Oral Prescription Opioids as a High-Risk Indicator for Hepatitis C Infection: Another Step Toward HCV Elimination

Background The opioid epidemic across the U.S. poses an array of public health concerns, especially HCV transmission. HCV is now widely curable, yet incident rates are increasing due to the opioid epidemic. Despite the established trajectory from oral prescription opioids (OPOs) to opioid use disorder (OUD), OUD to injection drug use (IDU), and IDU to hepatitis C virus (HCV), OPOs are not a defined risk factor (RF) for HCV infection. The objective of this study was to observe rates of HCV testing and Ab reactivity (HCVAb+) in patients receiving OPOs to substantiate them as a RF, ultimately contributing to HCV elimination. Methods Data from MedStar Health patients receiving OPOs from 1/2017 to 12/2018 were collected and analyzed using chi-squared or student t-tests and logistic regression for uni- or multi-variable analyses, respectively. Statistical significance was defined as P < .05; Epi Info and SAS v 9·4 were used for statistical analyses; IRB approval was received. Results There were 115 415 individuals prescribed OPOs over the study period. In this population, 8.6% (932) were HCVAb+ when tested and not previously diagnosed (10 900); 3.4% (3893) had an OUD diagnosis, 20.6% (803) of whom were HCV tested; 25.4% (361) of all HCVAb+ (1421) had an OUD diagnosis. OUD (ORadj 8.53 [7.22-10.07]) was an independent predictor of HCVAb+ in this population. Conclusions (1) In a large population prescribed oral opioids, HCVAb+ was 8.6%, higher than our previously published data (2.5%) and the US rate (1.7%); (2) only 20% of patients diagnosed with OUD were tested; and (3) only 25% of HCVAb+ patients were classified with OUD; this suggests underreporting of OUD in this population. Primary Care and Community Health Recommendations: (1) Re-testing for HCV in patients taking OPOs; (2) increased HCV testing among OUD patients; and (3) improved surveillance and reporting of OUD.

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Opioid disposal rates after spine surgery

Surgical Neurology International ◽

10.25259/sni_856_2021 ◽

2021 ◽

Vol 12 ◽

pp. 472

Author(s):

Susanna Davis Howard ◽

Anish Agarwal ◽

Kit Delgado ◽

Edward Rodriguez-Caceres ◽

Disha Joshi ◽

...

Keyword(s):

Cohort Study ◽

Spine Surgery ◽

Text Messaging ◽

Telephone Survey ◽

Median Number ◽

Prescription Opioids ◽

Opioid Epidemic ◽

Opioid Misuse ◽

Opioid Use ◽

Urban University

Background: Diversion of prescription opioids pills is a significant contributor to opioid misuse and the opioid epidemic. The goal of this study was to determine the frequency and quantity of excess opioid pills among patients undergoing spine surgery. Further, we wanted to determine the frequency of appropriate opioid disposal. Methods: This was a prospective cohort study of patients undergoing elective spine surgery within a multi-hospital, academic, urban university health system enrolled in a text-messaging program used to track postoperative opioid disposal. Patients who self-reported discontinuation of opioid use but with leftover pills were contacted via telephone and surveyed on opioid disposal. Results: Of the 291 patients who enrolled in the text-messaging program, 192 (66%) patients reported discontinuing opioids within 3 months of surgery. Although 76 (40%) reported excess opioid pills after cessation of use, only 47 (62%) participated in the telephone survey regarding opioid disposal. The median number of leftover pills among these 47 patients was 5 (5, 15) and 64% had not disposed of their prescription. Conclusion: Among the 47 telephone survey participants, a persistent gap remained in postoperative opioid excess and improper disposal. Future efforts must focus on initiatives to improve opioid disposal rates to reduce the quantity of opioids at risk for diversion and to reduce excess prescribing.

