Answer Addiction

Tag: intravenous drug use

  • West Virginia HIV Outbreak Is A "Nightmare"

    West Virginia HIV Outbreak Is A "Nightmare"

    Approximately 74 new cases of HIV have been reported in Cabell County since January 2018.

    Despite having many public health policies in place to prevent the spread of disease—including a needle exchange program—one West Virginia county is seeing an alarming spike in new HIV transmissions largely brought about by drug users sharing needles. 

    Seventy-four new cases of HIV have been reported in Cabell County since January 2018, according to Politico. 

    “The ground is fertile,” Judith Feinberg, a professor of behavioral medicine and infectious diseases at West Virginia University, told Politico. “This is the nightmare everyone is worried about.”

    Harm Reduction Efforts

    In 2015, Cabell County started a needle exchange program. It also has drug treatment programs, STI testing and expanded access to PrEP, a treatment regimen that can reduce the risk of contracting HIV if taken daily. All of this is unusual, especially for a rural county. The fact that HIV has taken hold despite these efforts make the outbreak especially concerning. 

    Michael Kilkenny, physician director at Cabell’s health department, said he can’t explain why HIV cases are increasing, despite the county’s efforts. “I have no answer for that. At night, it’s what you ask when you are screaming at the sky,” he said. 

    Jay Adams, an HIV care coordinator at the federal Ryan White HIV/AIDS program, said that the outbreak would have been significantly worse in any other county. 

    “I don’t think this would have been contained with any degree of success in any other county in the state,” he said. 

    High-Risk Counties

    A 2016 report from the Centers for Disease Control and Prevention (CDC) identified counties that were at high risk for new HIV infections because of the prevalence of intravenous drug use. Half of West Virginia’s counties—including Cabell—were on the list.

    Other areas of the country, including Indiana and Massachusetts have seen spikes in HIV infections related to the opioid epidemic. 

    John Wiesman, Washington state health secretary and co-chair the Presidential Advisory Council on HIV/AIDS, said that officials are realizing how much the opioid epidemic is impacting HIV transmission. The Trump administration has aimed to stop new HIV transmissions by 2030, but that is a lofty goal, said Wiesman. 

    “We’re recognizing every day just how big a challenge this is,” he said. “There are a lot of things making this a really difficult task, and one of those is the opioid epidemic. We’ve got all of these overlapping issues coming together, a lot of which are social factors, which is why it is so important to have both a medical approach and a larger health and human services approach to this epidemic.”

    View the original article at thefix.com

  • Most Drug Users Willing To Utilize Safe Injection Sites, Study Finds

    Most Drug Users Willing To Utilize Safe Injection Sites, Study Finds

    A new study found that 77% of drug user were willing to utilize safe consumption sites.

    “Safe consumption sites” provide a space to use drugs under medical supervision, away from the streets and with clean equipment such as syringes. They have existed abroad since the ‘80s but not in the U.S. (at least not legally). Some are for them, some are against them. But what about the drug using community?

    Safe consumption programs (also known as supervised injection facilities or SIFs) in Canada and Australia have reported reductions in fatal overdoses and the spread of HIV and hepatitis B and C. As the U.S. faces crisis-level opioid abuse and overdose, it is now forced to confront the potential of SIFs across the country.

    A new study confirmed the willingness of “high-risk opioid users” to utilize these sites as a form of harm reduction. In a survey of 326 people who reported using heroin, fentanyl and illicit opioid pills, about 77% of them reported that they were willing to go to SIFs.

    Among the respondents, 60% reported habitually using drugs in “public or semi-public” spaces, and more than a third had overdosed in the past six months.

    The research was led by a team at Johns Hopkins Bloomberg School of Public Health and was published in the Journal of Urban Health in June.

    “On the whole, we found a strong willingness to use safe consumption spaces,” said study lead author Ju Nyeong Park. “This is important because often the voices of people who use drugs are not included in policy debates or in the implementation of public health interventions.”

    The research confirmed that the majority of respondents are “motivated to be safe and take precautions to reduce their exposure to harm,” said study senior investigator Susan Sherman.

    “It’s encouraging because even though these are people engaging in very high-risk behaviors in very different contexts… they were willing to use this harm-reduction intervention,” said Park.

    100 Safe Consumption Sites In 12 Countries

    Currently there are more than 100 such facilities in 12 countries, though none are in the United States. A legal battle taking place in Philadelphia may affect the future of SIFs in the U.S.

