Deeper Look: Opioids

The opioid crisis is one of the greatest public health challenges facing the U.S., causing an unprecedented surge in overdose deaths, and fueling the rapid rise in new Hepatitis C infections from injection drug use in communities across the country.

As opioid abuse rates have skyrocketed, new Hepatitis C infections have also increased. Data on HepVu show that an estimated 4 million Americans were living with Hepatitis C between 2013 and 2016. Though the majority, or roughly three-fourths, of all infections were among Baby Boomers (those born between 1945 and 1965), there has been a spike in new Hepatitis C infections among younger Americans.

The number of new Hepatitis C infections more than doubled from 2012 to 2019, largely reflecting infections due to the rise in injection drug use. This has created a syndemic, in which the opioid and Hepatitis C epidemics are linked – with the burden of Hepatitis C being directly exacerbated by injection drug use.

The Opioid Epidemic

In 2017, the U.S. Department of Health and Human Services (HHS) declared a public health state of emergency due to the opioid epidemic. Opioids are highly addictive and include prescription pain relievers, synthetic compounds such as fentanyl, and illegal drugs such as heroin. More than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids. Opioid-involved overdose deaths rose from 21,089 in 2010 to 47,600 in 2017 and remained steady through 2019. This was followed by a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths.

The opioid epidemic’s growth even contributed to a decrease in annual U.S. life expectancy, which declined to 77.3 years in 2020 primarily be attributed to deaths from the COVID-19 pandemic, although drug overdose deaths accounted for over one-third of all unintentional injury deaths.

Key Insights:

• In 2021, 8 of the top 10 states with the highest opioid prescription rate were in the South
• In 2021, 4 of the top 5 states with the highest percentage of pain reliever misuse were in the South.
• In 2021, 7 of the top 10 states with the highest rates of narcotic overdose deaths were in the South.
• In 2020, all top 10 counties with the highest rates Hepatitis C Mortality were in the South
• In 2020, all top 10 states with the highest rates of Hepatitis C mortality are either in the South or West
• In 2021, 8 of the top 10 counties with the highest rates of narcotic overdose deaths were in West Virginia
• The top 3 states with the highest percent increase in narcotic overdose deaths from 2020 to 2021 were Alaska, Oregon, and Kansas.
• There were 3 states that saw a decrease in the rate of narcotic overdose deaths from 2020 to 2021: Hawaii, Nebraska, and Maryland.

The HIV and Hepatitis C Syndemic

A syndemic refers to two or more interrelated epidemics that are mutually reinforcing and interact in a way that amplifies the overall burden of disease. Although not all people who abuse opioids inject drugs, people who inject drugs are at significantly higher risk of transmission of blood-borne viruses, including HIV and Hepatitis C.

Hepatitis C and HIV can be transmitted by sharing needles, syringes, water, alcohol swabs, and other equipment used to inject drugs. In 62-80% of people who inject drugs co-infection with HIV and Hepatitis C is common. As younger Americans engage in injection drug use, there is also a greater risk of women of childbearing age contracting Hepatitis C and pregnant women exposing their babies to the virus.

The Centers for Disease Control and Prevention (CDC) recommends routine HIV and viral hepatitis screening for people who inject drugs. Additionally, prevention efforts, such as syringe service programs and substance use treatment services, can slow the growth in the number of new Hepatitis C and HIV infections due to injection drug use. By identifying new infections early, patients can be treated for HIV, or cured of Hepatitis C, and stop additional infections from occurring.

People with HIV and Hepatitis B

Hepatitis B virus (HBV) and HIV are bloodborne viruses transmitted primarily through sexual contact and injection-drug use. Because of these shared modes of transmission, a high proportion of adults at risk for HIV infection are also at risk for HBV infection. People with HIV who become infected with HBV are at increased risk for liver-related morbidity and mortality.