Painkillers are killing more Americans than any illegal drug. Here is Virginia’s response.

The Problem

Unintentional injuries and violence are among the leading causes of death, hospitalization, and disability in Virginia. Typical culprits on the top of that list are motor vehicle accidents, accidental gun deaths, and poisonings. In 2014, however, trends began to change.

For the first time in the state’s history, fatal drug overdose is now the number one method of unnatural death in the Commonwealth. It killed 986 people in 2014, eclipsing both motor vehicle-related fatalities and gun-related deaths.1

This new reality mimics trends in opioid and heroin addiction nationally. Also in 2014, more Americans died of drug overdoses than any other year on record, accounting for more than 47,000 total deaths.2 While a significant percentage of these deaths are a result of heroin overdoses, over half are related to opioid-based prescription painkillers, such as oxycodone, fentanyl, hydrocodone, or methadone.3

Oxycodone, fentanyl, and heroin are the most common painkillers seen on the streets today. Historically, oxycodone has been the number one prescribed drug to cause opioid overdose. However in recent years, fentanyl, which is up to 100 times more potent than morphine, has surpassed it.4

This is due to the fact that fentanyl is being illicitly produced instead of pharmaceutically produced. This illicit form of fentanyl is produced by international drug traffickers who import the drug into the United States and often mix it into heroin being sold. According to the Virginia Department of Health (VDH), by late 2013 and early 2014, some heroin being sold on the street was actually completely fentanyl, unbeknownst to the user.1

This illicitly produced fentanyl, especially fentanyl mixed with heroin, has been the biggest contributor to the significant increase in the number of fatal opioid overdoses in Virginia.

Source: Virginia Department of Health1

The Response

The rise of this epidemic has understandably caught the attention of policy leaders, law enforcement officials, and healthcare professionals alike. In typical government fashion, taskforces were formed, workgroups convened, and coalitions established.

Virginia Governor Terry McAuliffe created the Governor’s Task Force on Prescription Drug and Heroin Abuse in the beginning of 2015. The Task Force was directed to provide a range of policy recommendations, including how to: (1) raise public awareness about the misuse of prescription painkillers, (2) train health care providers on best practices for pain management, (3) identify treatment options and alternatives to incarceration for people with addiction, and (4) promote the safe storage and disposal of prescription drugs.3

The enforcement of these recommendations is currently underway across the state and many players are involved. State agencies, academics, law enforcement, and health care providers are forming partnerships and collaborating with each other in order to do their due diligence.

As an example, the Virginia Department of Medical Assistance Services (DMAS) worked with the Department of Behavioral Health and Developmental Services (DBHDS) to increase access to treatment for Virginia’s Medicaid members by increasing Medicaid reimbursement rates for addiction services.5

The new rates go into effect in April 2017 and increase some payments up to 400 percent. In preparation for the big change, DMAS, DBHDS, and VDH have also partnered together to host statewide trainings for medical providers, behavioral health providers, and administrative professionals. The trainings will raise awareness about the new reimbursement structure as well as educate providers on how to implement evidence-based addiction management services into their practice.

Medication addiction treatment, otherwise referred to as MAT, is one of these evidence-based treatments. MAT combines continuous behavioral counseling with anti-addiction medicines like buprenorphine or Suboxone in order to address the physical, mental, and social factors of addiction. Suboxone, which is a synthetic mix of buprenorphine and the overdose reversal drug naloxone,  suppresses opioid cravings, decreases withdrawal symptoms, and is proven to help addicts recover from their illness. A study conducted by the National Institute on Drug Abuse (NIDA) found that Suboxone reduced prescription painkiller abuse in nearly half of all participants.6

With the new payment incentives and increased education and trainings for MAT, Virginia will undeniably see an increase in the number of providers that offer fully comprehensive services. As a result, low income populations who are most disproportionately affected by the substance use epidemic will have improved access to community-based addiction treatments that promote full integration of physical health and traditional mental health services.

