CDC Releases Guide for Hepatitis C Counseling and Testing Centers for Disease Control and Prevention The availability of increasingly effective therapies for hepatitis C risks, creating the illusion that this endemic is under control and is being remedied. As with all medical interventions, the availability of such treatments is meaningless unless the population at need is identified, and the treatment is applied. The Centers for Disease Control and Prevention (CDC) released two new guides on Hepatitis C counseling and testing for public health and primary care settings recently. Both resources provide contextual information about the spread and prevalence of Hepatitis C, in addition to summarizing clinical procedures for testing and treating individuals with Hepatitis C. The CDC recommends any current and past users of injection drugs, recipients of transfusions or organ transplants, and health care workers receive testing
for Hepatitis C.
Editor’s Comments William Haning, MD, FASAM, DFAPA Conflict of interest (COI) and management of conflict of interest, much like the pathogenesis and treatment, are distinctly different themes. The identification of COI, whether among politicians, physicians, or military-industrial consultants spurs indignation. Yet the motivation for conducting research need not have anything to do with the outcome of the research, in fact is irrelevant to it. And reflex indignation has the same stultifying effect, whether in medicine, politics, or development of an effective military defense...
Treating Opioid Dependence with Injectable Extended-Release Naltrexone (XR-NTX): Who Will Respond? Journal of Addiction Medicine (free ASAM member resource) Once-monthly intramuscular extended-release naltrexone (XR-NTX) has demonstrated efficacy for the prevention of relapse in opioid dependence, providing an alternative to agonist or partial agonist maintenance (ie, methadone and buprenorphine). The question remains, for whom is this unique treatment most efficacious and can patient-treatment matching factors be identified? This study conducted with a Russian population acknowledges its source of commercial support.
Suicide Trends Among Persons Aged 10–24 Years — United States, 1994–2012 Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Suicide is the second leading cause of death among persons aged 10–24 years in the United States and accounted for 5,178 deaths in this age group in 2012. Firearm, suffocation (including hanging), and poisoning (including drug overdose) are the three most common mechanisms of suicide in the United States. Previous reports have noted that trends in suicide rates vary by mechanism and by age group in the United States, with increasing rates of suffocation suicides among young persons. The value of this analysis to addictionists is in two areas: Overdose as poisoning, and the difficulty identifying acts of self-poisoning as volitional or accidental; and suicide as a common risk in the population with addiction, both from mood disorder and from poor impulse restraint.
CDC Releases Hepatitis C and Injection Drug Use Fact Sheet Centers for Disease Control and Prevention The Centers for Disease Control and Prevention (CDC) released a new fact sheet on Hepatitis C and injection drug use recently. The fact sheet describes the symptoms and treatment options for Hepatitis C and outlines how Hepatitis C is spread through injection drug use. The fact sheet encourages current and past users of injection drugs to contact their doctors about testing.
Final Guidance Issued on Abuse-Deterrent Opioids Journal of the American Medical Association Directed toward industry, the Food and Drug Administration (FDA) has issued a final guidance document to provide manufacturers with a framework for evaluating and labeling abuse-deterrent opioids. Congress had threatened to cut the FDA commissioner’s budget by $20 million if the agency did not finalize its January 2013 draft document by June 30 (http://1.usa.gov/1NKgeFl).
Oct 4 - The Day the Silence Ends Facing Addiction This notice of a public demonstration underlines the relative lack until recently of a consumer- or patient-driven advocacy movement, for the treatment of addiction. “The time has come to UNITE To Face Addiction and stand up for recovery. On October 4, 2015 a transformative event will take place in Washington, DC that will ignite and build a movement to address one of the most pressing health issues of our time.”
Increasing Incidence of the Neonatal Abstinence Syndrome in US Neonatal ICUs New England Journal of Medicine This study warrants attention for its description of a striking increase in NAS, alone. Using multiple cross-sectional analyses and a deidentified data set, the authors analyzed data from infants with the neonatal abstinence syndrome from 2004 through 2013 in 299 neonatal intensive care units (NICUs) across the United States. The authors evaluated trends in incidence and health care utilization and changes in infant and maternal clinical characteristics.
Polypharmacy Among Anabolic-Androgenic Steroid Users: A Descriptive Metasynthesis Substance Abuse Treatment, Prevention and Policy This piece examines a population for which the original, perplexing DSM category of “polysubstance dependence” was written. It has been noted that one of the major drawbacks to successful anabolic-androgenic steroid (AAS) interventions is public health officials’ failure to recognize AAS users’ extensive pharmacological regimen. A synthesis of the qualitative or descriptive literature on polypharmacy by AAS users is, both from a clinical and research perspective, important in order to increase the understanding of the polypharmacy often associated with AAS use.
Increases in Hepatitis C Virus Infection Related to Injection Drug Use Among Persons Aged ≤30 Years — Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012 Centers for Disease Control and Prevention: Morbidity and Mortality Weekly Report During 2006–2012, a total of 1,377 cases of acute HCV infection were reported to CDC from Kentucky, Tennessee, Virginia, and West Virginia. Of the 1,374 cases with a recorded age and classified as either urban or nonurban, 616 (44.8%) were among persons aged ≤30 years. The median age of persons with acute infection was 25 years in both nonurban (range = 6–30 years) and urban (range = 6–30 years) counties. This corresponds to a geometric increase in both prescription opioid diversion and heroin use in the same region.
How Traumatic Experiences Leave Their Signature on the Genome: An Overview of Epigenetic Pathways in PTSD Frontiers in Psychiatry Epigenetic mechanisms are a class of molecular mechanisms by which environmental influences, including stress, can interact with the genome to have long-term consequences for brain plasticity and behavior. As PTSD, by definition, requires exposure to a traumatic event, and because genes are exquisitely sensitive to stress and trauma, epigenetic alterations have received attention as possible contributors to the development and persistence of PTSD symptoms.
Needle Exchanges Gain Currency Wall Street Journal Evidence that HIV and hepatitis C are spreading among intravenous drug users is prompting more state and local officials to consider setting up needle exchanges—including some who had been resistant to such programs.
Methamphetamine Accelerates Cellular Senescence through Stimulation of De Novo Ceramide Biosynthesis Plos One This is an important piece for understanding the contribution of methamphetamine to both neuronal and cardiac myofibril death. Methamphetamine is a highly addictive psychostimulant that causes profound damage to the brain and other body organs. Post mortem studies of human tissues have linked the use of this drug to diseases associated with aging, such as coronary atherosclerosis and pulmonary fibrosis, but the molecular mechanism underlying these findings remains unknown.
Major NIH Study Will Examine the Effects of Drugs on the Developing Brain ASAM Magazine A longitudinal cohort study of 10,000+ subjects tracked from ages 9-10 to adulthood, this ambitious and potentially incomparably valuable multi-agency study is described in general terms. “No large prospective study of the effects of drugs on neurodevelopment has ever followed participants from childhood all the way through this crucial second decade of active brain maturation. It will enable us to fill in some major gaps in our understanding.” The landscape of substance use among the nation’s youth is changing. Increasing public acceptance and shifting policies around marijuana are making that drug more accessible in some states. New designer drugs are appearing almost monthly. And e-cigarettes are changing the way young users become exposed to nicotine and even re-glamorizing what had until recently been a
drug in decline.
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