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Epidemiology of Substance Use Disorders

Substance Use Disorders ◽

10.1093/med/9780190920197.003.0001 ◽

2020 ◽

pp. 3-28

Author(s):

L. Morgan Snell ◽

Andrew J. Barnes ◽

Peter Cunningham

Keyword(s):

The United States ◽

Opioid Use Disorder ◽

Opioid Overdose ◽

Prescription Opioids ◽

Opioid Epidemic ◽

Provider Education ◽

Opioid Use ◽

Prescribing Practices ◽

The Us ◽

Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

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CIHR Canadian HIV Trials Network Co-Infection and Concurrent Diseases Core: Updated Canadian Guidelines for the Treatment of Hepatitis C Infection in HIV-hepatitis C Coinfected Adults

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/251989 ◽

2014 ◽

Vol 25 (6) ◽

pp. 311-320 ◽

Cited By ~ 1

Author(s):

Mark Hull ◽

Stephen Shafran ◽

Alice Tseng ◽

Pierre Giguère ◽

Marina B Klein ◽

...

Keyword(s):

Hepatitis C ◽

National Standards ◽

Published Data ◽

Line Treatment ◽

Hepatitis C Infection ◽

First Line ◽

Hcv Therapy ◽

Genotype 2 ◽

Hcv Coinfection ◽

First Line Treatment

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV and is responsible for a heavy burden of morbidity and mortality. Management of HIV-HCV coinfection is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug-drug interactions between new HCV direct-acting antiviral therapies and antiretroviral regimens.OBJECTIVE: To update national standards for the management of HCV-HIV coinfected adults in the Canadian context.METHODS: A standing working group with specific clinical expertise in HIV-HCV coinfection was convened by The Canadian Institute of Health Research HIV Trials Network to review recently published data regarding HCV antiviral treatments and to update the Canadian HIV-HCV coinfection guidelines.RESULTS: Recent data suggest that the gap in sustained virological response rates between HCV monoinfection and HIV-HCV coinfection has been eliminated with newer HCV antiviral regimens. All HIV-HCV coinfected individuals should be assessed for HCV therapy. First-line treatment for genotypes 1 through 6 includes pegylated interferon and weight-based ribavirin dosing plus the nucleotide sofosbuvir for 12 weeks. Sofosbuvir in combination with the protease inhibitor simeprevir is another first-line consideration for genotype 1 infection. Sofosbuvir with ribavirin for 12 weeks (genotype 2) and 24 weeks (genotype 3) is also recommended as first-line treatment.DISCUSSION: Recommendations may not supersede individual clinical judgement.

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Centrally acting stimulants in patients receiving opioid agonist therapy; a national prospective cohort study in Norway from 2015 to 2017

10.21203/rs.2.14354/v1 ◽

2019 ◽

Author(s):

Jørn Henrik Vold ◽

Christer Aas ◽

Svetlana Skurtveit ◽

Ingvild Odsbu ◽

Fatemeh Chalabianloo ◽

...

Keyword(s):

