YOUNGSTOWN, Ohio (WKBN) – The recent increase in the misuse of prescription painkillers and heroin in the United States has sparked another growing epidemic – hepatitis B and C infections.
There are three forms of hepatitis — A, B, and C. All forms attack a person’s liver. While hepatitis A is passed along through contamination from fecal matter, hep B and C can spread through direct contact with infected blood.
The blood-borne viral infections have reached epidemic proportions in most states.
IV drug abusers at higher risk for hepatitis
Dr. Daniel Brown, chief medical officer at Meridian Healthcare, said 65 percent of patients coming in for treatment of a heroin addiction are hepatitis C positive.
“Those who are using IV drugs are over 80 percent positive,” he said.
The Centers for Disease Control and Prevention estimates there were nearly 30,000 acute hepatitis C infections nationwide in 2013 and 3.2 million Americans are infected.
Hepatitis C is transmitted via blood. Brown said IV drug abusers are at a higher risk because of shared needles.
“Any kind of drug solution through a needle is going to retain some of that blood through the needle,” Brown said.
Many people with hepatitis don’t know they have it. The CDC recommends that Baby Boomers get tested for hepatitis C because many undiagnosed cases have been found in the generation that came of age in the 1960s and 70s.
Brown said along with the epidemic of opioid abuse, a new generation of people is getting infected and that group is getting younger every year.
“Hepatitis C is a chronic illness. It lasts in your body for the rest of your life once you’ve contracted it. Even though it is a slow disease, it is a very serious disease. Patients who have hepatitis C die about 20 years younger than the average population,” Brown said.
Today, the CDC recommends health professionals test more people for viral hepatitis, bringing more awareness to the problem.
Hepatitis cases on the rise in our Valley
The number of hepatitis C cases in Mahoning, Trumbull, and Columbiana counties over the last six years are on a steep incline, according to state and local health departments.
Approximately 4.4 million people are estimated to be living with the hepatitis B or C infection. In Ohio between 2009 and 2013, reported rates of acute hepatitis B increased by 137 percent and reported rates of acute hepatitis C increased by 400 percent, according to the 2015 Ohio State Health Profile.
“We also recognized that CDC, through their survey, tells us that one-third of the population, 18- to 30-year-olds, injection drug users are infected with hepatitis C,” said Columbiana County Health Commissioner Wesley Vins.
Erica Horner, the director of nursing at the Mahoning County District Board of Health, said the typical age group for the highest numbers of chronic hepatitis C was people over 50 years old. But that’s no longer the case.
“We are starting to see an increase in the 20 to 29 age group, is starting to creep up to the highest number of newly diagnosed.”
The Ohio Department of Health sends information to local health departments through the Ohio Disease Reporting System to help track hepatitis C.
“When we get that, we are able to follow up with those people, see who they’ve had contact with,” said Jennifer Davis, the director of nursing at the Columbiana County Health Department. “As far as knowing if it directly correlates with IV drug use, we don’t get that part of the information here at the health department.”
In Trumbull County, there were 520 newly confirmed and probable hepatitis cases in 2016 alone.
“We don’t know if it’s due to better reporting of if more people are getting tested. There are a lot of factors that can cause that increase but definitely, there is a correlation between the rise in hep C and the rise in the opioid epidemic,” said Sandy Swaan, director of nursing at the Trumbull County Combined Health District.
While each health department is dealing with a different number of viral hepatitis cases, each agreed they are looking at ways to combat the problem, along with the opioid epidemic.
“C is treatable, as are A and B. The success rates for the newer treatments for hepatitis C have been hugely successful, so hopefully we’ll see more progress in that area, but there is no vaccine for hep C,” Vins said.
In Ohio, the CDC supports several adult viral hepatitis prevention programs. This has enabled our local health departments to better educate those who may be misusing opioids.
The state also offers a hotline for anyone who may be struggling with addiction and is in need of community resources — all they have to do is dial 211.
A controversial solution to the hepatitis problem
According to local public health officials, some acute hepatitis C infections go away with treatment within a few months.
“Now we have these newer medications that within eight weeks, in some cases longer for different types of hepatitis C, we’re seeing patients with zero viral load within several weeks of starting the medication,” Dr. Brown said.
But about two-thirds of cases turn into long-term, chronic infections which can cause liver damage, liver cancer, and even death.
Health experts in the Valley have been in talks to establish needle-exchange programs to combat the spread of viral hepatitis and put an end to the opioid epidemic.
“Prevention is the best method of preventing the disease, and that is by not sharing needles with someone who has used a needle,” Swann said.
Syringe Service Programs provide free sterile needles and syringes in exchange for used needles and syringes, which are then safely disposed of. The programs also provide access to hepatitis vaccines and prevention methods, overdose treatment and education, and mental health resources.
There are currently 228 Syringe Service Programs in 35 U.S. states, the District of Columbia, and Puerto Rico. In Ohio, there are currently four needle exchange programs and only three in Pennsylvania. The closest programs to us are in Cleveland and Pittsburgh.
In Trumbull County, the thought of a needle exchange program is in the early planning stages.
“It is an evidence-based program that is proven to reduce the rise in hepatitis C. It does not promote drug use. People who use drugs are probably going to continue to use drugs until they get some kind of rehabilitation or recovery type of help,” Swann said.
Health experts said needle exchanges also give public health workers a chance to educate drug users while providing other health services.
Vins, with Columbiana County, said the issue of providing needles to injection drug users is a complicated issue.
“It’s a very complicated process to vet that through and making sure that’s something the community wants to do, that there is community support. So I’m not going to rule it out in the future, but I think now it’s still in discussion.”
Mahoning County isn’t writing the idea off yet either.
“We’ll be continuing to conduct surveillance and talk to our community partners,” Horner said.
Trumbull County is hoping for support even though the program is costly.
“We’re looking to getting some commitment and buy-in in our community to set something like that up so that we do prevent the rise in hepatitis C,” Swann said.
Again, bringing a needle exchange program to Trumbull or any other local county is still in the beginning stages of discussion and planning.
However, Trumbull’s Combined Health District is hoping to get the funding to launch a program like this — attempting to bring an end to the spread of viral hepatitis and eventually, the opioid epidemic as a whole.
Editor’s note: Columbiana Health Commissioner Wesley Vins’ name was misspelled in the television story. It has been corrected online. WKBN regrets the error.