Showing posts with label hepatitis. Show all posts
Showing posts with label hepatitis. Show all posts

Sunday, 19 June 2016

Princess Health and Dangers of HIV and hepatitis from intravenous drug use reach far beyond addicts and families, threatening a wide swath of Ky.. Princessiccia

The growing use of heroin and the abuse of prescription painkillers in Kentucky also mean that the state "is being ravaged by the diseases that follow in their wake: hepatitis and HIV. These dangers also reach far beyond addicts and their families, threatening a wide swath of the population," Laura Ungar reports for The Courier-Journal.

Kentucky has one-fourth of the 220 U.S. counties that the U.S. Centers for Disease Control and Prevention had judged to be at high risk for outbreaks of HIV and hepatitis C among intravenous drug users, Ungar notes in the second installment of a three-part series on heroin in Kentucky and adjoining states.
"Acute hepatitis B rose 114 percent in Kentucky, Tennessee and West Virginia from 2009 to 2013, even as incidence remained stable nationally, according to one study," she reports. "According to another study, the rate of new hepatitis C cases among people 30 and younger more than tripled from 2006 to 2012 in Kentucky, Tennessee, Virginia and West Virginia. More recently, cases of acute hepatitis B and C in Kentucky reached 281 last year, up from 120 in 2003."

Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Ungar that hepatitis C has become the top cause of death from reportable infectious diseases in the U.S., and an HIV outbreak in Austin and Scott County, Indiana, �was a wake-up call� for the country. Ungar notes, "Addicts may also be spreading both diseases without knowing it. Up to three in four people with hepatitis C, and one in eight with HIV, don�t know they have it, experts say."

Dr. William Cooke, an Austin physician "who treats dozens of patients with HIV and hepatitis, said many communities are ill-equipped to handle the threat," Ungar writes. "All over the region and nation, he said, there�s too little substance abuse treatment, too little emphasis on the poverty that often accompanies addiction and too little compassion."

Kentucky has authorized needle exchanges where addicts can get clean syringes to avoid the threat of infection from contaminated needles. "Officials say needle exchanges are an important part of a comprehensive strategy to control disease," Ungar notes. "But critics argue these programs enable drug use, and many area residents reject the idea of using public money to fund them. So the prospect of more syringe exchanges in the region remains uncertain."

Ungar gives the basics of how the diseases spread: "HIV, which can be transmitted through semen and other bodily fluids in addition to blood, is mainly spread by having unprotected vaginal or anal sex with someone who has HIV, or sharing used needles, which can harbor live viruses for up to 42 days. But it also can be transmitted to health care workers by needle sticks, or from mother to child during pregnancy, birth or breastfeeding, especially if the mom isn't taking medicine.

"Hepatitis B and C, which are caused by separate viruses, are easier to catch than HIV because there are higher levels of virus in the blood. Hepatitis B is more often contracted through sex or accidental needle sticks than hepatitis C, but both types are commonly spread by sharing tainted needles."

Wednesday, 25 May 2016

Princess Health and Woman stuck by needle faces up to one year of testing for HIV and hepatitis; dirty needles becoming common in public places. Princessiccia

By Melissa Patrick
Kentucky Health News

A Monroe County woman was stuck by an insulin needle found in a pair of sweatpants she purchased at the Walmart in Tompkinsville and now faces up to a year of testing to make sure she hasn't been infected with HIV or hepatitis, Jacqueline Nie reports for WBKO-TV in Bowling Green.
Insulin syringes are commonly used by IV drug abusers

"I had to be tested for HIV and hepatitis and a drug screening," said Mary Crawford, who was stuck by the needle. "I have to go back from that in 30 days and be tested again, and again in 6 months from that 30 days."

"Crawford says through at least these next 7 months, she cannot share anything with her husband or children," Nie repports. Crawford warned others to be careful: "It could happen to anybody, anywhere."

The latest Kentucky Health Issues Poll found that 13 percent of Kentuckians said they knew someone with heroin problems. And insulin syringes and needles are commonly used to inject it.

Clark County Public Health Director Scott Lockard said that while this was the first time he had heard of a needle being placed in an article of clothing in a department store, he said it is not unusual for dirty needles to be found in public.

"Unfortunately it is becoming more common for used needles to be found by the public," Lockard said in an e-mail. "I have had reports of needles being found locally on streets, in parks, public parking lots, unoccupied buildings, and in restrooms in public venues."

The problem is so bad in Northern Kentucky, where 35 percent in the poll said they knew someone with a heroin problem, that they released public service announcements before Easter to remind children to look for needles before eggs. The Northern Kentucky Heroin Impact Response Taskforce organized police and egg-hunt organizers to search parks for needles prior to the hunts, and said it will continue to search public places for needles throughout the summer, Ben Katko reported for WXIX-TV (Fox 19).