    In April, it was reported that Safehouse, a local non-profit organization involved in efforts to establish the nation’s first SIFs in Philadelphia, countersued the government in its attempt to block efforts to open the sites. They argued that SIFs are less about drugs and more about providing a medical service, in addition to giving people the option to access treatment.

    View the original article at thefix.com

  • US Health Chief Announces Support For Needle Exchange Programs

    US Health Chief Announces Support For Needle Exchange Programs

    The Health Secretary’s reversal on needle exchange programs may be related to a new 2030 deadline related to HIV.

    Speaking at the National HIV Prevention Conference on Tuesday, Health and Human Services Secretary Alex Azar expressed support for needle exchange programs as a way to stop the spread of HIV.

    Republicans like Azar have largely resisted these programs, believing that they will encourage drug use—but evidence to the contrary appears to have convinced the HHS Secretary otherwise.

    “Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican health secretary, but we’re in a battle between sickness and health, between life and death,” Azar said during his speech according to The Hill. “The public health evidence for targeted interventions here is strong, and supporting communities when they need to use these tools means fewer infections and healthier lives for our fellow Americans.”

    Needle exchange programs have existed for years, but are as important as ever with the national opioid crisis. These programs have reduced the spread of dangerous viruses such as HIV and hepatitis C through intravenous drug use. The first such program in the U.S. was established in 1988 in Tacoma, Washington, and was rewarded with a 60% reduction in new hepatitis B and C cases.

    Studies over the decades have also consistently found that these services do not increase the number of intravenous drug users. At the same time, needle exchange programs cost significantly less than treating new cases of HIV and hepatitis.

    However, the larger Trump administration still opposes these programs as well as safe injection sites where individuals can use drugs without fear of arrest, and in the presence of medical professionals who both provide clean equipment and are ready to save lives in case of an overdose.

    In February, the Department of Justice sued Safehouse, a non-profit organization based in Philadelphia, to prevent them from opening the country’s first safe injection site.

    Azar’s reversal on needle exchange programs may be related to a new 2030 deadline related to HIV. Earlier this month, the Trump administration revealed its 2020 budget proposal, which included a request for $291 million for an ambitious plan to end the “HIV epidemic” in a decade.

    “For the first time in modern history, America has the ability to end the epidemic, with the availability of biomedical interventions such as antiretroviral therapy and pre-exposure prophylaxis (PrEP),” the budget plan reads.

    With Azar’s statements at the National HIV Prevention Conference, it appears that needle exchange programs could become a part of these efforts. Most of the $291 million requested will be given to the Centers for Disease Control and Prevention (CDC), which supports and helps to fund these services.

    View the original article at thefix.com

  • Some San Francisco IV Drug Users Choose Fentanyl Over Heroin, Report Says

    Some San Francisco IV Drug Users Choose Fentanyl Over Heroin, Report Says

    Harm reduction advocates in the city urge IV drug users who choose to use fentanyl to run additional drug tests to “see what else might be in the mix.”

    The synthetic opioid, fentanyl, currently tops the list of drugs with the greatest likelihood of causing a fatal overdose; more than 18,000 people died from fentanyl-related overdoses in 2017, according to a report from the National Center for Health Statistics. Fentanyl’s lethal potential has been the subject of countless media stories.

    But a recent article on Stateline, the Pew Charitable Trust’s research and analysis blog, reported that some IV drug users in San Francisco’s Tenderloin district are actively choosing fentanyl over heroin.

    City health officials state that a number of factors have contributed to the drug’s popularity, including a low death rate, a degree of transparency among dealers and a sizable supply of the overdose reversal drug Narcan from local health and harm reduction groups.

    While much of the country saw fentanyl enter the illicit drug market in the mid-2010s, it wasn’t widely available in California until 2015. But as the Stateline article noted, the toll taken on California’s drug community—and in particular, on San Francisco IV drug users—wasn’t as severe as the wave of deaths that swept through New England and the Appalachian region.

    Figures from 2016 show that the California death rate that year hovered at 4.9 deaths per 100,000 persons, while the national death rate was 13.3 deaths per 100,000.

    Part of the reason for the lower numbers can be attributed to treatment and prevention efforts. The Stateline blog noted that California expanded Medicaid to low-income adults in 2010 and established a strong baseline of treatment options in subsequent years. San Francisco, in particular, has open lines of dialogue between drug users that help to guide the city’s health policy.

