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 2.4 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. The number of deaths due to opioid abuse have more than doubled since 2015, with 91,799 deaths reported in 2020. Males accounted for 69.4% of opioid deaths in 2020 compared to 30.6%.  Synthetic opioids such as fentanyl were the main driver of drug overdose deaths with a nearly 6-fold increase from 2015 to 2020. In 2020, males accounted for 73% of synthetic opioid related deaths with a 6-fold increase from 2015 to 2020 compared to 5-fold increase in women. 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.

The 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.