By: Marcus J. Hopkins
Whenever I speak to colleagues in the medical profession about my work with Hepatitis C (HCV) and coverage data, I inevitably begin citing some of the grim statistics related to the disease: recent spikes in new HCV diagnoses indicate that poorer people between the ages of 13-35 are the new face of the disease; the most effective drugs to treat the virus cost more for twelve weeks of treatment than most Americans make in a single year; that opioid prescription drug and heroin abusers are likelier than virtually any other population to contract HCV; how the disease is largely un- or under-reported, because states lack the funds to adequately monitor and track the disease.
That I am familiar with the topic and can speak with some authority on the matter is clear, but what I am consistently asked by physicians, specifically, is why I believe we should make testing compulsory for those who are not Baby Boomers, the conventional wisdom being that this population, because they are likelier to have received blood transfusions prior to 1990, are high on the list o potential candidates for HCV. As I try to explain that, the new face of the disease is quickly becoming Injection Drug Users (IDUs) who are younger, whiter, and poorer, I find myself met with consternation. How can I possibly think that compulsory – and potentially costly – blanket screening would produce a net positive result?
My experience comes from having lived during and through the AIDS epidemic of the 1980s and 90s. As a kid and teenager growing up during the age of Comprehensive Sex Education, the constant mantra was “Get tested, get tested, get tested.” The campaign knew that teenagers and young adults were going to have sex with one another, and getting tested was one of the best ways to prevent the spread of HIV; by knowing your status, you could protect yourself and others with whom you might come in contact. These messages were blasted all over the media, in schools, in health classes, in science classes, on television shows, on the radio, in popular music – and, for the most part, this tactic was effective. New infections have largely plateaued over the past twenty years, or so, at roughly 50k annually in the U.S. That these types of marketing and policies directed toward HCV could produce similar results is, to me, a no-brainer.
Despite our differences on testing policies, a constant refrain I hear, especially from Appalachian physicians, is one detailing the woes of opioid drug abuse. “We see more people in the ER for drug abuse-related issues, than for virtually any other reason,” a nighttime ER nurse relayed to me, while collecting a throat culture to check for flu. “How these people get ahold of so many pills is beyond me!”
I hear that, a lot – doctors and nurses who seem simply flummoxed as to how patients come by these prescription drugs, considering the high number of opioid pain relievers prescribed in WV (137.6 for every 100 West Virginians) (Centers for Disease Control and Prevention, 2014). I’m told stories about how boring and pointless are the mandatory opioid educational courses, when they’re not a part of the problem; why should they have to take them, and waste their time on something that’s not really in their wheelhouse?
This might be the biggest disconnect that I encounter – how the behaviors of medical personal and prescribing physicians as they relate to opioid prescription drugs may be driving the increase in new drug abuse-related HCV infections. When a healthcare professional focuses only on the behaviors of patients, without acknowledging that their own role in providing their patients with access to these highly addictive drugs, it is a reminder of just how vital, and yet seemingly unheeded, those mandatory opioid education courses are. Their tacit assertion that common drug dealers, and not themselves, are the crux of the problem demonstrates how badly they need those courses.
Given the high correlative relationship between prescription drug abuse (and its potential, and perhaps eventual, path to heroin) and HCV infections, one might be led to think that the best place to stem the problem would be with the providers of the vice. Of course, a one-solution course of action will never be enough to effectively, or even adequately, combat the problem; multiple angles must be attacked in order to win the war against HCV, and unless we put forth adequate funding, staffing, and physical resources to fight these battles, we will likely fail to win the war.
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.