In Columbus, Ohio, a teenage boy who was undergoing treatment for substance use disorder was surprised a couple years ago to learn he’d been infected with hepatitis C. The boy, then 17, was attending private school — and sharing needles with classmates to use heroin, says Dr. Carlos Malvestutto, infectious diseases fellowship program director at Ohio State University Wexner Medical Center in Columbus.
“He had a complete lack of awareness about the risks of contracting hepatitis C and HIV [from sharing needles],” Malvestutto says. “He believed that was something that wouldn’t happen to him and his friends. They’d progressed from using pills [opioids] to sharing needles, and he thought he was safe.”
Fortunately, the teenager hadn’t contracted HIV, and medication cured his hepatitis C infection, Malvestutto says. The 2016 episode illustrates how the nation’s ongoing opioid crisis is creating another long-term public health threat: a surge in HIV and hepatitis C infections. In 2016, Centers for Disease Control and Prevention researchers published findings identifying 220 counties in 26 states nationwide that were most vulnerable for HIV and hepatitis C outbreaks among people who inject drugs, in the context of the opioid epidemic. Tens of thousands of people (if not more) who inject heroin, fentanyl and other opioids are at risk of contracting HIV or hepatitis C from a contaminated syringe.
HIV, a virus that attacks the immune system, is treated with antiretroviral therapy. Hepatitis C, a viral infection that causes liver inflammation, could lead to long-term health problems, such as cirrhosis and liver cancer. Highly effective antiviral medication can cure it over two to three months.
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The link between injection opioid use and these infectious diseases makes it critical that people who inject drugs have access to prevention and treatment information and services, says Gretchen Weiss, director of HIV, sexually transmitted infections and viral hepatitis programs at the National Association of County and City Health Officials. “The connection between the opioid epidemic, injection drug use and the spread of infectious diseases like HIV and hepatitis C is undeniable,” she says. “It’s crucial that people have access to information and services that will help them prevent infection. This includes information about safer injection practices and access to clean needles, syringes and other injection equipment.”
Studies indicate that many people who inject drugs aren’t aware of the risks they take when they share needles. For example, research suggests that only 1 in 4 injection drug users obtained all their needles and syringes from sterile sources, according to the December 2016 Vital Signs report by the CDC. In a public telebriefing, Dr. Tom Frieden, the then-director of the CDC, described the sharing of needles as “a horrifyingly efficient route of spreading HIV, hepatitis and other infections.”
Scott County, in southeastern Indiana, is a case study for just how quickly needle-sharing can spread HIV and hepatitis C. In January 2015, Indiana state health officials launched an investigation after authorities identified 11 confirmed cases of HIV in Scott County, a rural community of 4,200 residents. That was more than double the typical number of HIV cases — five — reported in the county annually.
By April 2015, state health officials had identified 129 people in the county with HIV, and another six who had preliminarily tested positive for the virus, according to the CDC’s Morbidity and Mortality Weekly Report. “The majority of cases were in residents of the same community and were linked to syringe-sharing partners injecting the prescription opioid oxymorphone (a powerful oral semi-synthetic opioid analgesic),” the report said. Ultimately, more than 200 people in Scott County were newly infected with HIV during the outbreak, and nearly all were co-infected with hepatitis C, Weiss says.
Many of the counties most vulnerable for HIV and hepatitis C outbreaks among persons who inject drugs are clustered in states hit hardest by the opioid epidemic: Ohio, Indiana, Michigan, West Virginia, Tennessee, Kentucky and Missouri. Nationwide, more than 64,000 people died of a drug overdose in 2016, and the lion’s share of those fatalities — more than 42,000 — involved opioids, a record number, according to the CDC.
The best way to avoid contracting HIV or hepatitis C or dying from an opioid overdose is to stop injecting illicit drugs, clinicians and public health officials say. Recognizing that many people with drug misuse disorder will struggle to stop injecting illicit drugs and may not succeed, at least not immediately, public health authorities — while not encouraging or condoning substance misuse — recommend these strategies to cut down on the odds of becoming infected with HIV or hepatitis C:
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1. Look for a needle exchange program. Research shows that programs in which people who inject drugs turn in their used needles in exchange for clean ones are effective in preventing the spread of HIV and hepatitis C, says Dr. Mark S. Roberts, chair of the department of health policy and management at the University of Pittsburgh Graduate School of Public Health. Such programs are often run by local health departments, nonprofits and other community-based organizations. To find out whether there’s a program in your area, check with local and state health authorities or log onto the website of the North American Syringe Exchange Network at nasen.org. NASEN is a nonprofit “dedicated to the creation, expansion and continued existence of syringe exchange programs as a proven method” of stopping the spread of blood-borne pathogens among people who inject drugs. There are 194 such programs available in 33 states, the District of Columbia, the commonwealth of Puerto Rico and the Indian nations, according to NASEN.
2. Take advantage of health services offered by needle exchange programs. Many needle exchange programs offer more than clean needles. For example, the program run by Baltimore city’s health department also offers HIV and hepatitis C testing and trains clients how to reverse an overdose with a narcan kit, says Dr. Leana Wen, commissioner of health for the city of Baltimore.
3. Know your status. Get tested for HIV and hepatitis C, Weiss advises. Clinicians test for both infectious diseases with a simple blood test. If you learn that you’re infected, you can start treatment. In the early days of the HIV-AIDS epidemic in the 1980s, an HIV diagnosis was tantamount to a death sentence, but significant advances in antiretroviral therapy means HIV can be a chronic manageable condition. HIV treatment is crucial to keeping the virus suppressed, which both benefits the health of individual and helps prevent transmission through needle sharing.
4. Don’t assume you can safely share needles with family members and close friends. Many people who inject drugs have a false sense of safety when it comes to sharing needles with family members and close friends, Weiss says. In Scott County, researchers found some family members shared needles, contributing to the outbreaks. “Some people believe that it’s OK to share needles with family members, like a brother, a sister, an uncle or an aunt,” Weiss says. “It’s not.”
5. Clean you needles thoroughly. To be certain your needles are free of infectious viruses, clean them with bleach, advises Harry Nelson, chairman of the Behavioral Health Association of Providers, a Los Angeles-based national trade association for behavioral health industry professionals, owners and operators. The CDC offers a chart showing how to clean syringes in three steps: First, rinse the syringe in water, tap or shake it for 30 seconds and then discard the water from the syringe. In another container, disinfect the syringe by submerging it in pure bleach; then rinse it with clean water.
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6. Clean your “cookers” — and don’t share them. People who inject drugs often use non-sterile “cookers” — items such as the bottoms of drink cans, syringe barrels, bottle caps and spoons — to mix and heat their drugs. Cookers can be used to prepare heroin and pills for injection. “Sharing any injection equipment, including ‘cookers,’ can spread HIV or hepatitis C,” says Dr. Sarah E. Wakeman, medical director of the substance use disorders initiative at Massachusetts General Hospital in Boston.
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6 Ways People Who Inject Drugs Can Avoid HIV and Hepatitis C Infections originally appeared on usnews.com