    “San Francisco’s harm reduction community systematically talks to drug users about their preferences and experiences,” said Daniel Raymond, policy director of the national Harm Reduction Coalition. “[They] continuously feed that information to the San Francisco Department of Health, which uses that intelligence to inform its message and overdose prevention strategies.”

    When the drug arrived in San Francisco in 2015, public health and harm reduction groups banded together to increase treatment options, availability to Narcan and drug testing strips, and outreach programs. The drug is also clearly labeled by dealers, so there is less of a chance of accidental ingestion, and its street cost is lower than heroin. As a result, fentanyl is the drug of choice for about half of Tenderloin users, as well as those in some neighboring communities.

    “For drug users, it’s just like you or I making decisions about the products we choose when we grocery shop,” said drug test administrator Kristen Marshall in the Stateline article. “Fentanyl is stronger, you need less of it, and it’s cheaper. So why wouldn’t I, as somebody with limited funds, want to spend my money on something that’s a better value and therefore a better product?”

    To be clear, fentanyl remains a dangerous drug, even more so than heroin. And many Tenderloin drug users avoid it, especially those who overdosed on other drugs laced with fentanyl. But for those that deliberately choose it, Marshall said that a policy of less-is-more appears to work.

    “Use less of it, use it slower, use it with other people, and keep Narcan with you,” she said. “It’s also important to test your drugs. Even if you know you’re getting fentanyl, you need to run additional tests to see what else might be in the mix.”

    View the original article at thefix.com

  • How I Came To "Believe” In Safe Injection Sites

    How I Came To "Believe” In Safe Injection Sites

    The part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.  

    So last night I’m at a town hall event on drug addiction and someone mentions safe injection sites in the audience. My heart begins to pound from having my hand up and hoping to get called on, so I can ask about this, among other topics.  

    The panel looks around at each other trying to see who will bite first, as it’s clearly a controversial topic. Finally, the one “token recovery guy” speaks up, “You know, studies are positive, but people are very opposed to the idea, and the last time we had a discussion about it a fight nearly broke out.”

    And so, I wanted to get up. And I wanted to have that fight.  

    But I was taught to cease fighting anything and anyone. What about fighting substance use disorder? I thought my disease was doing pushups? Certainly, this disease is wreaking havoc across our country, especially with the younger generations, and what are we, as a community, prepared to do about it?  

    Who is fighting on the front lines? While communities claim “not in my backyard” absolution, so do the “anonymous people” who are in recovery in this country. They are told to have no opinion on outside issues. But, to me, this isn’t an outside issue, because the part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.  

    Thankfully, I have met many who are rank and file generals in this fight, however compared to the #’s we could have, it is disappointing, and makes creating change in our communities even more difficult.  

    Clearly, safe injection options are not a solution, but saying “he or she must not have wanted it enough” when they drop out of the only pathway we are offering, which for mainstream recovery is a 12-step program, is an even less valid answer.  

    12-step can be successful, alongside other treatment modalities, but it is often seen as “the” solution and not “a” solution.

    And what about statistics? Research shows that overdose rates decrease around the area of the safe injection site. If this statistic alone isn’t a good enough reason to support them how about that the rate of people who were entering treatment in those areas increased? 

    Look, don’t get me wrong, I was once on the other side of this conversation. I had a lot of misguided beliefs before I entered recovery. I once thought when I was 16 and my drinking career had just begun, that if I could get my dad to give me driving lessons while I was drinking, I wouldn’t have a drinking and driving problem!

    Clearly being open-minded that my own thinking could be wrong is an important aspect of recovery, and so while I was made to think I should be open-minded about the program, I was indoctrinated to believe recovery was a static black-and-white thing, and that I was a miracle because I didn’t use, and while this may be true, it also underlined another assumption, that those who didn’t make it were not entitled to these miracles.  

    The idea that there is a level of participation required for someone to enter recovery is not lost on me, but the fact of the matter is, more and more people, especially those from the younger generations, are struggling to find their way in recovery and our answer to the staggering overdose and relapse rates is “they must not have been ready.”  

    So now what? What do we do with people who aren’t ready? Tell them to go out and give their substances another try? Drugs which could easily kill them in one shot? In my mind, if someone is not ready for abstinence-based recovery it isn’t that they have failed, it’s that they may not have reached that point yet, they may never reach that point, and who are we to say what that should look like.  

    There are many people who reach a significant “bottom,” only to find themselves using again. Can anyone say, who is honest with themselves, that a “bottom” is what creates recovery? Surely it can help, but there are many who hit that point and beyond, and for those people, while their lives continue to crumble around them, what is available?

