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. As many as 4 million Americans are living with Hepatitis C.

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. Nearly 108,000 persons in the U.S. died from drug-involved overdose in 2022, including illicit drugs and prescription opioids. Opioid-involved overdose deaths rose from 49,860 in 2019 to 81,806 in 2022. The opioid epidemic’s growth even contributed to a 0.67 year decrease in annual U.S. life expectancy between 2019 and 2022. Though these declines coincide with the period of the COVID-19 pandemic, opioid overdose deaths are an important contributor to decreasing US life expectancy. From November 2023 to October 2024,  78,378 United States residents died from an unintentional or undetermined intent drug overdose.

Key Insights:

• In 2022, 8 of the top 10 states with the highest opioid dispensing rates were in the South.
• In 2022, 8 of the top 10 counties with the highest opioid dispensing rates across the U.S. were in either Virginia or Kentucky.
• In 2022, 6 of the top 10 states with the highest percentages of pain reliever misuse were in the South.
• In 2022, 7 of the top 10 states with the highest rates of narcotic overdose deaths were in the South.
• In 2022, the Northeast region had the highest narcotic overdose mortality rate compared to other U.S. regions.
• In 2022, all top 10 states with the highest rates of Hepatitis C mortality are either in the South or West.

• North Dakota, Delaware, and South Dakota experienced more than a 30% increase in Hepatitis C mortality from 2021 to 2022.

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, 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 as well as mother-to-child transmission.

The Centers for Disease Control and Prevention (CDC) recommends routine periodic 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.