polo club strongsville Opioid crisis drives hep C spike
Hepatitis C, a quiet but not insignificant health risk is rising in tandem with prescription opioid and heroin abuse across Vermont.
According to the Vermont Department of Health, newly reported cases of hepatitis C more than doubled among Vermonters 20 to 39 years old between 2010 14.
Half of all newly reported cases in 2015 were among 15 to 39 year olds, and though the 2016 data is preliminary, slightly more than half of new cases reported last year were among Vermonters aged 20 39.
This mirrors national and regional trends. Massachusetts, parts of Maine and Appalachian states also reported sharp rises in hepatitis C infections in 2015.
“Nationwide, the numberofnew hepatitis C cases each year has risen steadily since 2011,” said Dr. Steven Lidofsky, professor and director of hepatology at the University of Vermont
Medical Center, in a recent email correspondence. The new cohort of hepatitis C virusinfected injection drug users are young, white, non urban residents who used oral prescription opiates prior to using heroin, according to a CDC backed study.
Traditionally, i t has been the baby boomer generation (those born between 1945 65) associated with the hepatitis C virus, because practices like reusing syringes were in effect before the disease was discovered (1989) and donated blood and organs were not screened prior to 1992.
Sometimes referred to as the “forgotten virus,” the CDC warns that between 40 and 85 percent of people who have contracted the virus do not know they are infected and each year hepatitis C now kills more people than HIV. The Vermont Department of Health says its numbers do not include Vermonters who are unaware of their hepatitis C status. Those infected with the virus often do not experience symptoms until two or more decades after infection, when chronic liver disease and other diseases related to hepatitis C become clinically apparent.
“If the diagnosis of hepatitis C is not recognized soon after exposure, it would not be possible to make lifestyle changes such as avoiding alcohol intake (which can accelerate liver damage) or to reduce inadvertent transmission to household members, such as by sharing razors, nail clippers, or toothbrushes,” Lidofsky said. “Individuals at risk should be tested early.”
Because the virus can live for up to three weeks on anything that has had even the smallest amount of infected blood on it despite being dried or even too small to see it is important for a person to get tested if they’ve ever injected drugs or lived with someone who has.
There are a few places in Vermont that offer free and anonymous hepatitis C testing and have syringe exchange programs that collect and properly dispose of used syringes and provide free new ones, clean injection equipment and sterile water. According to the Vermont Department of Health, 950,000 sterile syringes were dispensed through Vermont’s exchange programs in 2014 and 2015. Those programs also offer HIV testing, education and counseling and related resources.
Laura Byrne, executive director of the HIV/HCV Resource Center in Lebanon, New Hampshire, has run such a program at the Good Neighbor Clinic in White River Junction since 2006 and started one this year at the Springfield Health Center on March 6.
“The longer I do this kind of work, I see syringe exchange programs filling a really unique position along the road to recovery for people,” she said. “It gets them in. It gets them talking about medicationassisted or abstinence based treatment or counseling. It gets them into the medical center where the exchange programs are located, where they can get other services. It allows for a continuity of care for our clients.”
Those services include referrals to follow up health care, which Byrne stressed is extremely important for those who have tested positive for the hepatitis C antibodies. Education about the virus is also key.
“Hep C is a hardy virus,” she said. “It can be passed on days later; given the right temperature and volume conditions, it can live in the barrel of a syringe for 65 days. But it’s not just the equipment. I’ve heard stories from clients lately, numerous times, that they never shared needles but they test positive. And what they don’t realize is that it’s not just needles;
it could be the water they used, if someone else who has the virus drew up from the same water.”
Byrne’s program also focuses on harm reduction techniques to help prevent overdosing and provides Narcan the naloxone nasal spray that can block opioids and restore normal breathing in someone who is overdosing to clients and friends and family members of those who are using heroin, along with a brief training on how to use it.
There are similar programs in Rutland and St. Johnsbury (exchange programs) and Montpelier and Burlington (HIV services, prevention, free testing and education), run by Vermont CARES, which recently started a mobile version for towns in Addison, Caledonia, Essex, Franklin, Grand Isle, Lamoille, Orleans, Rutland and Washington counties. The Howard Center in Burlington also has an exchange program, as well as free hepatitis C and HIV testing and other services.
“There is a lot that goes on at the syringe exchange that is more than just giving people needles,” Byrne said. “Education and testing are hugely important to be able to protect people who are actively using street drugs. The people who do find out they have hep C, they take precautions.”
About 15 to 25 percent of people can clear the hepatitis C virus on their own, without treatment. For those who do not and develop chronic hepatitis C (about 75 to 85 percent of newly infected people), the CDC says about 90 percent will clear the virus with the new oral medication treatments now available. But, unlike other viruses, people do not build immunity against hepatitis C and there is a possibility for re infection, especially if someone is an active injection drug user.
That, combined with the high cost of the medication, may explain the hurdles in place for those seeking treatment for hepatitis C. Insurance companies, including Medicaid, place restrictions on patients who require treatment, such as requiring clean drug tests or denying coverage until the patient has reached a more advanced stage of liver disease. are denied access to the new treatments.
This past December, the Medicaid Drug Utilization Review Board advised the Vermont Department of Health Care Access to expand the availability of prescription drugs that treat hepatitis C to patients who had Stage 2 liver disease, instead of just those who had progressed to stages 3 or 4. The review board also recommended the state lift restrictions denying medication to patients who had used drugs or alcohol within six months of treatment. Though the department had previously stood by its policies, citing the high price of the medication and slow reimbursement times, the new guidelines were implemented this year allowing recent or active injectiondrug users access to the treatment they need.
“There are people working to expand access to treatment for Vermonters,” Byrne said. ” The new treatments are oral, shorter, there are fewer side effects and most people who get treatment clear the virus.”
Doctors and health advocates across the board agree that getting tested is recommended for both baby boomers and anyone who has injected drugs, whether or not they remember sharing any equipment, even if it happened just one time. And, for those who do get tested and have developed chronic hepatitis C?
“Don’t panic,” said Lidofsky. “Address basic health issues. Avoid highrisk behavior. Avoid alcohol intake. Get evaluated for hepatitis C treatment (it works),
but be aware that successful treatment does not lead to immunity against hepatitis C.”