    To me, this is why we need to offer as many solutions to this problem as we can. Not offering alternative methods like safe injection sites, or medically assisted treatment, is like saying to someone who has diabetes they can’t go to the hospital for support, or shouldn’t have to take insulin, they should just use their higher power, and if they can’t clearly, they don’t want to be healthy enough.

    Change is possible without necessarily being at a point of relying on grace only. While I believe in grace and have my own stance on faith, I believe this “coveted” winners circle of recovery is an issue and is not saving lives, especially amongst young people.

    Do I believe willingness is an important key to recovery? Certainly, yet how many of us become willing along our path of using? So why would we not want to create opportunities for the people who are using, to not only stay alive, but be near recovery support services?  

    When someone has a reoccurrence of use, do we no longer consider them in recovery? Therefore, by that logic, anyone who is in active use has the potential to effect this same change in their lives. Hospitals, fire houses, police stations, med express, anywhere, anytime someone wants out of the cycle, it should be as easy as getting a flu shot. It is that easy to get high or drunk.

    Finding drugs is way easier than finding recovery, unfortunately, we don’t seem to be making much headway on that stat. It shouldn’t be so difficult to get help, and yet it is. Clearly, we have quite a way to go, and so while we stand at the frontlines arguing for much-needed treatment options, housing options, peer support options for people in early recovery, we need to also keep our eye on how we can affect those who haven’t gotten to that point yet.    

    So, I didn’t get up and fight at the town hall meeting, because I know that the only way change will be affected is if compassion and reason win over misunderstanding and hatred. The only way we can win, and by we, I mean the parents who lost children to overdoses, and by we, I mean the advocates who mentor peers who end up overdosed in alley ways, and never make it home to their families, is if we can convince society that shaming people is not working and giving them opportunities for change are the best ideas we have currently.   

    I understand clearly that this option is seen as enabling to some. That we are encouraging people to use by providing needles and a safe place to go. The concept is not lost on me, but current models are not working. Prevention talks often fall on deaf ears, and while it doesn’t mean we shouldn’t continue to try to reach people, it does mean we need to get real about whether we are doing all we can do to help prevent overdose deaths in this country. 

    If someone who is opposed has a better idea of how we can get the people in our communities, who are using illicit substances, out of the shadows and into the light where we can see them and help them, please by all means share it.  

    To me the big bad wolf in this situation is that we would have to admit as a community, that people in our community, have heroin problems. We don’t like to admit that, and unfortunately it’s killing people.  

    I would argue that whatever motives you have for being opposed to this option, check them against the idea that centralizing use as best as possible helps to a.) measure your community and its needs, b.) provide safety and support to a vulnerable part of the population c.) encourage the next step for people to move on with their lives and d.) minimize the risk to police and health care workers responding to overdoses.  

    One of these reasons alone in my mind is enough to at least give it a try. Saving just one life means so much, especially if it is your child, your brother, your sister or your parent. Sharing this pain with too many people in too short of a time period is how I came to believe in safe Injection sites. 

    Erik Beresnoy is a father, advocate, and a writer on topics that range from recovery, and spirituality to music and philosophy.  Erik has been an active member of the recovery movement since 2008, when he himself entered recovery, and began to not only repair his life but to also seek help repair his community by working to implement new strategies. His current projects include Empowerment Coaching for the Ammon Foundation, and implementing a transformational program in NYC called Dare to Dream for Synergy Education. He is a certified recovery coach as well as a board member for Rockland Recovery Homes. His other works can be viewed at soberspiritmeditation.com.

    View the original article at thefix.com

  • Heroin-Related "Wound Botulism" Found in San Diego

    Heroin-Related "Wound Botulism" Found in San Diego

    Nine people have been hospitalized with the heroin-related illness in California.

    An outbreak of a rare and life-threatening illness linked to black tar heroin use was discovered in San Diego, prompting health officials in the Southern California city to launch an investigation while warning doctors and IV users alike to be aware of the condition.

    The Centers for Disease Control (CDC) reported that nine cases of wound botulism, which is caused by a toxic bacterium entering the body through a wound, were discovered between 2017 and 2018, which resulted in one fatality and intensive care treatment for all nine individuals.

    Though the number of cases may seem relatively small, only 20 cases of wound botulism are reported per year for the whole of the United States, so the situation was cause for alarm for both state and national health care officials.

    According to the CDC report, two patients with a history of using black tar heroin — so called because of its dark, sticky appearance, caused by crude and often contaminated processing — were believed to have contracted wound botulism though IV drug use.

