Massachusetts Witnesses HCV Resurgence

By: Marcus J. Hopkins, Blogger

Hepatitis C (HCV) has made a resurgence in Massachusetts, where hundreds of Intravenous Drug Users (IDUs) have created both a problem with opioid-related overdoses and an epidemic in new diagnoses, according to Kevin Cranston, director of the state Department of Public Health’s Bureau of Infectious Diseases.

HCV has long been associated with the Baby Boomer generation, most of whom contracted the virus through blood transfusions received prior to proper HCV screening. Thanks to education, blood screenings, and needle exchange programs (in states where they’re legal), HCV infections had been on the decline throughout the 1990s. That is no longer the case.

Drugs and drug use is, like other trends, cyclical – certain types of drugs come into and go out of fashion in roughly five-to-ten-year cycles. Opioids, however, have come back in a big way, and this time, heroin isn’t the only game in town. With the widespread introduction of pharmaceutical opioids in the mid-1990s (e.g. – Oxycodone), abuse of those drugs has become an increasing problem, not only for its addictive qualities, but also for the increase in IDU-related viral infections.

In Massachusetts, most new cases of HCV are occurring in people under the age of 30. This is largely attributed to heroin and pharmaceutical opioid abuse in a new generation of IDUs who can get their fix much more cheaply than their peers who prefer accelerants as their drugs of choice. The epidemic is so great that, over the past few years, Massachusetts has identified over 2,000 new cases annually.

The trend for younger IDUs starts where most problems start – the home. Young people typically begin their addiction by taking their parents’ prescribed painkillers, or by becoming addicted by using the pain medications prescribed to them after a sports-related injury. Once the pharmaceutical options are no longer available to them, many turn to heroin, which is much more readily available and cheaper on the streets than prescription opioids.

More troubling than the drug abuse, itself, is the sense of invincibility that often accompanies youth. Many younger IDUs don’t view HCV (or HIV, for that matter) as something that can “…happen to [them],” and if it does, there are always drugs to treat them.

As a Health Communication Specialist, I often get questions from younger attendees regarding HIV and HCV asking, “But…haven’t they cured that, yet,” or “Well, if you get it, can’t you just treat it with medication?”

MassHealth logo embedded on map of Massachusetts

Photo Credit: Association of Developmental Disabilities Providers

Unfortunately, treating infectious diseases is just not that simple, nor is it cheap. While Massachusetts does have a fantastic open formulary/PDL for their MassHealth (Medicaid) program for lower income citizens (one of the other common indicators for IDUs), the cost of newer HCV treatment regimens has largely contributed to a dramatic increase in spending, further stressing already stretched budgets to their breaking points.

Needle exchange programs are legal in Massachusetts, and are largely credited with a decline in new HIV diagnoses amongst IDUs. There are fears, however, that the same behaviors that have led to a sharp increase in HCV diagnoses will lead to a new resurgence in HIV infections, as well, within the same population. These fears are largely substantiated by HIV statistics from the CDC, showing that the largest increase in new infections over the last decade has occurred in those aged 13-25

Image promoting needle exchange for IDUsExchange programs have long been controversial, particularly in conservative circles, where the common belief is that such programs will bring the “wrong kind of element” into communities, and will encourage drug use and abuse, rather than having any sort of positive impact. These beliefs do not, however, stand up to scientific scrutiny, as research has repeatedly shown that needle exchange programs contribute to lower rates of injection-related viral infections; additionally, they consistently show no appreciably increase in drug use and abuse in area where needle exchange programs are readily available an accessible.

As of March 2015, the Massachusetts state public health lab began automatically testing every blood sample received for both HIV and HCV, a very positive step forward, and certainly a very progressive step in a state known for its bold action on public health fronts. This is, obviously, a step I would like to see being taken in every state; that being said, the reality is that it’s both too costly for most states to undertake and very unlikely to occur, particularly in the states where such actions are most needed (i.e. – the American South).

We, at HEAL Blog, will continue to monitor the situations in both Massachusetts and Indiana as more information becomes available.

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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. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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