Counties are also working at the local level to carry out some of the Governor’s recommendations.  According to Loudoun Emergency Medical Services (EMS), in 2015 Loudoun County had a total of 35 suspected heroin overdoses and since January 2016, there have been 71 overdose incidents recorded, 30 of which appeared to involve an opiate.

Loudoun County Police Department drug drop off box

For years, local county and town law enforcement agencies have participated in biannual Drug Take Back Days. These events have resulted in disposal of almost 8,000 pounds of unneeded prescriptions, but the Loudoun County Health Council recognized the need for disposal locations that offered continuous access throughout the year.

Drug collection boxes provide a safe way for residents to dispose of prescription drugs without cost to them. The local Health Department sought and received a grant from the CVS Pharmacy and the Partnership for Drug-Free Kids to increase the number of drug drop off boxes from one to now five sprinkled throughout the county.  

The drug collection boxes give citizens the opportunity to remove as many unused or expired prescription drugs as possible and are another evidence-based approach to prevent further drug abuse and drug overdoses in the community.

Worry in Southwest

In light of the great work being done by these state and local agencies, there still remain some skeptics about the impact and effectiveness of medication assisted treatment for opioid addiction.

Despite the fact that Suboxone is not supposed to produce a narcotic high, users who snort or inject it, or combine it with benzodiazepines or alcohol, report being able to achieve similar euphoric effects of heroin or strong prescription painkillers.

In fact, towns in rural southwest Virginia describe Suboxone as a “menace” to their community.7 According to an article in the Culpepper Star Exponent, “Suboxone is the most-abused, most-sought-after street drug across that part of the state.” Law enforcement officials are increasingly concerned that people are using the drug to help feed their addictions instead of cure them.

However, experts believe it is likely that in southwest Virginia the availability of Suboxone has been perpetuated from cash clinics that don’t typically offer the comprehensive evidence-based treatment that addicts need to be successful. Behavioral counseling is an integral part of MAT and people abusing Suboxone may not be receiving the full spectrum of care, either due to access issues, financial barriers, psychosocial neglect, or a multitude of other reasons.  

While the dangers and abusive potential of Suboxone are indeed a reality for many people in the region, policymakers in Virginia and in Washington, DC remain strong proponents of MAT if executed correctly. President Obama’s 2017 proposed budget includes $1 million for expansion of MAT, and Virginia is expected to receive federal funding to match its $11 million dedicated to fighting the opiate epidemic.7

The access and availability of MAT will certainly increase as we move into the new year, and experts hope the situation in Southwest will not become the norm. Ideally, with boots on the ground and policy experts amidst, enforcement of the Task Force’s recommendations will curb the spread of this threatening epidemic in all areas of the Commonwealth.

References:

[1] Virginia Department of Health. (July 2016). Office of the Chief Medical Examiner Fatal Drug Overdose Quarterly Report, First Quarter 2016. Retrieved from http://www.vdh.virginia.gov/content/uploads/sites/18/2016/04/Quarterly-Drug-Death-Report-FINAL_July-2016.pdf

[2] Lopez, G. (June 2, 2016). The opioid painkiller and heroin epidemic. Retrieved from http://www.vox.com/2015/10/1/9433099/opioid-painkiller-heroin-epidemic

[3] Virginia Department of Health Professions. (April 6, 2015). Governor’s Task Force on Prescription Drug and Heroin Abuse Interim Report. Retrieved from https://www.dhp.virginia.gov/taskforce/minutes/20150512/TaskForceInterimReport05122015.pdf

[4] Center for Disease Control Health Advisory. (October 26, 2015).  Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. Retrieved from https://www.vdh.virginia.gov/OEMS/NewsFeatures/CDCHealthAdvisory-Fentanyl.pdf

[5] Department of Medical Assistance Services. (July 1, 2016). Virginia’s Addiction Treatment Services Delivery System Transformation Concept Paper: 1115 Waiver for Addiction Treatment Services. Retrieved from http://www.dmas.virginia.gov/Content_atchs/bh/VA%20Addiction%20Tx%20Services%20Concept%20Paper-FINAL-7-1-2016.pdf

[6] Partnership News Service. (November 9, 2011). Prescription Opioid Addiction Can Be Treated with Suboxone, Study Shows. Retrieved from http://www.drugfree.org/news-service/prescription-opioid-addiction-can-be-treated-with-suboxone-study-shows/

[7] Ramsey, J. (August 8, 2016). In SW Va., drug to help addicts attacked as part of the problem. Retrieved from http://www.dailyprogress.com/starexponent/news/in-sw-va-drug-to-help-addicts-attacked-as-part/article_d317f8f0-5dc2-11e6-868a-a7b72f83a47b.html.

