone as far as the proposal under discussion in Bern. Switzerland is re-examining its stance on the drug after some politicians and experts criticised complete bans as ineffective, with the proposal - currently in its early stages - following trials now under way to permit the legal sale of cannabis. "The war on drugs has failed, and we have to look at new ideas," said Eva Chen, a member of the Bern council from the Alternative Left Party who co-sponsored the proposal. "Control and legalisation can do better than mere repression." Wealthy Switzerland has one of the highest levels of cocaine use in Europe, according to the levels of illicit drugs and their metabolites measured in waste water, with Zurich, Basel and Geneva all featuring in the top 10 cities in Europe. Swiss cities, including Bern, are also showing increasing usage, while prices of cocaine have halved in the last five years, according to Addiction Switzerland, a non-governmental organisation. "We have a lot of cocaine in Switzerland right now, at the cheapest prices and the highest quality we have ever seen," said Frank Zobel, deputy director at Addiction Switzerland. "You can get a dose of cocaine for about 10 francs these days, not much more than the price for a beer." Bern's education, social affairs and sport directorate is preparing a report on a possible cocaine trial, although this does not mean it will definitely take place. "Cocaine can be life-threatening for both first-time and long-term users. The consequences of an overdose, but also individual intolerance to even the smallest amounts, can lead to death," the Bern government said. Bern parliament member Chen said it was too early to say how a pilot scheme would develop, including where the drug would be sold or how it would be sourced. "We are still far away from potential legalisation, but we should look at new approaches," Chen said. "That is why we are calling for a scientifically supervised pilot scheme trial." For a trial to take place, parliament would have to amend the law banning the recreational use of the drug. The decision could come in a matter of years, or earlier if the current cannabis schemes - where the drug is on sale at pharmacies - show successful results, political experts said. Any legalisation would be accompanied by quality controls and information campaigns, Chen said, with the approach also reducing a lucrative criminal market. Experts are divided, with even those in favour of the trial concerned about the potential dangers. "Cocaine is one of the most strongly addictive substances known," said Boris Quednow, group leader of the University of Zurich's Centre for Psychiatric Research. He said its risks were in a completely different league to alcohol or cannabis, citing links to heart damage, strokes, depression and anxiety. On the other hand, Thilo Beck, from the Arud Zentrum for Addiction Medicine, the largest centre for addiction medicine in Switzerland, said it was time for a more "grown up" policy towards cocaine. "Cocaine isn't healthy - but the reality is that people use it," said Beck. "We can't change that, so we should try to ensure people use it in the safest, least damaging way." Leo, a cocaine user from Geneva, said legalising the drug would make treatment easier, as well as reduce violence and crime linked to supply. It would also make it easier to control the quality of the drugs on sale. "Prohibiting drugs doesn't give good results in terms of health policies and prevention," Leo told Reuters. "On the contrary, it looks like countries who chose to legalize it or to depenalize drugs, have better results in terms of prevention and global health policies. "Switzerland has been courageous in its policies with other drugs, so I think the next stage should be the legalisation of cocaine." 

For more information: http://tinyurl.com/4x4d2n2f