Posts Tagged ‘Hepatitis C’


Empty board


Prisoner death from drug withdrawal:

In my blog entry on October 20, 2015, I discussed the horrible death from drug withdrawal suffered by David Stojcevski in the Macomb County, Michigan, jail. I’ve been scouring the internet looking for updates on the lawsuit the family has filed against the county, but haven’t found anything. However, I’m pleased to find many news stories about this awful incident, which helps to keep the issue of medical treatment of prisoners in the news. This is something we must change. Incarcerated people should not be allowed to die from drug withdrawal!

Bad legislation:

On April 12, 2015, I blogged about NC bill S297, which is legislature intended to make drug use by a pregnant woman a criminal act. Regrettably, this sorry and misguided piece of legislation was passed on its first reading in the NC senate. It’s now been referred to the Committee on Rules and Operations of the Senate. If you live in NC, when you vote, remember that Republican Brent Jackson presented this bill, which I believe will keep pregnant women from seeking medical care during pregnancy if they have the disease of addiction. This bill is not good for society, pregnant women, and especially not good for fetuses.


I’ve written a few blog entries (September 2, 2011; March 30, 2013; May 21, 2013; and November 7, 2015), about Probuphine, implantable small rods that deliver buprenorphine into a patient’s bloodstream over six months.

In January of 2016, an advisory committee to the FDA voted to recommend Probuphine for approval by the FDA for the treatment of opioid addiction. The FDA is expected to hold its vote at the end of this month. You will recall that despite a similar recommendation last year, the FDA did not approve this implant, stating more study was needed, especially on patients who were stable at lower dose of buprenorphine.

This time, Titan Pharmaceuticals is seeking approval in patients who are stable on 8mg of the sublingual buprenorphine or less per day.

Of the minority of people on the advisory panel who voted no to the recommendation, concerns were expressed about identifying appropriate patients for this medication, and risks of both implantation and removal of the rods.

I’m still not clear if there will be changes to the rules for implantation and removal of the Probuphine rods. For a buprenorphine prescriber to be able to offer Probuphine, she would have to take a training class for the procedures for implantation and removal. This requires time away from work, to meet an uncertain demand for this product. Not all doctors who prescribe buprenorphine will want do this procedure anyway.

If I want to do this procedure in my office, how to I get the implants? Do I have to buy them, and wait for the patient to pay me back? Do I write a prescription and have the patient pick them up at the pharmacy? Will insurance cover the medication and the procedure? If yes, how long would I have to wait for payment from these companies? I’ve been able to stay in business at my private office by keeping overhead pared to a minimum, so if Probuphine requires an investment by me, I may decide it’s not worth my time and effort.

Hepatitis C treatment

As described in my July 3, 2015 blog entry, the CDC recently reported a surge in the numbers of U.S. citizens who have contracted Hepatitis C. Now another drug has entered the market to treat Hep C, but remains extremely expensive. Earlier this year, Merck pharmaceutical company launched a new Hep C drug called Zepatier. It’s an oral drug that costs an estimated $54,000 for a twelve week course, compared to $80,000 for a similar course of Harvoni. However, early reports say Zepatier cure rates may not be as high as Harvoni’s, so we await more information.

Many health insurance systems can’t afford to pay this much money for treatment of their insured, and so many people infected with Hep C have found their insurer refuses to pay for this new treatment that cures Hep C in most patients. Without insurance, few people could shoulder that expense themselves.

So we have another treatment option, and a little bit less expensive. Let’s hope this trend continues.

ALKS 5461

In my blog post from January 17.2015, I reported a new drug on the horizon that was hoped to be a novel treatment for resistant depression. This medication, known as ALKS 5461, contains buprenorphine (just like Suboxone, Subutex) and samidorphan, a new opioid receptor blocker. The medication was theorized to treat depression by the buprenorphine’s antagonistic action on the kappa receptors, and the samidorphan would serve to block the effect of buprenorphine on opioid receptors, so that the patient would not develop an opioid dependency.

Unfortunately, ALKS 5461 failed to show benefit in two phase III clinical trials, leading Alkermes stock to fall when this data was announced in January of 2016. Despite these results, Alkermes is reported to be continuing research into this potential new medication for depression.

Increasing Cases of Hepatitis C in Appalachia


The Centers for Disease Control and Prevention (CDC) released information last month about the increased incidence of Hepatitis C in four states: Kentucky, Tennessee, West Virginia, and Virginia. From 2006 until 2013, acute Hep C cases in those states increased by 364%, in people younger than 30 years old. Seventy-three percent of those new cases occurring in people who injected drugs. The incidence in non-urban areas rose more than in urban areas.

Because many new Hep C infections occur in patients who have few symptoms, the incidence reported by the CDC likely underestimated the true number of true cases.

The authors of the study reminded us that HIV is transmitted the same way as Hep C, and increased incidence of HIV could potentially increase as well. The authors emphasized the importance of making effective addiction treatment available for intravenous drug users, as well as preventive efforts to stop the spread of infectious diseases like HIV and Hep C.

These facts are scary. The surge in opioid addiction over the last fifteen years could be followed by a surge in HIV and Hepatitis C infections. In a recent post (May 7, 2015), I described a micro-epidemic of HIV in a small Indiana town, where 140 new HIV cases were diagnosed in a town of only 4200 people. I don’t want to see this happen again and again in small towns in the U.S.

Let’s learn from the 1980’s, when the AIDS epidemic first emerged. The U.S. did not strongly and immediately support measures that could have limited the spread of this disease. Think how many cases could have been prevented with good information, condoms, needle exchange, and addiction treatment.

Let’s not wait until the situation worsens to do something. We must get serious about harm reduction measures and increased access to addiction treatment.

Needle exchange, where intravenous drug users are provided with clean needle in exchange for used needles, reduces the risk of infectious diseases like HIV and Hep C. Naloxone kits can reverse otherwise fatal opioid overdose deaths. Of course, the ultimate harm reduction measure readily available addiction treatment for addicts who want it.

I know many people at federal and state levels are aware of this problem and have been working on it. Let’s help change happen by giving harm reduction measures our support. For more reading on harm reduction, check out this website:
This is our excellent harm reduction organization here in North Carolina. Click on the “Advocacy” tab to find out what you can do to help.

Even if you don’t care about what happens to drug addicts, it is in your personal best interest to keep other people in our population from contracting infectious diseases that can affect us all.