Hepatitis C ◽

Prescription Database ◽

Opioid Use ◽

Hepatitis C Infection ◽

Agonist Therapy ◽

Opioid Agonist ◽

Opioid Agonist Therapy ◽

Addictive Drugs ◽

Adhd Treatment ◽

Norwegian Prescription Database

Abstract Background It is estimated that about a third of patients on opioid agonist therapy (OAT) have Attention Deficit Hyperactivity Disorder (ADHD). Treatment by centrally acting sympathomimetics (CAS) is one of the essential approaches. This study evaluates the use of CAS in the Norwegian OAT population in the period from 2015 to 2017. Types and doses of CAS, and co-dispensations of other addictive drugs like benzodiazepines, z-hypnotics, gabapentinoids, and non-OAT opioids, as well as direct-acting antivirals (DAA) against hepatitis C infection, are evaluated. Methods Information about all dispensed CAS, OAT opioids, and the defined addictive drugs were recorded from the Norwegian Prescription Database. The number and the doses of dispensed drugs were used to estimate dispensation rates, the types, and the doses of dispensed CAS. Logistic regression analyses were employed to assess the associations between CAS and OAT opioid use, and dispensations of other addictive drugs and DAA against hepatitis C infection. Results A total of 9,235 OAT patients were included. The proportion of patients who used both CAS and OAT opioids increased from 4 % to 5 % during the study period. The three most dispensed CAS were methylphenidate (59 %), lisdexamphetamine (24 %), and dexamphetamine (17 %). Buprenorphine as OAT opioid (adjusted odds ratio: 1.59, CI: 1.24-2.05) was associated with being dispensed CAS. Among patients who received CAS annually throughout the study period, the dispensed doses of methylphenidate increased from 63 mg/day in 2015 to 76 mg/day in 2017 (p = 0.01). About 60 % of these patients were also dispensed other addictive drugs concomitantly in 2017. Conclusion Co-dispensation of CAS was low among patients on OAT in Norway, considering a higher prevalence of ADHD in this patient group. On the other hand, concurrent dispensations of multiple addictive drugs are common in this population. Understanding the underlying causes of such prescribing is essential, and research on how to optimize CAS treatment of people with ADHD receiving OAT is needed.

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Effect of a Mobile-Health Intervention (A-CHESS) on Hepatitis C Testing Uptake Among People with Opioid Use Disorder: A Randomized Controlled Trial (Preprint)

10.2196/preprints.23080 ◽

2020 ◽

Author(s):

Karli R Hochstatter ◽

David H Gustafson Sr ◽

Gina Landucci ◽

Klaren Pe-Romashko ◽

Olivia Cody ◽

...

Keyword(s):

Hepatitis C ◽

High Risk ◽

Drug Use ◽

Risk Behaviors ◽

Opioid Use Disorder ◽

Opioid Use ◽

Injection Equipment ◽

Testing Uptake ◽

Hcv Antibody ◽

Hcv Testing

BACKGROUND The growing epidemic of opioid use disorder (OUD) and associated injection drug use has resulted in a surge of new hepatitis C virus (HCV) infections. Approximately half of persons with HCV infection are unaware of their HCV status. Improving HCV awareness and increasing screening among people with OUD is critical. A-CHESS is an evidence-based, smartphone-delivered relapse prevention system that has been implemented among people with OUD who are receiving medication-assisted treatment (MAT) to improve long-term recovery. OBJECTIVE We incorporated HCV content and functionality into A-CHESS to (1) to characterize the HCV care continuum among people in early remission and receiving MAT for OUD and (2) determine whether incorporating HCV content and functionality into A-CHESS increases HCV testing. METHODS HCV intervention content, including dissemination of educational information, private messages tailored to individual’s stage of HCV care, and a public discussion forum, were implemented into the A-CHESS platform. Individuals with OUD were randomly assigned to receive MAT alone (control arm) or MAT + A-CHESS (experimental arm). Quarterly telephone interviews, conducted from baseline to month 24, assessed risk behaviors and HCV testing history. Cox proportional hazards regression was used to assess overall whether individuals who received A-CHESS were tested for HCV (including either antibody or RNA tested) at a higher rate than those in the control arm. To assess the effect of A-CHESS on subsets of individuals at highest risk for HCV, additional analyses examined the effect of the intervention among individuals who injected drugs and shared injection equipment. RESULTS Between April 2016 and April 2020, 416 individuals with OUD were enrolled. Overall, 44% of the study population was HCV-antibody positive, 30% were HCV-antibody negative, and 25% were considered untested at baseline. At month 24 there was no difference in HCV testing uptake between intervention and control participants overall. However, among the subset of 109 individuals who engaged in injection drug use, there was a slight trend towards increased HCV testing uptake among those who received A-CHESS (89% versus 85%; Hazard Ratio: 1.34; 95% CI: 0.87-2.05; P=.18), and a stronger trend was observed when focusing on the subset of 32 individuals who reported sharing injection equipment (87% versus 56%; Hazard Ratio: 2.92; 95% CI: 0.959-8.86; P=.059). CONCLUSIONS Incorporating HCV prevention and care information into A-CHESS may increase the uptake of HCV testing while preventing opioid relapse when implemented among populations who engage in high risk behaviors such as sharing contaminated injection equipment; however, studies that are powered to detect differences in HCV testing among high risk groups are needed. CLINICALTRIAL ClinicalTrials.gov, NCT02712034. Registered on 14 March 2016. INTERNATIONAL REGISTERED REPORT RR2-10.2196/12620

