Late-April, 2018

 

In Brief is NEAETC's news service covering the latest developments and educational resources about HIV, hepatitis, health disparities, and related topics. To subscribe, please click HERE.

 

Opioid Epidemic 

 

Surgeon General Urges Many Americans to Carry Naloxone for Reversing Opioid Overdose

On April 5, U.S. Surgeon General Jerome Adams issued an advisory urging many Americans to carry naloxone, a life-saving drug that can reverse the effects of an opioid overdose. The medication is already routinely carried by many first responders, including emergency medical technicians and police officers. However, to help address the growing opioid epidemic, the Surgeon General is now recommending that more persons – including persons at risk for an opioid overdose, as well as their family and friends – also keep the drug on hand. “Each day we lose 115 Americans to an opioid overdose – that’s one person every 12.5 minutes,” noted Surgeon General Adams. “It is time to make sure more people have access to this lifesaving medication, because 77% of opioid overdose deaths occur outside of a medical setting and more than half occur at home . . . To manage opioid addiction and prevent future overdoses, increased naloxone availability must occur in conjunction with expanded access to evidence-based treatment for opioid use disorder.”

 

NIH Launches HEAL Initiative to Address Opioid Epidemic

This month, the National Institutes of Health (NIH) also rolled out the HEAL [Helping End Addiction Long-term] Initiative – which NIH describes as “an aggressive, trans-agency effort to speed scientific solutions to stem the national opioid public health crisis.” In particular, “This Initiative will build on extensive, well-established NIH research, including basic science of the complex neurological pathways involved in pain and addiction, implementation science to develop and test treatment models, and research to integrate behavioral interventions with Medication-Assisted Treatment for opioid use disorder.” Thanks to increased funding allocations from Congress, NIH is nearly doubling funding for research on opioid misuse/addiction and pain from approximately $600 million in fiscal year 2016 to $1.1 billion in fiscal year 2018.” The key objectives of HEAL are to prevent addiction through enhanced pain management, and improve treatments of opioid misuse disorder and addiction. 

NIH research to enhance pain management will focus on:

  • understanding the origins of chronic pain, by developing new tools and biomarkers to detect changes in the brain associated with acute and chronic pain, and then developing tools to control pain and restore function;
  • developing new, effective, and non-addictive approaches for pain management; and
  • enhancing clinical practice by defining and supporting best approaches for pain management.

Research to improve treatments for opioid misuse disorder and addiction will include:

  • “precision prevention” techniques – strategies tailored to individual needs;
  • new treatments for addiction, which NIH describes as “flexible and complementary treatment options for opioid use disorder to reduce drug use, prevent overdoses, and support recovery”;
  • overdose prevention and reversal – developing new agents to prevent and reverse opioid overdose, including for potent drugs such as fentanyl and carfentanil;
  • enhanced treatments for mothers with opioid use disorders and infants with neonatal opioid withdrawal syndrome; and
  • optimized medication assisted treatments.

amfAR Recommends Strategy to Fight HIV, Hepatitis C, and the Opioid Epidemic

In its new 15-page report, Toward an Effective Strategy to Combat HIV, Hepatitis C and the Opioid Epidemic: Recommendations for Policy Makers, The Foundation for AIDS Research (amfAR) urges the adoption of a multifaceted strategy to increase access to treatment, reduce HIV and hepatitis C (HCV) infections, and lower the risk of fatal drug overdoses. The strategy recommendations include:

Increase Access to Treatment

  • increase funding and reduce barriers to addiction treatment programs, including medication-assisted treatment;
  • maintain insurance coverage for people with substance use disorders; and
  • support research for new treatment options and overdose prevention.

Reduce HIV and HCV Infections

  • lift the ban on the use of federal funding for syringes;
  • develop state legislation authorizing the operation of syringe services programs (SSPs) and increase funding for SSPs;
  • remove barriers to receiving treatment for HCV;
  • maintain funding for services for people with HIV; and
  • support surveillance for HCV, HIV, and other infections.

