A surge in hepatitis C cases, especially in younger populations, is the hidden result of the opioid epidemic.
Since 2010, hepatitis C virus infections have risen at an alarming pace. The virus has led to more deaths in the United States than any other infectious disease, according to a study released in February 2019.
Researchers determined that the OxyContin drug reformulation of 2010 was a major contributor to the rise in hepatitis C infections, leading to unintended long-term public health consequences. Changes in the drug drove prescription medication users to seek more potent illegal drugs, like heroin.
Hepatitis C is a blood-borne, preventable, and treatable disease. The potency of the infection, combined with escalating injection drug use, is driving a rise in infections in younger Americans. People who engage in high-risk behaviors, like needle sharing and unprotected sex, are more likely to be exposed to hepatitis C.
This new public health threat can be eliminated with the right prevention and treatment efforts. Advancements in testing make screening more convenient and efficient for patients, and new treatments decrease the likelihood the disease will progress and cause severe liver deterioration.
What happened as a result of OxyContin’s 2010 reformulation?
OxyContin became widely used in the United States in 1996. It was aggressively promoted and prescribed for two reasons:
- It was marketed as a better way for moderate and severe chronic pain patients to manage their symptoms.
- The drug was expected to curb recreational use because it did not provide the euphoric effects that other painkillers provided.
However, individuals were able to abuse the drug by changing the way they took the slow-releasing prescription. When OxyContin is crushed and snorted or diluted in water and injected, it provides a strong immediate high that rivals the effects of heroin use.
When the manufacturers of OxyContin reformulated the drug in 2010, they introduced an abuse-deterrent version. This addition was supposed to be a breakthrough. Instead, it led users to switch to heroin.
The reformulated painkiller made it more difficult to snort or inject, and, therefore, made it less appealing to recreational drug users. When users were unable to achieve the same high they had in the past, individuals began switching to more dangerous illegal drugs, like heroin and fentanyl.
The major shift to injectable street drugs exposed many more people, including women and younger people, to the life-threatening hepatitis C virus.
Researchers recently determined that states with above-median OxyContin misuse before the reformulation experienced a 222% increase in hepatitis C infection rates in the period after the medication was changed.
States with below-median misuse experienced only a 75% increase in hep C infections.
Hepatitis C poses long-term damage to the public
Until the opioid crisis, hepatitis C impacted mostly older generations, specifically those born between 1945 and 1965 and referred to as baby boomers, according to the US Centers for Disease Control and Prevention (CDC). Many likely became infected with the disease before universal healthcare precautions were taken to ensure equipment and blood supplies weren’t tainted with blood-borne pathogens. It wasn’t until 1987 that the CDC recommended that healthcare professionals take comprehensive measures to prevent the spread of highly contagious diseases, like hepatitis C and HIV.
Today, young people, including newborns who contract the disease from their infected mothers, account for the highest number of new hepatitis C infections. About 3.5 million people in the United States are living with hepatitis C, according to the US DHHS. The actual number may as high as 4.7 million, due to those who may not have been diagnosed, according to HHS.
Up to 85% of newly infected people develop chronic hepatitis C because the disease carries few detectable symptoms until the illness progresses, according to the CDC.
Most find out about their infections when they are diagnosed with cirrhosis or liver cancer. In the United States, hepatitis C is the leading cause of cirrhosis and liver cancer, and the most common reason for a liver transplant.
What role should doctors play in curbing the spread of hepatitis C?
The numbers show that the healthcare community must take action. The CDC recommends they support drug treatment and recovery services, including medication-assisted treatment, such as methadone treatment.
With counseling and psychosocial support, the US Food and Drug Administration-approved medications safely and effectively help people stop injecting opioids.
Doctors also should promote a range of testing, treatment and prevention services for infectious diseases, including hepatitis C and B, tuberculosis, and HIV, for these at-risk populations.
Also, a Clinical Infectious Diseases study released in October 2018 showed that telemedicine-based treatment, which offered counseling via video conferencing as part of an opioid use disorder program, was a feasible model for managing hepatitis C in patients undergoing methadone treatment.
How to get more information about hepatitis C testing
Learn more about the guidelines for screening for hepatitis C and the testing available.