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Opioid Infectious Disease Sign-On Letter

February XX, 2018
Dear Speaker Ryan, Minority Leader Pelosi, Chairman Frelinghuysen, and Ranking Member Lowey:

On behalf of the undersigned organizations we write to urge you to include an increase of $100 million to the viral hepatitis programs at the Centers for Disease Control and Prevention (CDC) to address the alarming increases in the number of new hepatitis B (HBV) and hepatitis C (HCV) cases, and other infectious diseases, such as HIV, in the United States in the final FY2018 Labor, Health and Human Services, Education, and Related Agencies Appropriations bill. The undersigned organizations were pleased that $6 billion over two years was included in the Bipartisan Budget Act of 2018 to assist in this nation’s fight against the opioid epidemic. We urge you to allocate $100 million of that amount to the CDC to address infectious diseases.  

The nation’s infectious disease public health infrastructure is an underutilized resource in our collective response to the opioid epidemic. The systems and programs built over the last two decades to respond to HIV and viral hepatitis are well poised to conduct outreach, engagement, and early intervention services with individuals who use drugs. A comprehensive response to the opioid epidemic, which resulted in over 33,000 opioid overdose deaths in 2015 and over 64,000 overdose deaths in 2016, must include wide-ranging infectious disease prevention efforts, strategies to reduce fatal overdose, increased substance use treatment, and reductions in the infectious disease consequences of the opioid epidemic, particularly rising cases of HBV, HCV, and HIV.  

In FY2017, the CDC’s viral hepatitis programs received only $34 million. Funding levels have long been insufficient to combat the growing number of viral hepatitis cases in the country. It is imperative that we act on the urgent need for additional funding at CDC to respond appropriately to the recent explosion of opioid use in the United States that has created tremendous risk for HCV, HBV and HIV outbreaks. 

Over the last several years, the opioid epidemic has led to alarming increases of new viral hepatitis and HIV infections attributed to injection drug use. According to the CDC, the number of new cases of HCV increased 290% between 2010 and 2015, mainly due to the increase in injection drug use. The opioid crisis also reversed a steady decline in the number of new HBV cases, causing a 20% increase in 2015. A recent CDC study also shows that between 2004 and 2014, admissions to drug treatment programs for patients who inject opioids increased by 93%, while acute HCV infections rose in parallel by 133%. The sharpest increases in new HCV cases were among 18- to 29-year olds - a staggering 400% rise over a ten-year period.  

Outbreaks of HIV and HCV related to the shared use of syringes have occurred in Indiana, San Diego, Kentucky and elsewhere in the past two years. The CDC has identified 220 counties across 26 states that are vulnerable to outbreaks of HCV and HIV. Over 93% of those 220 counties vulnerable to outbreaks do not currently have comprehensive syringe service programs. Without these programs and the resources needed to provide sterile injection materials, transmission rates will continue to increase. Multiple studies have shown that, the presence of comprehensive syringe service programs at the community level is effective at decreasing HIV prevalence.  

Increasing funding would allow CDC’s hepatitis program, in concert with other programs, including those for HIV/AIDS and STD Prevention, to focus on the following activities:

-  Enhance existing, and create new, program and clinical infrastructure at locations serving vulnerable populations to effectively increase viral hepatitis and HIV testing and linkages to substance use prevention services, care and treatment for those who are newly diagnosed with viral hepatitis and/or HIV and opioid use disorders. This infrastructure should include linkages to medication-assisted therapies and overdose prevention medications, such as naloxone.

-  Increase education to high risk groups and affected communities, including pregnant women, about the intersection of the opioid epidemic and infectious diseases, such as viral hepatitis and HIV. Increase training for Disease Intervention Specialists (DIS) and other clinicians and providers about substance use, risk of infectious disease and current medical treatments and effective linkage techniques.

-  Increase viral hepatitis surveillance infrastructure in state health departments to detect acute viral hepatitis infections and enhance ability to conduct cluster identification and investigations.

-  Increase capacity of community coalitions, state health departments, and community based organizations to implement effective primary infectious disease prevention programs and services tailored to persons who use drugs and have opioid use disorders.

-  Increase access to, and proper disposal of, sterile injection equipment, where legal and with community support.

Changing the course of the opioid epidemic and its infectious disease consequences requires an honest and critical examination of efforts among all stakeholders. With your continued leadership on this issue, CDC will be able to better prioritize and implement effective public health programs addressing the continuum of prevention and treatment services. We strongly encourage you to allocate at least $100 million of the $6 billion over two years that was recently agreed to in the bipartisan budget agreement be allocated to address the infectious disease consequences of injection drug use. 


NASTAD (the National Alliance of State and Territorial AIDS Directors)
The AIDS Institute

Posted By: AIDS United, Policy Department - Thursday, February 16, 2017

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