One way to keep dirty needles off the street is through needle exchanges, which allow intravenous drug users to exchange dirty needles for clean ones. These programs were authorized in Kentucky by the 2015 anti-heroin bill, but require both local support and funding.

So far, only 14 counties in Kentucky have either approved or are operating needle exchanges: Jefferson, Fayette, Jessamine, Franklin, Clark, Kenton, Grant, Harrison, Pendleton, Carter, Boyd, Elliott, Pike and Knox. Some jurisdictions have rejected exchanges, saying they encourage drug use, despite pleas from experts who say that's not true and the programs lead users to treatment.

"Needle exchanges work," former state health commissioner William Hacker said. "It decreases the spread of infectious diseases. It takes dirty needles off the street. It is safer for the law enforcement and EMS. It also provides an opportunity to interact with people and divert them to effective treatment."



Thursday, 24 March 2016

Princess Health and  Boyd, Clark counties approve needle exchanges; Boyd's is a limited, one-for one; Covington's proposed limits draw objections. Princessiccia

Princess Health and Boyd, Clark counties approve needle exchanges; Boyd's is a limited, one-for one; Covington's proposed limits draw objections. Princessiccia

By Melissa Patrick
Kentucky Health News

Clark and Boyd counties are the ninth and 10th Kentucky counties to approve a needle-exchange program, and Madison and Anderson counties are talking about it. Meanwhile, the city of Covington has approved an exchange with conditions that don't match its health department's plan, and one of the conditions might not even be legal.

Needle exchanges were approved under the state's anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and the hepatitis C virus (HCV), which are commonly spread by the sharing of needles among intravenous drug users.

Clark County Health Director Scott Lockard noted that the federal Centers for Disease Control and Prevention has "identified 54 counties in Kentucky as being vulnerable to rapid dissemination of HIV or HCV infection among persons who inject drugs. Of the top 25 most vulnerable counties in the nation 16 of them are in our state."

Clark County

On March 23, the Clark County Fiscal Court approved on a 4-2 vote a needle exchange that will start on or before June 1, but the program will need re-authorization in January, Greg Kocher reports for the Lexington Herald-Leader.

"Both the Fiscal Court and the [Winchester] City Commission inserted a sunset clause in the orders requiring the health department to present data on our program in January 2017 in order to get re-authorization for a longer time period," Lockard told Kentucky Health News in an e-mail.

He noted that the CDC identified nearby Wolfe County as the most vulnerable county in the nation to rapid dissemination of HIV and HCV among drug users, with adjoining Powell and Estill counties 15th and 25th, respectively.

"Residents from all three of these counties frequently come to Clark County for medical services from our provider community and the health department," he said. "More must be done in the area of prevention if we are to avoid a situation similar to what Scott County, Indiana, encountered."

That county, about 30 miles north of Louisville, has drawn national attention for its high rates of HIV and hepatitis C, mostly caused by intravenous drug users who share needles. According to published reports, "from November 2014 to mid-June 2015, the Indiana county of 24,200 reported 170 HIV cases. It reported 130 new cases of hepatitis C in 2014," noted Bill Robinson of The Richmond Register.

According to Lockard, Clark County's program will use a patient negotiation model, which does not require a one-to-one needle exchange, during the initial visit, but will try to get close to a one-for-one model on subsequent visits.

"We will educate participants that they need to return needles to get needles," he said.

Boyd County

The Boyd County Fiscal Court voted 4-1 March 15 to approve a one-to-one needle exchange for one year, Lana Bellamy reports for The Daily Independent. 

The Ashland City Commission had already given its approval for the exchange, which may begin as early as July. Bellamy reports that the program will be paid for by special taxing districts, and all of the fiscal court members voiced concerns about the sustainability of the funding.

Ashland-Boyd County Health Department Director Maria Hardy told the court that syringes typically cost about 97 cents each, but the health department will be able to buy needles from a distributor for 9 cents each, Bellamy writes.

The Boyd County program will assign tracking numbers to its participants to protect their identities and allow a maximum of 40 needles to be exchanged each week.

County Commissioner John Greer, the only member to vote against the resolution, said he was concerned the program would encourage drug abuse and Sheriff Bobby Jack Woods agreed, Bellamy reports. This is a common concern among opponents of needle exchange programs, though evidence-based studies have proven otherwise.

Covington

During the same week, the City of Covington approved a needle-exchange program, but with conditions that could kill the program, Terry DeMio reports for The Cincinnati Enquirer.

The conditions are that all participants be tested for hepatitis C, hepatitis B, HIV, and, where applicable, pregnancy. That could be illegal, DeMio reports.

