Archive for the ‘BBV transmission’ Tag

The War on Drugs versus livers

Thursday, May 30th, 2013

Kofi Annan has been reading my blog again. Last week I again raised my concerns about the spread of Hepatitis C, and this week he and his Global Commission on Drugs Policy have concluded that current drugs policy has resulted in a Hep C pandemic. I’m impressed he managed to pull a paper together so quickly – but then he’s probably been a follower of mine for a while if his opinions on the futility on the War on Drugs are anything to go by.

He and his posse of world leaders have this week published a report stating that current drugs policy is “repressive” and “ineffective”. Claiming that, by treating drug use as a criminal justice issue instead of a health issue, governments are breaching human rights and putting their communities at unnecessary risk, their argument about the spread of Hep C is conclusive and damning.

The report claims that those countries with the harshest drug policies, including the USA, provide the biggest deterrent to accessing health services which would reduce the chance of contracting the virus. This has led the commission to conclude that “The war on drugs is a war on common sense”.

There are some positives though (and not just the Hep C type), with Scotland being hailed as a model of good practice. Having learned about blood-bourne virus (BBV) transmission the hard way with the HIV outbreak of the 80s, Scotland’s Hepatitis C Action Plan has succeeded in reducing the numbers of those infected, both by increasing preventative measures, such as hugely increasing access to clean injecting equipment to reduce new infections, and by improving access to treatment for those who already have the virus.

The biggest win, for me, is Scotland’s eight-fold increase in Hep C treatment in prisons. Working with the War on Drugs policies, rather than against them, this idea uses the revolving door of incarceration as an intervention opportunity. Whereas, in England, it’s still nigh on impossible to even get liver function tests done for someone in prison (to enable quicker prescribing of an opiate blocker to encourage no ongoing use on release – common bloody sense, but seemingly too much trouble for prison healthcare teams, whose responsibilities end the second the individual walks out of their door), Scotland are now offering full Hep C treatment in prisons.

This is refreshing – treatment services in England are notoriously out-dated and a nightmare to negotiate. I have taken clients to appointment after appointment at hospitals, only to be told that six months drug-free is not a long enough period of stability to ensure treatment success and reduce risk of reinfection (“because drug addiction is a relapsing condition” – thanks for the positivity, guys), or that reducing alcohol use from nine cans of Special Brew a day to two cans of Carling is still not enough of a reduction in consumption. There is no evidence-base to support their criteria – in fact some Hep C services go and dish out treatment on the streets to current drinkers and injectors – but the liver specialists in big hospitals do not particularly relish being forced into changing their treatment population. They’d much rather work with people with hereditary liver conditions, or even drinkers, than IV drug users, and they gate-keep their services accordingly.

Because of the potential and significant mental health impacts of the intense treatment, reported low mood is another classic reason for being deemed ‘not appropriate for treatment’. This seems to miss that point that, for someone whose existence is miserable, repetitive and cut-throat, and who may not have anywhere to live or food in their belly, low mood is kind of a must-have. So no drug or alcohol use, never feeling down, and a stable living environment – it makes you wonder who amongst us would actually qualify for Hep C treatment. (I would fail on all counts.)

But if this public health disaster isn’t bad enough, there is a hidden population who do not seek testing or treatment, because they perceive their injecting behaviour to be healthy. Steroid users are increasing in numbers, with little or no access to safer injecting information or blood-bourne virus prevention advice. I have heard many reports of one needle being passed around four or five men in a gym toilet, meaning a high risk for all of BBV infection and bacterial infection. And given that drug users generally spend their time working out and bulking up whilst in prison – and Hep C rates amongst IV drug users are estimated at 80% in the county I work in – it doesn’t bode well for the beefcakes, who may not know that the healthy-looking, fake-tanned meathead in front of them was once a pale, scrawny smackhead.

Whilst working in a busy city-centre needle exchange several years ago, one canny gym owner used to come and get boxes of needles to distribute to his customers. Most gym owners aren’t so conscientious – they will happily sell steroids to their members, but these come without injecting advice or equipment. One gym owner in the whole of one of the biggest cities in the country. That’s a whole lot of new livers required in twenty years’ time – for those whose hearts last that long.

Anyway, for the rest of you, some quick advice – don’t share toothbrushes or razors, and use a clean piece of paper or a straw each instead of sharing a grimy twenty pound note when you’re banging cocaine up your noses in pub toilets. Hep C can be transmitted by a single invisible drop of blood, and, unlike HIV, can live outside the body for up to four weeks. It’s a feisty little beast. And livers are quite handy.

Also here’s a shout-out to the big man, KA, and all his homeboys and girls. Good work on the report, guys, and let me know if you want me to join your little commission thing – and in the meantime, peace.

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