Opioids Linked to Hep C Uptick

Knoxville News Sentinel USA TODAY NETWORK - TENNESSEE

The United States’ overall rate of hepatitis C infection more than doubled from 2004 to 2014 — and among people under 40, it increased by 300 to 400 percent.

The reason for the jump? Transmission through injecting opioid drugs, said a report published Thursday in the American Journal of Public Health.

Lead author Jon Zibbell, senior public health analyst in the Behavioral and Urban Health program of Atlanta-based RTI Health Solutions, said public health officials have long presumed the link, but the research, performed in conjunction with a number of other agencies, provides data to back it up.

Spread through reusing equipment

Injection drug use is now the most common risk factor for hepatitis C, itself the most common chronic bloodborne infection in the United States, and data indicates 28 percent of injectors are infected within a year.

“Once the virus is introduced into a network of persons who inject drugs, it can circulate quickly through the reuse of contaminated drug injection equipment — specifically, needles, syringes, cookers and filers,” the report said.Zibbell said that’s accounted for hepatitis C outbreaks in various parts of the country — and public health experts expect more.Hep C part of opioid epidemicZibbell, formerly with the Centers for Disease Control and Prevention, had previously studied the relationship between hepatitis C infection and drug injection in four states — Tennessee, Virginia, West Virginia and Kentucky — and found a 200 to 300 percent increase in the number of infected people who’d injected drugs.“At the time, hepatitis C wasn’t being talked about as part of the opioid epidemic,” Zibbell said, noting the absence of infectious disease in the president’s report on opioid addiction. “It was really kind of a game changer.”Expanding the study model to look at all 50 states, “what we found was, the same thing happened.”Up to 400 percent increase among youngThe study looks at infection rates among people admitted for substance abuse treatment and found “statistically significant” increases of 400 percent among ages 18-29 and 300 percent among ages 30-39. At the same time, the infection rate among people with risk factors other than injected drug use didn’t see the same increases.Because hepatitis C infection doesn’t always cause symptoms immediately, and because such a small percentage of people addicted to opioid drugs receive substance abuse treatment, both the number of cases and the increase in them are likely much higher, Zibbell said.The CDC estimates for every case of hepatitis C, another 33 go undetected.The study showed the largest increases occurred east of the Mississippi River and in central Appalachia — including Tennessee. Though men and women were infected, women were infected at a higher rate. The study also found “statistically significant” increases in hepatitis C infection among Hispanics, which Zibbell said could occur as Hispanics “assimilate” into populations already using injectable opioid drugs. In addition, in many urban areas, people of color are statistically more likely to die of opioid overdose, he said.“That was a real eye-opener for us,” he said. “It can really speak to the epidemic not just being a ‘white’ epidemic.”Burden to health care systemHepatitis C, along with HIV and endocarditis — infection of the lining of the heart and its valves — form a “big burden to the health care system” in terms of cost and manpower, Zibbell said. HIV outbreaks have been less common because of a lower prevalence of the virus, he said, but have occurred — such as last year in rural Indiana — and HIV patients, more and more, are infected with hepatitis C also.He hopes the report will help drive a national health response that includes treating hepatitis C — for which there is now a cure, albeit an expensive one — and HIV along with drug addiction. Treating diseases independent of one another has been a “missed opportunity,” he said.Treating hepatitis C in people who spread the virus through injecting drugs could have a significant public health impact, he said, comparing the hepatitis C virus, which exists only in humans, to smallpox: “We have a cure for hepatitis C. ... We could eliminate this virus from the world.”Jon Zibbell, formerly with the Centers for Disease Control and Prevention, had previously studied the relationship between hepatitis C infection and drug injection in four states — Tennessee, Virginia, West Virginia and Kentucky — and found a 200 to 300 percent increase in the number of infected people who’d injected drugs.

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