nida responds to the syndemic of opioids, viral hepatitis ......nida responds to the syndemic of...
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NIDA Responds to the Syndemic of Opioids, Viral Hepatitis and HIV
Wilson M. Compton, M.D., M.P.E.Deputy Director, National Institute on Drug Abuse
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Virtually All of the U.S. Have Increased Drug Overdoses: Estimated Age-adjusted Death Rates per 100,000 for Drug Poisoning by County.
1999
Source: https://www.cdc.gov/nchs/data-visualization/drug-poisoning-mortality/index.htm
2016
Page ▪ 2
63,362 Deaths in 2016
(42,249 from Prescription
and Illicit Opioids)
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Evolution of the Opioid Overdose Deaths: Analgesics Heroin Fentanyl
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
20,000
17,087 Prescribed
19,413 “Fentanyl”
15,469 Heroin
Source: NCHS WONDER, NCHS Data Brief 294Page ▪ 3
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Viral Hepatitis, HIV, and opioid addiction are co-occurring epidemics.
HIV
HCVOpioid
Dependence
• Shared risk factors and causes
• Cross-cutting benefits of treatment
Syndemic Conditions
Viral Hepatitis , HIV and Opioid Addiction are Part of a Syndemic of Intersecting Epidemics
HIV (and Hepatitis C) Outbreak Linked to Oxymorphone Injection
Use in Indiana, 2015Peters et al.
The New England Journal of Medicine2016;375:229-239
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0
500
1,000
1,500
2,000
2,500
3,000
3,500
Nu
mb
er
of
ca
se
s
Year
Injection Drug Use Is Driving new Hepatitis C Infections
National Notifiable Diseases Surveillance System (NNDSS)
• Persons who inject drugs are the reservoir (main source) of Hepatitis C infection
• Currently ~750,000 persons who inject drugs in USA
• Surge in Hepatitis C in young persons who inject drugs (18-25 years old)
• Heroin as an initiating opioid has increased sharply
Recommendation to Prevent Hepatitis C: Better access to effective
OUD treatments – Buprenorphine, Methadone and Naltrexone
• ~31,000 new HCV infections in 2015
• 1:1 male: female ratio, predominantly white
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Combined Use of Syringe Services Programs and
Medication Assisted Treatment Reduces HCV
Transmission Among People Who Inject Drugs (PWID)
Syringe Services Programs:
• Are an effective component of an integrated approach to reduce HIV/HBV/HCV in PWID
• Also offer alcohol swabs, sterile water, condoms, naloxone, testing, and referral to treatment
• Reduce overdose deaths and increase entry into treatment
Combining high access to syringe
programs with MAT reduces risk
of HCV infection by
74%Platt L, Cochrane Database , 2017.
HCV Infectivity: HCV Remains Infectious Up
to 6 Weeks on Improperly Cleaned Surfaces
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How Can NIH/NIDA Research Help?
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Using Research to End the Opioid CrisisNIH Opioid Research
PAIN MANAGEMENTSafe, effective, non-addictive strategies
OPIOID ADDICTION
TREATMENTNew, innovative medications and
technologies
OVERDOSE REVERSAL
Interventions to reduce mortality
and link to treatment
Non-Opioid Analgesics
Biomarkers For Pain
Opioid Vaccines
Nonpharmacological Treatments (e.g. TMS)
Respiratory Stimulation Devices
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New NIH Initiative to Address the Crisis: HEAL: Helping to End Addiction Long-term
• Collaborative, cross-cutting research• From basic to behavioral – and everything between• Innovative partnerships – across agencies, sectors,
organizations – will ensure rapid progress
• $500M just added by Congress• Adds to $600M current funds = $1.1B for FY18• Will propel HEAL
• Advances national priorities for pain, addiction research
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NIDA-Supported Hepatitis C Research
• NIDA: 2nd largest NIH funder— $32.6 M (FY2016)
• Interventions for rural, at-risk women; support for women in drug court; financial literacy & vocational training for at-risk women; tailored prenatalcare for pregnant women
• Rapid HCV testing in care settings
• Utilization of case managers within a coordinated care framework
• Adaptation of HIV model of “treatment as prevention”
• Efficacy of direct acting antivirals in substance using populations
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Reported Hepatitis C Cases by County, 2013-2014 Combined
Source: NNDSS
• Targeting opioid IDU, OD, HIV and HCV• One-year planning grants to describe:
‐ problem scope‐ contributing health trends‐ Resources, obstacles
• 4 Grants Funded RFA-DA-16-015
Partnership of NIDA and Appalachian Regional Commission (ARC)
In FY2017 broadened program to include CDC, SAMHSA and ARC
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NIDA, CDC, SAMHSA, ARC: Using Research to Combat HIV and Viral Hepatitis in Rural Areas
New England
Ohio
West Virginia
Kentucky
North Carolina
Illinois
WisconsinOregon
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22 MSAs:
• Improve recruitment of young (<30 years) PWID
• Include HCV testing in NHBS sites
• Expand recruitment outside of urban core
Plans for 2018
NIDA Joining CDC on the 2018 Update to the National HIV Behavioral Surveillance among Persons Who Inject Drugs
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Elimination of Hepatitis C
Work to date includes pilot funding to the University of Kentucky to develop community-based components:
NIDA and NCI are working with CDC to develop a study of the elimination of HCV in a high-risk community in Kentucky.
• Syringe exchange
•Drug treatment
• Linkages with criminal justice (because of high-risk persons re-entering the community)
•Access to medical care.
•Hepatitis C testing and TREATMENT
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www.drugabuse.gov