Faith in Kidneys

Disclaimer: All names and identifying information have been modified to protect the privacy of all individuals. The opinions expressed in these articles are the author's own and do not reflect the views of the University of Virginia.

Our world is not solely composed of “most-likely” situations. In the strange, curious, and at times inexplicable reality in which we live, the seemingly-impossible is sometimes synonymous with the achievable. Such was the case for Carter and his wife, Sarah.

What are the odds that either your parent, spouse, or child can be a fully compatible kidney donor to you? How about all three? It doesn’t take a quick Google search to realize that the chances of those three events happening together are not in your favor. However, that is exactly what happened to Sarah, whose battle with Henoch-Schönlein purpura (HSP) damaged her kidneys at the early age of ten years old. Usually, HSP, an autoimmune disease, is not serious in children and typically goes away over time. Again, typicality is never a guarantee.

Sarah received her first gift of life when she was thirteen, in the form of a kidney from her father. They had waited three years to operate because back then because doctors thought she needed to grow more in order to be closer to her father’s size; it was thought that this would increase the chances of surgical success. Because the first living organ donor kidney transplant occurred in 1960, the procedure during Sarah’s first transplant was drastically different from the one to which we are accustomed today. Fortunately, everything went well and Sarah was able to survive on her new kidney for twenty years.

Everything seemed fine until she became pregnant with her first child. Sarah’s HSP, the extra strain of pregnancy, and simultaneous battles with toxemia and diabetes led to the failure of the kidney that had helped her continue to live. It was time for Carter, the husband, to step in.

Twenty-one years ago, Carter donated one of his kidneys to his wife, with no hesitation in his mind. For him, the decision was automatic: “With my wife, there was absolutely no question about donating.” This second transplant went well, allowing Sarah to live for another twenty years. That should have been the end of the story, but then Sarah had a third kidney failure. While there were fifteen potential donors for another surgery, one stood out among the crowd: their son, also named Carter. He was just a child during his father’s transplant, too young to understand the situation in front of him. But now, Carter, a fully grown man, knew that as a blood relative he would be his mother’s best bet at life. It was his turn now.

This is an incredible story of a woman beating the odds, refusing to give up on life, and the three men who helped her along the way. They were willing and able to give her a piece of themselves to give her the gift of life. But the story doesn’t end there.

During his wife’s third surgery, Carter came across another opportunity to give, one that would take him into unchartered waters. Carter recounted the story in an interview with me: “I put up something on Facebook about it to my friends, and that on this certain day, I was going to be at a restaurant if anyone wanted to join me. 60 people showed up. One of them was a high school classmate, Kelly. Between 9th and 10th grade she got thrown off her horse and the injuries were so bad that she had to be homeschooled for the next 3 years. The pain medications that she was given ended up destroying her liver, and now she is in need of a liver transplant. I told her that if all tests worked out, I would give her part of my liver.”

As simply as Carter tried to portray the story, I knew that there was more to it than that. So I dug deeper, picking his brain on why he was willing to risk his health to help someone he barely knew.

Carter admitted that things were different this time around, especially now that the donor wasn’t his wife. “I know her name but I don’t really know her.” But Carter, now fifty-six years old, saw this as something that he was meant to do. “Something that was very important to me was that my son was raised. If my son was young, I wouldn’t be doing this. With any risk of something going wrong, I need to first and foremost be there for a child who is growing up. If something goes wrong, which is highly unlikely, then he’s an adult now. He’s twenty-seven. He’ll be okay.” Okay, that made sense. But was that the only thought that went through his head before making his decision?  I wanted to know more. There had to be more.