A Northern Kentucky Health Board spokeswoman told DeMio that they believe that they cannot require anyone to undergo any medical procedures, but said they were checking with legal counsel. Other health and harm-reduction officials told DeMio that this requirement is not legal, and that such a condition would likely prevent a program from getting off the ground.

"The Covington commission's resolution includes other conditions that differ from the health board's model program, too, and would require passage from the Kenton County Fiscal Court and the Board of Health before it's approved," DeMio writes.

These conditions include a requirement that two other counties in the Northern Kentucky Health District also adopt a needle-exchange program (only Grant County has); restrict use of the program residents of the district's four counties; and moving the exchange to St. Elizabeth Healthcare hospital.

The city also wants a one-for-one exchange, Michael Monks reports for The River City News.

The health department says its plan is "need-based," not one-for-one, because studies show that is the best way to reduce the risk of community exposure and spread of HIV and HCV. This is the main goal of the program, although needle-exchange programs also provide HIV and HCV testing and access to drug treatment.

The health department's plan is to initially provide clients with the number of syringes they would use in a week, along with a safe container for their return with instruction to return the used needles for new ones. Participants who don't return dirty needles after three trips would not receive new syringes, DeMio reports.

The department has been trying to establish needle-exchange programs in the district since the law passed one year ago. The Kenton County Fiscal Court is expected to discuss a needle exchange plan March 29, DeMio reports.

Dr. Lynne Saddler, the health department's director, told the Enquirer "that the Covington resolution was a start and that more discussion is planned by the health department."

Other counties

Madison County Health Department officials are also worried about becoming another Scott County, Indiana, as they face an epidemic of heroin use in their county, Bill Robinson reports for The Richmond Register.

Thus they have begun the process of educating their public officials, Robinson writes. Public Health Director Nancy Crewe presented her detailed findings to support a needle exchange at a quarterly joint meeting of the county Fiscal Court, Richmond City Commission and Berea City Council, noting that they were just beginning the long process of educating the public.

A needle exchange program was also brought up at the March meeting of the Anderson County Fiscal Court meeting, and was met with some disparaging remarks, Ben Carson reports for The Anderson News.

"What jackass thought of that idea?" asked Magistrate David Montgomery. "We might as well give them the dope, too."

Despite these comments, Montgomery did volunteer to be on a committee to explore a needle exchange program along with members of the health board, Lawrenceburg City Council, law enforcement, EMS and county jailer.

Robinson also reports that the Bourbon County Fiscal Court has voted to reject an exchange.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and in the counties of Pendleton, Carter, Elliott, Franklin, Grant, and Jessamine.

Friday, 12 June 2015

Princess Health and Louisville opens first needle exchange in state; officials predict rural counties will be slow to follow.Princessiccia

Photo by Scott Utterback, The Courier-Journal
Louisville Metro Public Health & Wellness opened its mobile needle-exchange program Wednesday, June 10, making Louisville the first place in Kentucky to implement such a program.

Lexington and Northern Kentucky are expected to follow soon, but officials say that establishing needle exchanges in much of Kentucky will be "more politically complex," Mike Wynn reports for The Courier-Journal.

"We're going to see some parts of our state where this is available and others where it is not," Scott Lockard, president of the Kentucky Health Departments Association, told Wynn. "Rural areas are opting for a slow and deliberate approach, heavy on education and dialogue," he said, and some communities won't even consider a exchange because of "seemingly endless hoops to jump through."

Bullitt County, south of Louisville, is a prime example. There, officials told Wynn that they plan to do a needs assessment and host a community forum with input from law enforcement and mental health experts.

"It's a work in progress," Public Health Director Andrea Renfrow told Wynn. "We are not able to go as quickly as Louisville Metro."

One critic, Magistrate Joe Laswell, told Wynn that he had talked to many voters who are against the exchanges and want to know why police wouldn't arrest addicts when they show up to swap out dirty needles. "I believe in charging and incarcerating," he said, apparently unaware that the addicts would need to have drugs in their possession to be charged.

Lockard, who heads the Clark County Health Department, told Wynn that he won't ask his board to take a vote until August and that he can't predict the political outcome when it goes to city and county officials.

In three other Bluegrass counties, Scott, Harrison and Nicholas, the board of the Wedco District Health Department wants to start a needle exchange, reports The Cynthiana Democrat, but can't proceed in any of the counties without approval of the fiscal court.

So, despite the two-year debate that just ended in Frankfort over the law, it's not really over.

Democratic state Rep. John Tilley of Hopkinsville, the legislature's biggest proponent for needle exchanges, told Wynn that giving city councils and fiscal courts final authority over the programs was necessary to sooth critics and pass a comprehensive heroin bill this year.

