Opioid Epidemic Trends and Resources

New NCHS Data Show Continued Spike in U.S. Overdose Deaths

There were a total of approximately 66,800 drug overdose deaths in the 50 U.S. states and District of Columbia during the 12-month period ending June 2017, according to the latest provisional overdose death count data published by the National Center for Health Statistics (NCHS).  This figure represents a 16.3% increase over the approximately 57,400 overdose deaths reported in the year ending June 2016. The 10 jurisdictions with the largest year-to-year increases in overdose deaths were: District of Columbia (62%); Pennsylvania (47%); Florida (46%); Ohio (44%); Delaware (42%); Maryland (35%); New Jersey (35%); Vermont (27%); New York City (26%); and Indiana (25%).  Please note that the report consists largely of the overdose death data presented in table form, together with technical notes about the data sources, quality, and completeness, as well as the classifications used. It does not include an analysis or discussion of the data trends for the U.S. as a whole or particular jurisdictions.

Opioid & Health Indicators Database from amfAR

If you are looking for national, state, or local data on the intersecting epidemics of opioid use, HIV, and hepatitis C, you should check out amfAR’s Opioid & Health Indicators Database. This free online resource provides graphic displays of data across these three public health crises.  The Database includes new indicator pages that allow users to view national opioid, HIV, and hepatitis C data, as well as services that are available at the state and county level, including substance use treatment facilities and syringe exchange programs.  Database users can also map local impacts, monitor local trends, and create side-by-side state or congressional district maps of opioid use and prescription rates. 

In related news, amfAR’s Public Policy Office held a briefing, Big Data and the Opioid Epidemic, on December 4 in Washington, D.C.  Representatives from the CDC, academia, and think tanks including the American Enterprise Institute, Center for Budget Policy and Priorities, FasterCURES, and the Kaiser Family Foundation discussed a range of topics, including: the current landscape of the opioid crisis; the challenge of averting opioid-related health crises such as the 2014 HIV and hepatitis C outbreak in Scott County, Indiana; and the importance of data collection, analysis, and sharing to help researchers and policymakers establish new public health-oriented approaches for dealing with the opioid crisis. A short summary of the briefing is available on the amfAR website.

Funding Opportunity

SAMHSA Funding Opportunity to Integrate Mental Health, Substance Use, and HIV Care and Prevention

Early this month, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services announced that it is accepting applications for the fiscal year 2018 Minority AIDS Initiative Service Integration grant program. According to SAMHSA, the purpose of the program is “to integrate evidence-based, culturally competent mental and substance use disorder treatment with HIV primary care and prevention services.” The population of focus for the grants includes persons with a serious mental illness or co-occurring disorder living with or at risk for HIV and/or hepatitis in at-risk populations, including racial and ethnic minority communities. (Please note that “co-occurring disorder” refers to the presence of both a mental health disorder and substance use disorder.)  SAMHSA expects that this program will help reduce HIV incidence and improve overall health outcomes for individuals with serious mental illnesses or co-occurring disorders.  The required activities under this direct services grant include:

•            providing HIV and hepatitis prevention services – such as screening, risk assessment, prevention counseling, rapid testing, pre-exposure prophylaxis, and hepatitis vaccination – within a behavioral health care setting;

•            providing case management services to coordinate all aspects of care, including behavioral health, primary care health, and HIV and hepatitis treatment, and other supportive services (such as housing, benefits, and employment); and

•            implementing outreach strategies to inform individuals of available behavioral health services, and HIV and hepatitis primary care and prevention services.

SAMHSA expects to make up to 10 grants with a maximum annual award of $485,000 each.  Projects can be up to four years in duration. The application due date is March 5. For additional information, please see SAMHSA’s grant announcement summary or the full Funding Opportunity Announcement document.

Funding Opportunity

SAMHSA Funding Opportunity to Integrate Mental Health, Substance Use, and HIV Care and Prevention

Early this month, the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services announced that it is accepting applications for the fiscal year 2018 Minority AIDS Initiative Service Integration grant program. According to SAMHSA, the purpose of the program is “to integrate evidence-based, culturally competent mental and substance use disorder treatment with HIV primary care and prevention services.” The population of focus for the grants includes persons with a serious mental illness or co-occurring disorder living with or at risk for HIV and/or hepatitis in at-risk populations, including racial and ethnic minority communities. (Please note that “co-occurring disorder” refers to the presence of both a mental health disorder and substance use disorder.)  SAMHSA expects that this program will help reduce HIV incidence and improve overall health outcomes for individuals with serious mental illnesses or co-occurring disorders.  The required activities under this direct services grant include:

•            providing HIV and hepatitis prevention services – such as screening, risk assessment, prevention counseling, rapid testing, pre-exposure prophylaxis, and hepatitis vaccination – within a behavioral health care setting;

•            providing case management services to coordinate all aspects of care, including behavioral health, primary care health, and HIV and hepatitis treatment, and other supportive services (such as housing, benefits, and employment); and

•            implementing outreach strategies to inform individuals of available behavioral health services, and HIV and hepatitis primary care and prevention services.

