Monthly Archives: March 2014

HCV Infection Conundrum: Stemming the spread of new infections resulting from drug abuse

By: Marcus Hopkins, HEAL Blogger

Having lived for many years in West Virginia, I’ve had a front row seat to the burgeoning addiction problems in Small Town America to opioids.  In the 1990s, small towns in WV were chosen as test markets for OxyContin, one of the most abused prescription drugs in the U.S., primarily for their high incidence of chronic and cancer-related pain issues, many of which were and still are connected to WV’s coal mining industry.

What started out as a simple test market, however, has turned into one of the highest per capita addiction statistics in the U.S.  Oceana, WV (locally known better as “Oxyana”) was ranked as No. 1 for prescription drug overdoses in 2011.

Incidentally, WV also has the third highest rate of HCV infection in the U.S.  These two statistics are not, in my view, anomalous; rather, they point to a troubling trend in the U.S. that continues to go unchecked – those who abuse injectable drugs are more likely to contract HCV (as well as other blood borne pathogens) than any other demographic.

Image of person injecting opiods

Piggybacking off of my last article, I decided to go on a listening trip at my new workplace, comparing what I heard in my last place of employment.  As a restaurant worker, I’ve become accustomed to hearing all sorts of sordid gossip and stories of personal defeat, failure, and success, including no small amount of drug abuse-related stories.  I, myself, have often participated in these conversations, but after having been clean for nearly six years, I find myself woefully disconnected with the current drug culture.

What is troubling, for me, is the sheer amount of nonchalance about the ravages of opioid abuse.  Several of my employees and coworkers are all too willing to share their stories of how their cousin’s brother’s best-friend’s uncle overdosed on Oxy, or how they, themselves, spent some time in an opioid rehab facility as a condition of their probation, but still consider themselves to be “strong enough” to resist temptation.

Drug abuse is present in every line of work, but is extraordinarily present in those industries whose employees receive tips as the bulk of their wages.  As a waiter, I know that I can easily walk out of a shift with $100 in my pocket, and were I of a mind to find a way to blow it, I could just as easily find a drug dealer willing to relieve me of those funds.

While most restaurant workers in more urban areas are often likely to abuse stimulants, such as cocaine and meth, workers in more rural settings have a higher preference for prescription painkillers.  More than once, I’ve inadvertently walked in on an illicit drug exchange between employees, the pills passing from one employee to another with the belief that their not-so-surreptitious transfer will fall under the radar of management.

On more than one of these occasions, I have been offered drugs in exchange for my silence.  Having waited tables more often in urban areas, painkillers aren’t really my thing, I explain, and as politely as I can, I decline, assuring them that what they do with their bodies is none of my business, so long as their activities don’t interfere with my life.

This is the unspoken code of restaurant workers – keep your peace, until you are personally affected; but, at some point, when do we, as a society, begin to accept responsibility for our silence?

A conundrum, to be certain, should we, in an effort to stem the spread of HCV in high drug abuse states like WV, focus more on addressing the substance abuse problem, itself, or on addressing the circumstances in which these abuses occur?

One of the things that helped to slow down the spread of HIV/AIDS in the 80s/90s was the introduction of needle exchange programs, where people could trade in their used needles for clean needles.  While many within the addiction advocacy community labeled these programs as providing tacit support for a spreading problem with drug addiction, what they couldn’t fault were the results:

  • According to a report released by the CDC in November of 2010, numerous reviews of needle exchange programs lead to reductions in injecting risk behaviors among IDU (Injection-Drug Users);
  • HIV incidence amongst IDUs declined by approximately 80% over a period of twenty years;
  • Additional services provided by many needle exchange programs, such as HCV prevention services and abuse program referrals further confer the benefits of these programs.

It’s difficult to understate the important of continuing existing needle exchange programs, as well as fostering the creation of new programs, particularly in areas of the nation where prescription drug abuse is not just high, but is, in fact, the norm.

At this time, I am unaware of any existing programs in the state of WV; when I last spoke with a healthcare professional about the rampant spread of HCV in our state, I was told that, while Charleston, the state capitol, once oversaw a needle exchange program, that program was deemed unworthy of continuation in the late 1990s.

As an advocate for the HIV/AIDS and HCV communities, I would be remiss if I did not express my support for the revival and continued funding of a statewide needle exchange initiative, particularly focused upon areas of the state where drug abuse is most virulent.  While WV may not be the most health-conscious state in the Union (and yes, we were a Union state), much of this is because resources have often been so scarce that they often never reached the people who most need them.

On the national front, the Harm Reduction Coalition advocates for injection drug users, including on the policy front.  They lobby local, state, national, and international governments to include provisions for expanded syringe access, overdose prevention, and access to healthcare services.  Additionally, they work to reduce stigma through the use of education, alliance and coalition building, policy analysis, information dissemination and direct advocacy with policy makers.

This type of advocacy is imminently important, as one of the biggest hurdles to overcome in legislative bodies is the negative perception of drug users held by those elected into office (despite a storied history of politicians abusing drugs).  What these officials fail to remember is that drug use and abuse affects every demographic, across the entire spectrum of income levels, ethnicities, and socioeconomic backgrounds; more often than not, drug users are portrayed by politicians and officials as the “lowest of the low” – rarely do we see media reports about middle and upper class drug users – and these portrayals are what shapes legislation crafted by elected officials.

Perhaps it is time to stop refocus our efforts as they relate to drug abuse away from shaming the users into quitting, and into educating them about the risks and ravages to which they open themselves by practicing unsafe usage behaviors.  Providing them with the tools to more safely feed their addition may seem counterintuitive (particularly in the treatment/recover community), but in order to turn back the tide of small town America’s HCV epidemic, we may have to resort to proven methods that worked with HIV.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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A Reflective Analysis of HCV Infection via Sexual Exposure

By: Marcus Hopkins, HEAL blogger

Image of "The Thinker"

After sharing my last blog post with some of my colleagues, one of my most respected peers, Professor Kreyenbuhl-Gardner, brought to my attention something that has been largely overlooked in my previous postings: HCV is inefficiently transmitted via sexual exposure.

One of the primary foci of HEAL Blog is HIV/HCV co-infection, and over the past few months, I’ve covered the rising rate of new HCV infections in younger demographic groups in correlation with an increase in those groups’ seeming willingness to take more and more sexual risks (i.e. – having sex without using condoms).

Now, this information does come with some caveats:

  1. While HCV transmission via sexual exposure is rare, recent data indicate that sexual transmission of HCV can occur, especially among HIV-infected persons.  In 2010, the Centers for Disease Control & Prevention (CDC) reported that surveillance data demonstrated that 10% of persons with acute HCV infection report contact with a known HCV-infected sex partner as their only exposure.
  2. There has been a slight increase in new infections related to sexual exposure – and it must be noted that this is a very slight increase – within sex partners with sero-discordant HCV status.

There’s little evidence that HCV transmission via sexual transmission will become the norm; at this time, it appears that the vast majority of new HCV infections will continue to occur via intravenous drug use.

What is notable is that, regardless of the means of transmission, there have been marked increases in the rate of infection in the age ranges between 19-39.  Whether this is directly related to transmission from intravenous drug use or sexual transmission is unclear.  That said, it is clear that this increase merits greater outreach efforts to this demographic.

While my colleague is correct that HCV is inefficiently transmitted, that does not mean we should not continue to educate people about smart sexual practices, certainly not when both HAV and HBV are both easily transmitted via sexual contact.

Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates.

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