What is the difference between donating a kidney to a loved one and donating your liver to an almost-stranger? Through Carter, I discovered that the lack of familiarity, trust, and relationship between recipient and donor is made up for by one single word: faith. Carter not only believes, he knows that he is doing a good thing, and that realization is what helped him make the decision. “Jesus Christ, He gave everything for us, He died for us, suffering a terrible death. As a Christian, that’s what we should do: serve others. The bigger and the better that we can serve other people, the more we should. To me, that’s why I do it- When we preach Christianity, it should not be through talk, it should be through actions.”

Those were some bold words words that were definitely easier said than done. Listening to Carter as he sat across from me, I was afraid that I just wasn’t understanding. “So, let me get this straight. You were just in a restaurant, listening to her story, and somehow, God just told you that you should do this?” I asked him. His simple smile said it all: “I believe that at the end of the day, it’s all up to God’s plan. Sometimes our plan doesn’t line up with his, but with a little faith, you can make your plan, His plan.” A little bit of faith can go a long way. As a man of faith, Carter wanted to follow up his words with his actions, a principle that is reflected in the Bible: “You see that a person is justified by works and not by faith alone.” (James 2:24).

Some say that theology and faith have no place in an ever scientifically-driven world. This story says otherwise.

    Technically, the Bible does not explicitly state that part of being a good Christian means choosing to be an organ donor. However, the foundation of the religion itself is based upon the ideal of unconditional love. They believe that God showers love upon them and that it is their responsibility to spread that love across the world, regardless of race, religion, or gender. Christianity revolves around service to others: “Do not withhold good from those to whom it is due, when it is in your power to do it.” (Proverbs: 3:27). The act of carrying out this belief can be seen in various ways, including organ donation. Carter saw an opportunity to act on his faith and realized that it was indeed within his power to give part of his liver to a stranger.

    But stories like that of Carter are not limited to just those who are religious. While ethics and theology have much in common, they are not the same. Carter’s decision to donate was an ethical decision that was backed by faith. But faith is not the only catalyst that can lead people to donate. Christians such as Carter are not the only ones who can become altruistic organ donors. Put religion aside for a moment and think of something that all humans have inside: goodwill. Whether that be holding the door open for the person behind you, smiling at the barista at Starbucks, or offering part of your liver to a stranger, we all have the potential to do good. Becoming a living organ donor is possible for anyone, not just someone of faith.

Moreover, it is also within our power to become registered as deceased organ donors. What does that entail? Being registered means that upon death, a team of doctors can remove your organs and immediately use them to save the lives of people who are in critical condition. These organs are extremely precious and fragile, as there is a time limit for transplantation before oxygen deprivation renders them useless. In a broad sense, being an organ donor gives you the chance to continue to do good even after death.

Any topic of discussion concerning death is bound to be complicated. People deserve to know all of the information about both living and deceased organ donations. Some religions and cultures prefer not to touch the body once someone has died, while others find it quite acceptable, and even encourage it. Pope Francis has even described the act of organ donation as a “testimony of love for our neighbor.” Almost all religions respect the idea of the individual’s choice to donate or not. At the end of the day, this is a matter of agency, and what factors will influence your decision. However, despite these potential bioethical tensions, the simple fact remains that becoming an organ donor will undoubtedly serve to help someone in need.

    We have a drought of organ donors in America. At the same time, the need for organ donations continue to rise. According to U.S. Department of Health and Human Services, there are over 120,000 people who are waiting list candidates for organ donations. It’s easy to blame the government, to point fingers at a “broken system” that the government has failed to fix. It is much harder to realize that we as a society share the blame, too. It takes people to make the decision to be organ donors, people who choose to make act on their goodwill.

    Of course, the problem of the shortage of organs will not solved by the simple idea of good will alone. It will take educating the public, learning what being an organ donor means. It will require a government effort to properly regulate the distribution of organs to those who need it across the country. But most importantly, the solution lies in more individuals like Carter, who will act out of faith or goodwill, making a positive difference in the lives of others.