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Hepatitis C Infection Screening and Management in Opioid Use Epidemics in the United States

The American Journal of Medicine ◽

10.1016/j.amjmed.2018.06.003 ◽

2018 ◽

Vol 131 (11) ◽

pp. 1276-1278 ◽

Cited By ~ 2

Author(s):

Xibei Liu ◽

Jay Shen ◽

Pearl Kim ◽

Seong-min Park ◽

Sungyoun Chun ◽

...

Keyword(s):

United States ◽

Hepatitis C ◽

The United States ◽

Opioid Use ◽

Hepatitis C Infection

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Hepatitis C Infection Screening and Management in Opioid Use Epidemic in the United States

The American Journal of Gastroenterology ◽

10.14309/00000434-201810001-02882 ◽

2018 ◽

Vol 113 (Supplement) ◽

pp. S1591-S1592

Author(s):

Annie S. Hong ◽

Syed M. Saghir ◽

Ji Won Yoo ◽

Mohamed Azab

Keyword(s):

United States ◽

Hepatitis C ◽

The United States ◽

Opioid Use ◽

Hepatitis C Infection

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Long-term Infective Endocarditis Mortality Associated With Injection Opioid Use in the United States: A Modeling Study

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1346 ◽

2020 ◽

Cited By ~ 1

Author(s):

Joshua A Barocas ◽

Golnaz Eftekhari Yazdi ◽

Alexandra Savinkina ◽

Shayla Nolen ◽

Caroline Savitzky ◽

...

Keyword(s):

United States ◽

Infective Endocarditis ◽

Mortality Rate ◽

Population Level ◽

Risk Groups ◽

The United States ◽

Published Data ◽

Opioid Epidemic ◽

Opioid Use ◽

Behavior Profiles

Abstract Background The expansion of the US opioid epidemic has led to significant increases in infections, such as infective endocarditis (IE), which is tied to injection behaviors. We aimed to estimate the population-level IE mortality rate among people who inject opioids and compare the risk of IE death against the risks of death from other causes. Methods We developed a microsimulation model of the natural history of injection opioid use. We defined injection behavior profiles by both injection frequency and injection techniques. We accounted for competing risks of death and populated the model with primary and published data. We modeled cohorts of 1 million individuals with different injection behavior profiles until age 60 years. We combined model-generated estimates with published data to project the total expected number of IE deaths in the United States by 2030. Results The probabilities of death from IE by age 60 years for 20-, 30-, and 40-year-old men with high-frequency use with higher infection risk techniques compared to lower risk techniques for IE were 53.8% versus 3.7%, 51.4% versus 3.1%, and 44.5% versus 2.2%, respectively. The predicted population-level attributable fraction of 10-year mortality from IE among all risk groups was 20%. We estimated that approximately 257 800 people are expected to die from IE by 2030. Conclusions The expected burden of IE among people who inject opioids in the United States is large. Adopting a harm reduction approach, including through expansion of syringe service programs, to address injection behaviors could have a major impact on decreasing the mortality rate associated with the opioid epidemic.