Opponents of the law say the exchanges promote drug use, while proponents cite evidence that doesn't support those claims, but instead "help prevent the spread of deadly and expensive diseases and pull addicts into treatment programs while keeping dirty needles out of parks and off the streets," Wynn writes.

A Lexington Herald-Leader editorial wrote about needle exchanges: "Congressional critics rely on a gut feeling that providing needles endorses drug use, but 20 years of research argues otherwise." Listing that where there are syringe exchange programs:
  • Participants are five times more likely to get treatment.
  • HIV and hepatitis C declines among drug users.
  • Participants can get referrals to substance abuse treatment, disease prevention education, vaccinations, condoms, counseling and testing for communicable diseases.
  • Costs are more than recaptured. A 2011 European study found that $1 spent on needle-exchange programs yielded $27 in health-care cost savings, prompting an international report to call needle exchanges "one of the most cost-effective public health interventions ever funded."
The federal Centers for Disease Control and Prevention recently reported that new cases of hepatitis C more than tripled in Kentucky, Tennessee, Virginia and West Virginia between 2006 and 2012, mainly from the use of dirty needles. Officials fear an outbreak of HIV and AIDS will follow.

Sunday, 7 June 2015

Princess Health and Hepatitis C is on the rise in Appalachian Kentucky, and dirty needles are to blame; officials predict surge of HIV to follow.Princessiccia

Kentucky has the highest rate of acute hepatitis C in the nation and public officials predict it could get much worse, Claire Galofaro and Dylan Lovan report for the Kentucky bureau of The Associated Press.

Dirty needles shared by drug users is the primary cause of this upsurge in hepatitis C, a contagious liver disease that destroys the liver, often leads to cancer or cirrhosis, and is the leading cause of liver transplants. It is spread primarily through contact with the blood of an infected person.

Patton Couch talks about his troubles.
(AP photo by David Stephenson)
Patton Couch, 25 and one month sober, is one of thousands of young Appalachian drug users recently diagnosed with hepatitis C. Galofaro tells the story of how one night four years ago, Couch said �he plucked a dirty needle from a pile at a flophouse and jabbed it into his scarred arm� even though he knew most of the addicts in the room probably had hepatitis C.

"All I cared about was how soon and how fast I could get it in," he says. "I hated myself, it was misery. But when you're in the grips of it, the only way I thought I could escape it was one more time."

Public-health officials are also concerned that Kentucky or part of it will become the next Scott County, Indiana, which is dealing with one of the worst American HIV outbreaks among injection drug users in decades, Galofaro notes. She says Scottsburg is much like many Appalachian towns � which have poor and/or few treatment options, and have long been seized by an epidemic of prescription drug abuse.

"One person could be Typhoid Mary of HIV," said Dr. Jennifer Havens, an epidemiologist at the University of Kentucky's Center on Drug and Alcohol Research, who has studied Perry County drug users for years as the hepatitis rate spiraled through small-town drug circles there. Of the 503 drug users she has tracked since 2008, 70 percent have hepatitis C.

�An explosion of hepatitis C, transmitted through injection drug use and unprotected sex, can foreshadow a wave of HIV cases,� Galofaro writes.

In Scott County, 160 people have tested positive for HIV in five months, compared to just 49 drug users testing positive in New York City in all of 2013, Greg Millett, director of public policy for the Foundation for AIDS Research, told Golofaro. �This is a canary in the coal mine for other places with high rates of hepatitis C,� he said.

In a study released last month, the federal Centers for Disease Control and Prevention found that hepatitis C cases across four Appalachian states � Kentucky, Tennessee, West Virginia and Virginia � more than tripled between 2006 and 2012.

Kentucky leads the nation in the rate of acute hepatitis C, with 4.1 cases for every 100,000 residents, more than six times the national average, according to the CDC.

Officials in Appalachian are �scrambling to figure out how to stop it, whether through needle exchange programs, drug treatment or jail,� Galofaro writes.

Kentucky passed a law in March allowing local health departments to create needle-exchange programs. The guidelines have been set, but it is up to the counties to decide whether they want one.

Louisville and Lexington plan to launch needle exchange programs this summer, but �few rural communities have expressed interest,� possibly letting the larger cities work out the details first, Van Ingram, executive director for the Kentucky Office of Drug Control Policy, told Galofaro.

Even with the law in place, the debate about the needle-exchange programs persist. Proponents maintain that �we have to change the way we think� about treatment and that doing nothing is not an option, others told her that in small communities, the �fear of being exposed as a drug user may keep users away,� and others objected on a moral ground, �claiming they facilitate drug use rather than prevent it,� Galofaro reports.