    The County of San Diego Public Health Services (COSD) issued an alert through the California Health Alert Network to notify Southern California doctors of the situation. A subsequent investigation by the COSD and the California Department of Health eventually found nine patients – eight confirmed and one probable – by April of 2018.

    All nine were IV drug users, and seven reported using black tar heroin. Of the latter number, six reportedly injected the drug through “skin popping,” or injecting the drug under the skin.

    Symptoms of wound botulism typically manifest several days after injecting the contaminated drugs and may include double or blurred vision, slurred speech, dry mouth and muscle weakness.

    If left unchecked, it can result in labored breathing and even paralysis. However, many of these symptoms coincide with signs of opioid use or overdose, and in four of the cases, the individuals were initially diagnosed with drug intoxication, and two were treated with the overdose reversal drug naloxone. 

    Eventually, all of the patients were diagnosed with wound botulism and treated with heptavalent botulism antitoxin (BAT), and eight were transferred to long-term care facilities; the ninth patient declined further treatment. One of the eight died after nine days in long-term care.

    The COSD issued health alerts in 2017 and 2018 notifying health care providers to inform IV drug users about the risks of contracting wound botulism and asking them to carefully observe patients reporting IV drug use history for symptoms. One day after the 2018 alert, clinicians reported additional cases of suspected wound botulism for two hospitalized patients.

    The CDC’s report concluded with a request for heightened awareness of the condition for both doctors and IV drug users, in light of the national opioid crisis.

    Dr. Sayone Thihalolipavan, the deputy public health officer for San Diego County, reiterated the need for careful observation of IV drug patients.

    “Even if they’re seeking treatment, providers might not be recognizing it for what it is,” he said. “Patients can think they’re feeling out of whack due to the drug itself and not realize that the drug is actually contaminated.”

    View the original article at thefix.com

  • Virus That Infected Our Ancestors May Play a Role in Addiction

    Virus That Infected Our Ancestors May Play a Role in Addiction

    Researchers studied whether the retrovirus played a part in promoting addiction in some individuals.

    A virus that infected a human-related species more than 250,000 years may be the key as to why some individuals are more likely to develop dependencies towards drugs or alcohol.

    A recent study found that traces of an ancient retrovirus – a virus that inserts its genetic code into its host’s DNA – known as HK2 was up to three times more likely to be found in the genetic makeup of individuals who had contracted either HIV or hepatitis C through intravenous drug use than individuals who had become infected through other means, such as sexual intercourse.

    Traces of the HK2 virus are believed to exist in approximately 5 to 10% of the global population.

    The study, conducted by researchers from the University of Athens in Greece and Oxford University in London, England, was published in the Journal of the National Academy of Sciences and was comprised of two parts: the Greek research group analyzed the genes of more than 200 individuals with HIV, while the English group looked at the DNA of approximately 180 individuals infected with the hepatitis C virus. 

    The Greek researchers found that the members of their study group that contracted HIV from intravenous (IV) drug use were 2.5 times more likely to have traces of the HK2 retrovirus in their genetic makeup than those who became infected through intercourse or other means.

    The English researchers found similar results in their study group, with those who contracted hepatitis C through IV drug use and were long-time drug users 3.6 times more likely to have traces of the retrovirus in their genes than those who were infected in another manner.

    As Live Science noted, when HK2 is found in an individual’s DNA, it is found in a gene called RASGRF2, which is involved in the release of dopamine – the neurotransmitter linked to the brain’s pleasure circuitry, and the chemical released by the brain in large amounts during drug use which scientists believe causes the repetition of such experiences.

    The second part of the study yielded less concrete results: scientists inserted traces of HK2 into the RASGRF2 gene in human cells that did not already contain it. While they discovered that the virus changed the means in which DNA created proteins, it remained unclear as to its direct connection to addictive behaviors.

    According to co-senior study author Aris Katzourakis, professor of evolution and genomics at the University of Oxford, the study is “the first time that researchers have shown that an ancient viral insertion that’s variably present in the population has a measurable, in this case detrimental, effect on our biology,” though as CNN noted, the RASGRF2 gene was associated with binge-drinking in a 2012 study.

    The next step is to determine how HK2 influences dependent behaviors, with the end goal being a “drug to target” where the retrovirus has infiltrated the gene.”

    Doing that may allow science to “help people recovering from this kind of behavior,” said Katsourakis.

    View the original article at thefix.com