SAMHSA expects to make up to 10 grants with a maximum annual award of $485,000 each.  Projects can be up to four years in duration. The application due date is March 5. For additional information, please see SAMHSA’s grant announcement summary or the full Funding Opportunity Announcement document.

Health Insurance Access

ACA Substantially Increased Health Insurance Coverage Among LGB Persons

During the early years after the Affordable Care Act (ACA) was implemented, the rate of uninsurance among lesbian, gay, and bisexual (LGB) individuals fell by nearly half – from 19% in 2013 to 10% in 2016 – according to The Affordable Care Act and Insurance Coverages Changes by Sexual Orientation. In this brief report published earlier this month, analysts from the Kaiser Family Foundation (KFF) estimate that this increase in insurance coverage corresponds to approximately 369,000 more insured LGB individuals nationwide in 2016 compared to 2013. KFF notes that the decline in the uninsurance rate experienced by LGB groups was similar to that seen among heterosexuals during the same period.  LGB individuals also experienced significant gains in Medicaid coverage between 2013 and 2016 – rising from 7% to 15% – likely the result of Medicaid expansion. KFF analysts calculate that this increase represents an estimated 511,000 more LGB individuals with Medicaid coverage in 2016 compared to 2013.  According to the report, “The ACA has played a significant role in increasing insurance coverage and reducing the rate of uninsurance for people in the United States and many of these gains have translated to the LGB population . . . As the Administration, Congress, and states continue to make changes to the health landscape, including to protections for LGBT individuals, it will be important to monitor these trends in future years.”

Health Communication and Social Media

More Digital Marketing and Email Tips from HIV.gov

The HIV.gov blog has published several new posts focusing on email and digital marketing as part of its ongoing series to help agencies and organizations make better use of digital tools for HIV communication.  These include:

•            Getting Started with Email Marketing – provides guidance on composing engaging subject lines, and incorporating graphics, calls to action, and contact information into your emails;

•           You’ve Got an Email List: Now What? – discusses personalization of your emails; targeted and triggered automation (triggered emails when your subscriber takes action); interactive emails; and “sticky content” – informational content that communicates your organization’s goals while also addressing subscribers’ lifestyles.

•           Building Digital Content for National Black HIV/AIDS Awareness Day 2018 (NBHAAD) – as the title implies, this post focuses on specific opportunities for using digital media to support activities related to NBHAAD. The post includes communication tips, together with links to graphics, key statistics, and personal stories related to Black persons living with HIV in the U.S., as well as information on accessing HIV testing and care services.

Other Resources

In Case You Missed Them: Benefits of HIV Research Forum & Chemsex Panel Discussion

On World AIDS Day 2017, the National Institutes of Health (NIH) Office of AIDS Research (OAR) hosted a two-hour forum entitled, HIV and Beyond: The Benefits of HIV Research. At the forum, leading scientists from several NIH Institutes and Centers discussed key HIV research developments over the course of the HIV/AIDS epidemic.  They described the ways in which these advances are affecting the lives of the nearly 37 million people living with HIV worldwide, as well as the impact HIV research has had on the prevention, diagnosis, and treatment of other conditions, including viral hepatitis, cardiovascular disease, cancers, and blood disorders, as well as the field of organ transplantation.  A brief summary of the forum by OAR director Maureen Goodenow is available on the HIV.gov website, and a video of the full event is available on Youtube.

The recent Biomedical HIV Prevention Summit in New Orleans featured a panel discussion entitled, Chemsex: HIV, Meth, and Opioid Use among Gay Men, the Trans Community, and Older People Living with HIV.  “Chemsex” is a term coined to describe the use of stimulants and other drugs combined with high-risk sexual behavior.  Chemsex has reached crisis proportions among older people living with HIV/AIDS and Black gay men, according to the Urban Coalition for HIV/AIDS Prevention Services (UCHAPS).  “Stigma, shame, isolation, and issues related to aging itself attract many gay and trans women and men living with HIV/AIDS to chemsex.  In the case of Black gay men, already bearing the burden of HIV, meth and opioid use can be devastating to a community already struggling to find resources.”  During the December 4 panel discussion, presenters examined the epidemiologic, clinical, and personal aspects of Chemsex.  The slide set from this panel discussion is available here. 

New CDC Quick Reference Guide: HIV Testing Algorithm

The CDC recently published a new quick reference guide that presents and describes its recommended laboratory HIV testing algorithm for serum or plasma specimens.  The algorithm indicates that laboratories should begin testing for HIV with an FDA-approved antigen/antibody immunoassay that detects HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen to test for established HIV-1 and HIV-2 infection and for acute HIV-1 infection, respectively. The algorithm also indicates that specimens with a reactive antigen/antibody immunoassay result – or repeatedly reactive, if repeat testing is recommended by the manufacturer or required by regulatory authorities – should be tested with an FDA-approved supplemental antibody immunoassay that differentiates HIV-1 antibodies from HIV-2 antibodies.  Depending on the results, further testing may then be required.  According to CDC, this quick guide should be used in conjunction with the 2014 document, Laboratory Testing for the Diagnosis of HIV Infection: Updated Recommendations.