The opioid epidemic is leading to a dramatic increase in new hepatitis C infections, according to a Centers for Disease Control and Prevention analysis. Between 2010 and 2015, the number of reported hepatitis C cases increased by 294 percent.
Hepatitis C is transmitted through contact with infected blood. Between 75 and 85 percent of people infected with the virus develop a chronic infection that can cause life-threatening complications.
The number of reported cases reached a five-year high in 2015, but experts believe that number drastically underestimates the number of actual cases. The CDC estimated that 33,900 people became infected with hepatitis C in 2015.
Annual Number of Reported Hepatitis C Cases
Source: Centers for Disease Control and Prevention
The growing number of infections was associated with increased injection drug use. Hundreds of thousands of people became addicted to opioid painkillers during the opioid epidemic. When the prescription drugs became difficult to access, many people switched to heroin. Heroin is an opioid that is chemically similar to morphine.
“These new infections are most frequently among young people who transition from taking prescription pills to injecting heroin, which has become cheaper and more easily available in some cases,” the CDC study’s co-author Dr. John Ward told CNN. “In turn many … people who inject drugs become infected with hepatitis C.”
These people often share unsterile needles, increasing the risk of spreading infectious diseases such as HIV and hepatitis. Hepatitis C contributed to an estimated 19,659 deaths in 2014.
Several communities have established needle exchange programs to provide sterile needles for injection drug users. However, a third of people who inject drugs said they shared a needle in the past year, according to a 2016 CDC report.
Effectiveness of State Policies to Prevent and Treat Hepatitis C
In a May report, CDC investigators analyzed the effectiveness of existing state laws related to the prevention and treatment of hepatitis C. They concluded that only three states — New Mexico, Washington and Massachusetts — had laws and Medicaid policies that could comprehensively prevent and treat hepatitis C infections among people who inject drugs.
Effective prevention laws included five elements:
- Explicit authorization of needle exchanges
- Exemption of needles and syringes from legal definitions of drug paraphernalia
- Decriminalization of possession of legally obtained needles
- Decriminalization of needle possession if possession is disclosed to a police officer
- Legalization of retail sales of syringes
State laws were categorized on a five-point scale ranging from most comprehensive to least comprehensive. Three states had policies the CDC ranked most comprehensive, and 18 states had policies ranked least comprehensive.
The CDC also categorized the Medicaid policies of 40 states as permissive or restrictive. Restrictive policies had barriers to hepatitis C treatment, such as a sobriety requirement. Twenty-four states had restrictive Medicaid policies. Of the 17 states with the highest rates of hepatitis C, only five had permissive Medicaid policies.
Treatment for Hepatitis C Remains Expensive, Hard to Access
In recent years, the U.S. Food and Drug Administration has approved two hepatitis C medications with high cure rates. However, the drugs are inaccessible to most patients.
A 2015 U.S. Senate investigative report criticized the makers of a medication called Sovaldi because it cost $1,000 per pill and $84,000 for full treatment. The same manufacturer, Gilead Sciences, also released a hepatitis C medication called Harvoni that cost $94,500 for a single course of treatment.
In 34 states, Medicaid covered Sovaldi only if the patient already had liver damage, according to a 2015 study published in Annals of Internal Medicine.
“It is just not feasible to provide it to everyone,” Matt Salo, director of the National Association of Medicaid Directors, told NPR in 2015. “States have to make sure that we’re going to prioritize and that those who need it the most get priority treatment. And that’s what you’re seeing.”
Treatment for hepatitis C can be complicated by drug use because side effects of hepatitis C medications can be mistaken for withdrawal symptoms. Those symptoms may cause patients to discontinue hepatitis C treatment and relapse into addiction.
But people who use injection drugs can be treated for hepatitis C and drug addiction at the same time. Medication-assisted treatments for heroin addiction can be administered alongside antiviral treatments for hepatitis C, according to the National Institute on Drug Abuse.
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