Health

HEALTH • Winter 2018 17 81 Hope Ave., Worcester, MA 01603, 508.983.6790, massccn.org Your Community Partner For children, adults, and seniors with complex lifelong needs, MCCN's experience and commitment helps them coordinate their health and well-being, and improve their quality of life. Contact 508.983.6790, or email info@massccn.org, today! ring and sweep the area for syringes, give out bleach kits, and talk to the people about safe injection practic- es," she said. The importance of this kind of work was made clear this summer when the state and federal officials began investigating a spike in HIV cases among injection drug users in Lowell and Lawrence this summer. Dr. Philip Bolduc, assistant profes- sor of family medicine and commu- nity health at UMass Medical School and the HIV program and fellowship director of the Family Health Center of Worcester, said the Lowell- Lawrence area was particularly vul- nerable because fentanyl was spread among injection opioid users there earlier than in many places. Compared with heroin, injected fen- tanyl provides a much shorter high, Bolduc said, so users often inject themselves more frequently. "Obviously the needle use is going sky-high with that, and the sharing as well," he said. Fentanyl has been spreading across the state. Dr. Matilde Castiel, Worcester's Commissioner of Health and Human Services, said use of the drug has been increasing since around 2010, but it's really picked up over the past four or five years. "I'm now doing urine screens and I see fentanyl," she said. "I wasn't two years ago." That makes Lowell and Lawrence a cautionary tale for this area. "There's no reason why it couldn't happen here," Bolduc said. "You just need the right conditions, someone who's infected in the needle-sharing network, and boom, you could be off to the races." Beyond providing clean syringes and other support to active injection drug users, local health officials and providers are using a number of tools to prevent that outcome. Bolduc said the Family Health Center offers medication-assisted treatment using Suboxone, one of the best-proven methods for helping people quit opioid drugs. In addi- tion, he said, doctors are now work- ing closely with people who use opi- oid medications for chronic pain, helping to prevent them from devel- oping dangerous dependency. Meanwhile, Castiel said, with peo- ple below age 20 making up a large part of opioid users and people at risk for diseases transmitted through drug injection, the Worcester schools are playing an important role in edu- cating young people about these dangers. "You want people to be aware that this is how these diseases are trans- mitted," she said. "We've been look- ing over, how do we communicate with the younger people, discussing these issues with them." Another side of the effort centers on people who have HIV. Thanks to advances in medicine, Bolduc said, people who receive proper treatment can keep HIV from progressing to AIDS, and won't pass the infection to sexual partners. Bolduc said research hasn't yet determined whether that's also true of sharing needles, but, according to the CDC, keeping the virus at bay probably provides at least some protection for users. Bolduc said that, years ago, many people with HIV were worried about the difficulty and side effects of maintaining the necessary medical regimen. But today medications are easy to take. That means that when people don't keep their disease under control it's often because of other issues in their lives, like mental ill- ness, domestic violence or poverty. "We used to be wrangling with medical issues," Bolduc said. "Now, to be honest, at least 80 percent of the time we're wrangling over social issues that our patients face." As with HIV, medical advances have greatly improved the prospects of people with hepatitis C in recent years. Just a few years ago, treating the infection, which can lead to dev- astating liver failure, involved a diffi- cult, unreliable medical regimen. But current drug options are highly suc- H cessful in getting patients back to health. And, importantly, since 2016 MassHealth and most private insur- ance in Massachusetts have begun covering the treatment even for peo- ple who are active drug users. "Before, you had to either be 'clean'—quote unquote—or you had to have advanced liver disease to start a hepatitis C treatment," Akstin said. "So that would be like if you were obese and had a heart attack and you went to the ER and they said we're not going to treat your heart attack because you're fat." While officials in some parts of the country are leery of tackling health issues in ways that support people even if they remain addicted to drugs, Akstin said local politi- cians have embraced the harm- reduction approach. "I would call them champions of the program," she said. "And our state reps are all supportive. They get it. And I think, the opioid crisis, I don't know too many people who haven't been touched by it." People in Worcester County are less likely to be living with HIV/AIDS than Massachusetts or U.S. residents as a whole. HIV/AIDS prevalence rate* * (Per 100,000) Source: Worcester and Massachusetts: Massa- chusetts Department of Public Health, current as of January 2017. US: CDC, current as of end of 2015 Worcester County Mass. U.S. 215 318 303 Amanda Mehaffey, a coordinator of prevention and screening at the AIDS Project in Worcester, with a model liver showing hepatitis C progression.

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