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Tag: IV 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

  • 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

  • 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