References:

http://www.americantransplantfoundation.org/about-transplant/facts-and-myths/

http://www.donorrecovery.org/2014/10/pope-francis-supports-organ-donation/

http://www.patheos.com/blogs/christiancrier/2015/09/12/is-organ-donation-a-sin-should-christians-donate-their-organs/
http://www.organtransplants.org/understanding/religion/

Racial Disparities in Opioid…Prescription?

An article published this past week through the Public Library of Science (PLOS ONE) provided an in-depth look at opioid prescription trends in emergency departments (Singhal, 2016). It has been well documented that minorities are less likely to be prescribed opioids by emergency rooms, with a major 2008 article by Pletcher et al providing some significant data on the subject (Pletcher, 2008). In an attempt to reassess the current literature and view the data through a new lens, Singhal and colleagues specifically looked at whether the opioids were administered in the emergency room or prescribed at discharge (Singhal, 2016). The distinction is a meaningful one, providing insight into provider-patient trust while potentially highlighting the presence of a systemic treatment bias against racial minorities.

Through the analysis of the National Hospital Ambulatory Medical Care Survey (NHAMCS) data collected from 2007-2012, the group found significant racial disparities in both administration and prescription of opioid medication for certain “non-definitive conditions,” including back pain and abdominal pain (Singhal, 2016). Odds ratios, which are statistical measures of an association between an exposure and an outcome, were computed. In this case, the exposure was race, the outcome opioid prescription. It was found that non-Hispanic blacks had 0.67 and 0.58 times the odds of receiving opioids at discharge and in the emergency department, respectively (Singhal, 2016). Both odds ratios were statistically significant, with P values less than 0.05. These ratios, along with the large sample sizes ranging from 3000-10,000 for the significant ailments, speak to the strength of the analysis.

These findings come on the tail of a recent social psychology report out of the University of Virginia by Hoffman et al. which exposed inherent bias against black patients by both laypeople and medical students (Hoffman, 2016). In the later experiment, 222 medical students were presented with patient scenarios and asked about their perception of patient pain, revealing that false beliefs about biological disparity between races led to a “racial bias in pain perception” (Hoffman, 2016). These two articles together highlight the need for further study of, and a focus on counteracting these pervasive biases. However, Singhal’s discussion also highlighted the complexity of assessing doctor-patient interaction and accurately representing the presence of minority bias via discrete data points.

One confounding variable that complicates this assessment is socioeconomic status. A recent New York Times article, which set out to review the Singhal article, points out that in many cases, racial disparity and low socioeconomic status are intertwined, complicating patient care, and the data corresponding to that care (Goodnough, 2016). Despite this confounder, though, the researchers interviewed for the article, including Raymond Tait, a pain researcher in St. Louis, are certain that race plays a role that should not be ignored.

Given this data, it appears as though further inquiry will be necessary to flesh out the problem more fully before meaningful interventions can be executed. The pain management field must self-assess while attempting to create metrics to more specifically explain clinical decision making. One of the major pitfalls of the Singhal paper was the acknowledgement that, even if there is bias, every patient presents differently, complicating the statistical analysis. Additionally, proper control of socioeconomic factors in analyzing racial disparity data should enhance the current picture of minority bias, and potentially point to opinions for intervention.

References: 

Goodnough, A. (2016, Aug). Finding Good Pain Treatment is Hard. If You’re Not White, It’s Even Harder. New York Times. Retrieved from http://www.nytimes.com/2016/08/10/us/how-race-plays-a-role-in-patients-pain-treatment.html?rref=collection%2Fsectioncollection%2Fhealth&action=click&contentCollection=health&region=stream&module=stream_unit&version=latest&contentPlacement=3&pgtype=sectionfront&_r=1

Hoffman, KM, Trawalter, S, Axt, JR, and Oliver, MN (2016). Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS 2016 113 (16) 4296-4301. Retrived from http://www.pnas.org/content/113/16/4296.abstract

Pletcher MJ, Kertesz SG, Kohn MA, Gonzales R (2008).Trends in opioid prescribing by race/ethnicity for patients seeking care in US emergency departments. JAMA. 2008;299:70–78. Retrived from http://www.ncbi.nlm.nih.gov/pubmed/18167408