Prevent Drug Overdoses

  • develop new funding streams to purchase naloxone and to make naloxone available to first responders and community members;
  • enact naloxone access and Good Samaritan laws; and
  • consider implementation of supervised consumptions sites.

The amfAR report concludes, “These recommendations provide a summary of federal and state actions that will be necessary to reduce drug-related deaths, reduce secondary infections like HIV and hepatitis C, and improve health outcomes for all people with substance use disorders. Ending the opioid epidemic is possible, but we must begin to act now.”

 

Impacts of Medicaid Expansion on the Opioid Epidemic

In related news, another recent amfAR study assessed the effects of Medicaid expansion on the U.S. opioid epidemic. In this study, amfAR researchers used Medicaid enrollment and reimbursement data from 2011 to 2016 in all states, and evaluated prescribing patterns of opioids and three Food and Drug Administration–approved medications used in treating opioid use disorders: buprenorphine, naltrexone, and methadone. Their analysis showed that per-enrollee rates of buprenorphine and naltrexone increased by more than 200% after states expanded Medicaid eligibility. In contrast, among the states that did not expand eligibility, prescribing rates increased by less than 50%. Prescriptions for methadone decreased in all states in this period, with larger decreases in expansion states.

According to amfAR, “the findings provide compelling evidence to refute claims made by some Members of Congress that Medicaid has fueled the opioid epidemic. The analysis also underscores that Medicaid is one of the most powerful tools in our arsenal to fight the opioid epidemic, and attempts to discredit its role in improving the lives of Americans living with substance use disorders are counterproductive and not supported by the best available evidence.”

 

Kaiser Brief Spotlights Key Points About the Intersecting HIV and Opioid Epidemics

The connections between HIV and the worsening U.S. opioid epidemic are also the focus of a recent graphically rich issue brief, HIV and the Opioid Epidemic: 5 Key Points, developed by the Kaiser Family Foundation. The key points, which are summarized in both text and graphic form are:

  1. The decline in HIV infections associated with injection drug use [IDU] has been a major success in the fight against HIV in the U.S., with the share of new HIV infections attributed to injection drug use falling from an estimated 40% in 1990 to just 6% in 2015.
  2. However, 2015 marked the first time in two decades where the number of HIV diagnoses attributed to IDU increased, largely associated with the opioid epidemic and subsequent HIV outbreak in Scott County, Indiana.
  3. The demographics of people with HIV attributed to injection drugs are increasingly similar to those most at risk for opioid use and addiction, with greater shares of those newly diagnosed being white and younger, relative to earlier years in the epidemic.
  4. While there are several proven strategies available to reduce risk of infectious disease associated with injection drug use, including the provision of Syringe Exchange Programs (SEPs), access varies significantly across the country and does not always align with opioid epidemic epicenters.
  5. While all Medicaid programs and some private plans cover Medication-Assisted Treatments (MATs) to address substance use problems, the AIDS Drug Assistance Program (ADAP) of the federal Ryan White HIV/AIDS Program offers an additional source of support for people with HIV with limited or no insurance coverage.

 

Chemsex Forum 

 

AIDSmap Reports Selected Highlights from Second European Chemsex Forum in Berlin

 

The HIV news site AIDSmap recently published several articles highlighting key findings presented at the Second European Chemsex Forum, which was held in Berlin, Germany, from March 22 through 24. Broadly defined, chemsex refers to the use of drugs – often illegal ones – to increase pleasure during sex. 

 

Non-Consensual Sex Is a Recurrent Problem in the Chemsex Environment – This article notes that, “In the context of chemsex, many men feel that their drug use or being in a highly sexualized environment blurs the line around consent. Overdosing means that men might drift in and out of consciousness or may cycle between pleasure and distress while having sex.”

