May is Hepatitis Awareness Month
The most common types of viral hepatitis in the US are Hepatitis A, B, and C. According to the Centers for Disease Control and Prevention (CDC), nearly 2.4 million people in this country live with hepatitis C. In contrast, some 862,000 face hepatitis B. Millions more are unaware of their viral hepatitis status at all. But many forms of hepatitis are not only preventable but treatable when detected early.
There are now seven approved drugs for hepatitis B (HBV)—with two types of injectable interferons and five oral antivirals that control HBV. Currently, there are at least six different treatment combinations for Hepatitis C (HCV), including one that can cure all types of HCV.
The CDC recommends sharing information about all the treatment and therapeutic options that are already widely available. They’re also asking the public to promote the CDC’s adult vaccine assessment tool, which spells out which vaccines (for A and B) are recommended based on a person’s age, health, and occupation. Only about 25% of adults are vaccinated for both A and B.
The vaccine assessment tool can be found here: https://www2.cdc.gov/nip/adultimmsched/
Wednesday, May 19th, is also National Hepatitis Testing Day.
And while the month earmarks awareness and prevention of all types of viral hepatitis, it’s also a time to reassess the hidden dangers of what these epidemics mean for those most marginalized by an often chronic—and sometimes, deadly—virus, like hepatitis B and C.
To that, the United States Department of Health and Human Services (HHS) released new buprenorphine practice guidelines on April 28th: Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder.
Buprenorphine is a controlled substance and opioid used to treat opioid use disorder, acute pain, and chronic pain.
The prevalence of HCV infection is extremely high among opioid-dependent individuals. Effective oversight of opioid addiction, together with an expanded offering of HCV treatment in primary care settings, is consistent with principles outlined in Patient-Centered Medical Home (PCMH) models. PCMH is a care services and delivery model that gets coordinated through a person’s Primary Care Physician—or practitioner—and it ensures that they receive the medically necessary or appropriate care both “when and where” they need it; and in a manner, they can plainly understand.
These new guidelines remove a long-standing requirement that ties buprenorphine’s practical use to certificates of training, which providers, practitioners, and advocates alike have cited as a systematic barrier to treating more patients. Patients are often caught in the shadows of an ongoing substance use disorder but would more actively seek treatment it was more widely available and without red tape.
The guidelines provide a special exemption from specific statutory certification requirements related to their capacity to provide counseling and ancillary services. It applies to all eligible physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives, who are state-licensed and registered by the DEA, to prescribe controlled substances.
The exemption allows these practitioners to treat up to 30 patients with opioid use disorder using buprenorphine without making specific training-related certifications.
More than 90,000 drug overdose deaths were predicted to have occurred in the US in the 12 months ending in September 2020. Assistant Secretary for Health Rachel Levine, MD, has stated that the “Increases in overdose deaths emphasize the need to expand access to evidence-based treatments, including buprenorphine that can be prescribed in office-based settings.”
Addiction treatment should be a routine part of healthcare. And guidelines like this provide real-world, boots-on-ground tools that impacted communities can take to better address and respond to the evolving overdose crisis—as well as increases in HCV cases nationally.
Equipping providers to save lives is what “Americans with this chronic disease need,” said Tom Coderre, Acting Assistant Secretary for Mental Health and Substance Use. “[A]nd [they] deserve readily available access to life-saving, evidence-based treatment options. These new guidelines are an important step forward in reducing barriers to treatment and will ultimately help more people find recovery.”
By: Scott Bertani, Director of Advocacy