Singhal A, Tien Y-Y, Hsia RY (2016). Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLoS ONE 11(8). Retrived from http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224

New test for risk of Alzheimer’s disease

            A new test has been developed to identify those at increased risk for Alzheimer’s disease (Science Bulletin, 2016). The biochip-based blood test was presented at the 68th AACC Annual Scientific Meeting & Clinical Expo in Philadelphia. The biochip, created by Randox Laboratories, will save patients both time and money by conducting multiple tests on the same blood sample and analyzing results in as little as three hours (Nichols, 2016). The biochips were also found to have the same accuracy as a standard DNA test.

            The gene for apolipoprotein is known to be a significant genetic risk factor for a multitude of neurodegenerative diseases, including dementia. Specifically, the E4 variant can increase a person’s risk for developing the disease 8-12 times when inherited from both parents. This new test detects the presence of the protein produced by this gene in a blood sample (Science Bulletin, 2016). According to research scientist Emma C. Harte, Ph.D, of Randox Laboratories, “pairing this test with medical and family history for risk of Alzheimer’s disease,” will greatly improve diagnostic ability as well as personalized medicine.

            Other tests for the disease have been less scientific. With cognitive decline comes progressive loss of senses, smell being the first to go. Researchers at the University of Florida found that those with a confirmed early-stage diagnosis of Alzheimer’s were able to smell a dollop of peanut butter with their right nostril, but not their left (Johnson, 2013). More recently, studies presented at the 2016 Alzheimer’s Association International Conference suggest that a poor score on an odor detection test correlated with subsequent memory loss (Borreli, 2016). These tests may be used in the future for an even cheaper and earlier test for Alzheimer’s disease.

(2016). New biochip-based blood test detects elevated risk for Alzheimer’s disease. Science Bulletin. Retrieved from http://sciencebulletin.org/archives/3971.html

Borreli, L. (July 27, 2016). Can't Smell Coffee? Maybe You Have Alzheimer's. Medical Daily. Retrieved from http://www.medicaldaily.com/alzheimers-disease-sniff-test-memory-decline-392885

Johnson, J. (October 9, 2013). Alzheimer's Test: Can You Smell Peanut Butter?. Newser. Retrieved from http://www.newser.com/story/175622/alzheimers-test-can-you-smell-peanut-butter.html

Nichols, H. (August 3, 2016). Alzheimer's: Biochip blood test detects disease risk. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/312094.php

Analyzing Illegal and Refugee Immigration from a Public Health Perspective

Immigration has been the topic of conversation across the political sphere as of late. The combination of the European migration crisis and the porous southern US border has brought about a fierce debate as to what should be done socially and economically with immigrants. However, one aspect of our nation’s refugee acceptance and illegal immigration issue that has not been discussed as frequently is the impact on public health.

The United States has worked for decades to eradicate some of the diseases that frequently plagued the general population. Through vaccination, new sanitation standards, and updates to dated public health practices, we have eliminated many of the diseases that are still prevalent in other nations. Unfortunately, it is possible that the massive amount of undocumented immigrants entering our country unscreened could cause a spike in previously nonexistent illnesses.

According to multiple reports released over the past few years, including one released on World Migrant Day, the number of tuberculosis, measles, whooping cough, mumps, scarlet fever, and bubonic plague cases has increased. Many healthcare professionals have made a direct link to illegal immigration. Below are a few of the statistics:

Tuberculosis: Up 1.7% in 2015 after 23 years of decline

Measles: 667 Cases in 2014 after eradication in 2000

Whooping Cough: 32,971 cases in 2014, 30 times the amount in 1976

Mumps: 688 cases in 2015, after a 99% decrease in prevalence in 1967

    All of these diseases have been linked to incoming refugees and undocumented immigrants through the southern border. Many of the camps that house illegal minors are plagued by disease. In 2014, former Congressman Phil Gingrey (R-GA) wrote a scathing letter to Congress about the lack of transparency regarding disease transmission among immigrants. He cited reports of Border Patrol agents contracting diseases from the children. One major news station even reports that tuberculosis is prevalent in multiple camps, citing anonymous reports from healthcare workers employed. Not only is this detrimental to health of Americans, but also the health of the immigrants.  