 

Loneliness and Community Are Key to Chemsex - From AIDSmap: “Ben Collins [forum organizer] outlined a typical process that some gay men go through in relation to chemsex. At some point, a man is feeling lonely or bored. He is looking for connection and intimacy, and tries to meet some of those needs using dating apps and social media. He gets introduced to drugs in a sexual context and gets more involved in the chemsex scene. For some men, this becomes problematic. Eventually he may withdraw from chemsex, at which point he becomes lonely again, as Leon Knoops explained. ‘Sex buddies talk amongst each other about how horny, extreme or extended the chemsex sessions are. As long as it’s fun, they’ve got a lot of friends. But once they start questioning the fun, or when they admit having lost control, these sex buddies often disappear into thin air.’”

 

The Chemsex Response Is Reshaping Sexual Health Services and Reinventing Harm Reduction – This article describes how the French community-based organization AIDES has adopted new approaches to provide sexual health promotion, education, peer support, and harm reduction services in a variety of settings, including sex parties, saunas, and sex clubs.

 

Disclosure and Criminalization 

 

Criminalizing HIV Exposure Deters Testing and May Increase Transmission

Laws that criminalize transmission my deter HIV testing among gay, bisexual, and other men who have sex with men (MSM) and might thereby increase HIV transmission, according to a recent study published in the journal PLOS One. In this Canadian study, HIV-negative MSM attending an HIV and primary care clinic in Toronto completed a questionnaire asking whether concern over being prosecuted for HIV non-disclosure affected their likelihood of agreeing to be tested for HIV. 

 

Of the 150 respondents, 7% reported that they were either less or much less likely to be tested for HIV due to concern of possible future prosecution if they were found to be infected with the virus but did not disclose it. “Subsequent models estimated that this 7% reduction in testing could cause an 18.5% increase in community HIV transmission, 73% of which was driven by the failure of HIV-positive but undiagnosed MSM to access care and reduce HIV transmission risk by using ART,” according to the study researchers. “While the full impact of non-disclosure laws may still be unclear, decreasing the pool of individuals on ART through a reduction in HIV testing will not reduce HIV transmissions.”

 

Novel HIV Treatments

 

New Drugs in the HIV Treatment Pipeline

In 2018, there are a far greater number of individual drugs and fixed-dose combinations for HIV infection than in the early years of HIV treatment. However, researchers and drug makers are continuing to develop, test, and market new agents designed to control HIV infection effectively and conveniently in a wide range of patients, including persons infected with HIV that is resistant to many of the current drugs, and those who have difficulty tolerating existing treatments due to drug side effects, drug interactions, and comorbid conditions. In a recent review article published on the TheBodyPro website, pharmacists Neha Sheth Pandit and Jomy George discuss new HIV medications in existing drug classes, as well as some with novel mechanism of action. The drugs described are listed below, followed by their drug class:

  • MK-8591 – nucleoside reverse transcriptase inhibitor (NRTI or “nuke”)
  • Doravirine – non-nucleoside reverse transcriptase inhibitor (NNRTI or "non-nuke")
  • Elsufavirine – non-nuke
  • Long-acting rilpivirine – non-nuke
  • Long-acting cabotegravir – integrase inhibitor
  • Albuvirtine – fusion inhibitor
  • Cenicriviroc (CVC) – CCR5 Antagonist
  • ABX-464 – Rev Inhibitor
  • Fostemsavir – gp120 attachment inhibitor
  • Ibalizumab – monoclonal antibody
  • PRO-140 – monoclonal antibody
  • UB-421 – monoclonal antibody
  • Toll-like receptor (TLR) agonists – latency reversing agents (LRAs)
  • Histone deacetylation inhibitors – LRAs
  • GS-CA1 – capsid inhibitor

 

Health Communication and Social Media

 

Additional Digital Marketing Tips from HIV.gov

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

  

 

 

 

 

 

 

 

 

 

 

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