New research from the Centers for Disease Control and Prevention (CDC) suggests that the recent steep increase in cases of acute hepatitis C virus infection is associated with increases in opioid injection.
The study examines data from CDC’s hepatitis surveillance system and from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national database that tracks admissions to substance use disorder treatment facilities in all 50 U.S. states. Across the nation, researchers found substantial, simultaneous increases in acute hepatitis C (133 percent) and admissions for opioid injection (93 percent) from 2004 to 2014. These increases were seen at not only the national level, but also when data were analyzed by state, by age, and by race and ethnicity. Taken together, the findings point to a close relationship between the two troubling trends.
“Hepatitis C is a deadly, common, and often invisible result of America’s opioid crisis,” said Jonathan Mermin, M.D., M.P.H., director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “By testing people who inject drugs for hepatitis C infection, treating those who test positive, and preventing new transmissions, we can mitigate some of the effects of the nation’s devastating opioid crisis and save lives.”
The new analysis, published Thursday in the American Journal of Public Health, builds upon earlier research identifying a similar regional trend in four Appalachian states that faced increasing rates of new hepatitis C virus infection. Hepatitis C is spread through infected blood, which can contain high levels of the virus in a single drop. This, combined with needle and injection equipment sharing behaviors among some people who inject drugs, is fueling infections among younger Americans.
Steep increases among young people, whites, and women
Rates of opioid injection—especially injection of prescription opioid pain relievers, as well as heroin—and acute hepatitis C virus infections increased most dramatically from 2004 to 2014 among younger Americans (ages 18-39).
- Among 18- to 29-year-olds, there was a:
- 400 percent increase in acute hepatitis C;
- 817 percent increase in admissions for injection of prescription opioids; and
- 600 percent increase in admissions for heroin injection.
- Among 30- to 39-year-olds, there was a:
- 325 percent increase in acute hepatitis C;
- 169 percent increase in admissions for injection of prescription opioids; and
- 77 percent increase in admissions for heroin injection.
There were also sharp increases among whites and among women.
Hepatitis C poses a long-term threat
Until recently, hepatitis C primarily affected older generations, but as the opioid crisis worsened, the virus gained a foothold among younger Americans. Most of the 3.5 million people in the United States already living with hepatitis C are baby boomers, born between 1945 and 1965, but the greatest increases in new infections are being seen in young people. And as infections increase among young women, so has the rate of hepatitis C among pregnant women—placing a new generation of Americans at risk.
About 75 percent to 85 percent of newly infected people develop chronic hepatitis C virus infection. As there are few noticeable symptoms, many people are unaware of their infection until serious liver problems or other health complications arise. Hepatitis C is the leading cause of cirrhosis and liver cancer and the most common reason for liver transplantation in the United States.
“We have the incredible opportunity to stop new infections and prevent people from dying of hepatitis C,” said John Ward, M.D., director of CDC’s Division of Viral Hepatitis. “With the right treatment and prevention efforts, we can eliminate hepatitis C as a public health threat within our lifetime – but to do so we must stop new infections at the source.”
Dual epidemics demand an integrated response
The new findings underscore the need for comprehensive community opioid prevention services programs that:
- Support drug treatment and recovery services, including medication-assisted treatment, which can help people who inject drugs stop injecting – the primary risk behavior leading to new hepatitis C virus infection.
- Provide a range of testing, treatment and prevention services for hepatitis C and other infectious diseases, including hepatitis B and HIV.
CDC and SAMHSA work closely with states, communities, and prescribers to prevent opioid misuse, abuse, and overdose and to address hepatitis C risk among people who inject drugs. CDC’s role is to:
- Track both the hepatitis C and opioid crises.
- Help states scale up effective programs and tailor prevention efforts to their local communities.
- Equip health care providers with the tools and guidance needed to make informed clinical decisions.
- Undertake research to identify and alert communities that are at particularly high risk for infectious disease outbreaks tied to injection drug use.