What is the Solution?

    A significant amount of regulation is required in order to halt the spread of these infectious diseases. Currently, refugees are not required to have any vaccines prior to entering the United States. This poses a massive risk to our public health, as the MMR vaccine was directly responsible for eradicating measles after it was required by law. With potential disease carriers entering the U.S. in large numbers, it is almost guaranteed that the public will encounter new illnesses more frequently than before. One of the first steps in preventing further outbreaks is to halt refugee migration and develop a comprehensive screening system for communicable diseases. Additionally, vaccination should be required for all refugees entering the country. The combination of these two processes would eliminate the threat that refugees currently pose to public health.

With respect to the southern border, the U.S. government needs to reduce the number of undocumented immigrants entering the country by a significant amount. There is no way to analyze the health of individuals who have entered and now remain in the country illegally. The only way to prevent diseases from coming up through the southern border is to cut down on illegal immigration.

    Our policy with regard to vaccination and screening significantly differs between migrants and refugees. Many vaccinations are required for United States immigration. This, combined with health screening, has resulted in an extremely small percentage of communicable diseases being brought into our country via legal immigration.

    In short, the massive importation of refugees and illegal aliens into the nation is a very real threat to public health. A comprehensive reform to our refugee health policies and border security is essential to prevent the reoccurrence of deadly communicable diseases. Let’s not decimate the hard work of public health workers before us in their successful efforts to eradicate these illnesses.

References:

“Guidelines for Evaluating and Updating Immunizations During the Domestic Medical Examination for Newly Arrived Refugees.” Centers for Disease Control. 11 June, 2015.

“Illegal Alien Minors Spreading TB, Dengue, Swine Flu.” Judicial Watch. 8 July, 2014.

“New Vaccination Criteria for U.S. Immigration.” Centers for Disease Control. 29 March, 2012.

“Six Diseases Return to US as Migration Advocates Celebrate ‘World Refugee Day.’” Breitbart. 19 June, 2016.

Orlando Shooting Sparks Debate Regarding Limits on Blood Donations from Gay Men

After the Pulse nightclub shooting in Orlando, Florida, blood banks from the surrounding areas put out a call for donors. Gay men were ready and willing to donate but were unable to unless they were celibate for the 12 previous months because of a ban imposed by  FDA. For some time now, gay rights activists have argued that the ban perpetuates the stigma of being gay. The largest mass shooting in the United States brought attention to the topic and some felt that it added “insult to this nightmare” (Mcneil, 2016).  

The FDA holds that their restriction is based on science and that the policy is the same in Australia, New Zealand, and the UK (Firger, 2016). The FDA also estimates that currently, 1 in 1.5 million blood donations transmits HIV to a recipient and that removing the ban would change this to one in 375,000 donations. The window period for transmission, or when a test will give an accurate result, of HIV is nine to eleven days, but this is for a typical patient and under the most exhaustive testing (Mcneil, 2016). Gay rights advocates argue that much more blood would be available if those who are in monogamous relations, take drugs to prevent HIV transmission, and always use condoms were allowed to donate (Firger, 2016). They maintain that the risks of infection would be low enough to be acceptable if combined with testing, and that the risks would be considerably more acceptable during a crisis like the Orlando shooting.

Firger, Jessica. "WILL THE FDA’S POLICY ON BLOOD DONATION FROM GAY MEN CHANGE AFTER THE ORLANDO MASSACRE?" Newsweek. Accessed June 24, 2016. http://www.newsweek.com/orlando-massacre-fda-blood-donation-ban-gay-men-470226.

Mcneil, Donald G. "Orlando Shooting Renews Debate Over Limits on Gay Men Donating Blood." The New York Times. 2016. Accessed June 25, 2016. http://www.nytimes.com/2016/06/16/health/orlando-shooting-renews-debate-over-limits-on-gay-men-donating-blood.html?rref=collection/sectioncollection/health.