Deeper Look: Opioids

The opioid crisis is one of the greatest public health challenges facing the U.S., causing an unprecedented surge in drug 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 2.3 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 tripled from 2010 to 2016, 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. From 2002 to 2017, the number of deaths due to opioid abuse have more than quadrupled. The opioid epidemic’s growth even contributed to a decrease in annual U.S. life expectancy, which declined to 78.6 years in 2016 primarily due to increases in suicides and opioid-related overdose 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. Nearly 75 percent of people with HIV who inject drugs are also infected with Hepatitis C. 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.