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1050. Hepatitis C Infection amongst People who Inject Drugs (PWID): Injection Practices and Risk Factors

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1236 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S554-S555

Author(s):

Nityasri Sankar ◽

Kim Murray ◽

Debra D Burris ◽

Kinna Thakarar

Keyword(s):

Risk Factors ◽

Hepatitis C ◽

People Who Inject Drugs ◽

Computer Assisted ◽

Opioid Epidemic ◽

Hepatitis C Infection ◽

Item Score ◽

Safe Injection ◽

Unsafe Injection ◽

Injection Practices

Abstract Background The rapidly progressing U.S. opioid epidemic has led to an increased prevalence of infections associated with injection drug use (IDU), such as Hepatitis C (HCV). Previous studies have identified a lack of screening, prevention, and treatment of HCV, which has contributed to an increase in HCV-related mortality. Transmission has been linked to unsafe injection practices. Our study aims to characterize risk factors associated with Hepatitis C (HCV) exposure amongst people who inject drugs (PWID) in Maine, a state heavily impacted by the opioid epidemic. Methods Data was obtained from a cross-sectional study of participants hospitalized with an IDU-associated infection at four hospitals in Maine identified as high-risk for HIV/HCV outbreaks. The Audio Computer-Assisted Self-Interview survey and medical record review were used to collect data. The components from the BIRSI 7-item score were used to assess the use of safe injection practices. HCV exposure was defined as HCV antibody positive and/or self-reported exposure. Analysis was performed using descriptive analyses and univariate regression modeling. Results Of the 101 participants enrolled, n=76 (75%) were identified as having exposure to HCV. Out of participants exposed to HCV, 57% reported homelessness (p=< 0.01). Participants exposed to HCV were more likely to have bacteremia during hospitalization (25%, p=.02). All participants unexposed to HCV perceived low likelihood of contracting HCV due to injecting (p=.01). Seventy-one percent of people exposed to HCV reported infrequent use alcohol pads prior to injecting (p=< 0.01) and 67% reported infrequent hand-washing (p=.09). Participants with a higher BIRSI-7 score had higher odds of exposure to HCV (OR=1.48, 95% CI 1.10-2.04). Conclusion The data obtained highlights significant relationships between HCV exposure and certain risk factors. Homelessness was found to be associated with HCV exposure, suggesting an opportunity for more targeted intervention within this subgroup of PWID. Unsafe injection practices as measured by the BIRSI-7 score were related to HCV exposure, indicating educational opportunities about safe injection practices. Overall, targeted harm reduction services could be beneficial in the screening and prevention of HCV exposure amongst PWID. Disclosures All Authors: No reported disclosures

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Censored Data Analysis Reveals Effects of Age and Hepatitis C Infection on C-Reactive Protein Levels in Healthy Adult Chimpanzees (Pan troglodytes)

Journal of Biomarkers ◽

10.1155/2013/709740 ◽

2013 ◽

Vol 2013 ◽

pp. 1-13

Author(s):

John J. Ely ◽

Tony Zavaskis ◽

M. Lon Lammey

Keyword(s):

Cardiovascular Disease ◽

Hepatitis C ◽

Censored Data ◽

Pan Troglodytes ◽

Statistical Significance ◽

Reference Intervals ◽

C Reactive Protein ◽

Hepatitis C Infection ◽

Reactive Protein ◽

Kaplan Meier

C-reactive protein, a conserved acute-phase protein synthesized in the liver and involved in inflammation, infection, and tissue damage, is an informative biomarker for human cardiovascular disease. Out of 258 captive adult common chimpanzees (Pan troglodytes) assayed for CRP, 27.9% of the data were below the quantitation limit. Data were analyzed by the Kaplan-Meier method and results compared to other methods for handling censored data (including deletion, replacement, and imputation). Kaplan-Meier results demonstrated a modest age effect and a strong effect of HCV infection in reducing CRP but did not allow inference of reference intervals. Results of other methods varied considerably. Substitution schemes differed widely in statistical significance, with estimated group means biased by the size of the substitution constant, while inference of unbiased reference intervals was impossible. Single imputation gave reasonable statistical inferences but unreliable reference intervals. Multiple imputation gave reliable results, for both statistical inference and reference intervals, and was comparable to the Kaplan-Meier standard. Other methods should be avoided. CRP did not predict cardiovascular disease, but CRP levels were reduced by 50% in animals with hepatitis C infection and showed inverse relationships with 2 liver function enzymes. Results suggested that hsCRP can be an informative biomarker of chronic hepatic dysfunction.

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