By: Marcus J. Hopkins, Blogger
For nearly three years, healthcare officials and epidemiologists have been sounding the alarm: the face of the Hepatitis C (HCV) epidemic is changing – it’s getting younger by the minute. We, here at HEAL Blog, have been beating that drum alongside them, and yet, the U.S. Centers for Disease Control and Prevention (CDC) has yet to formally change the screening recommendations to reflect the new reality. As more evidence piles up that new Acute HCV infections are largely being driven by prescription opioid and heroin Injection Drug Use (IDU) among Americans aged 15-45.
A piece written by the Digestive Health Team out of the Cleveland Clinic – Why Is Hepatitis C on the Rise in 20- to 29-Year-Olds? – explicitly says as much. In addition, while African-Americans share a disproportionate burden in the epidemic (as a percentage of the population), these issues are particularly pronounced in white, non-urban (suburban and rural) populations living primarily in Appalachia, the Midwest, and New England.
So, what is it about these areas that drives people to abuse prescription opioids, heroin, and/or other illicit drugs? There isn’t just one answer. A lot of the areas where these outbreaks and epidemics are so pronounced share several similarities – struggling economic circumstances; higher-than-average unemployment; less access to and utilization of healthcare services; high rates of Social Security Disability Insurance utilization; economies driven by high-intensity labor industries (mining, for example). Any combination of these factors can lead people to develop substance addictions; that these areas are more remote with fewer outlets and opportunities for employment, entertainment, or social engagement essentially creates enclaves where people can all but disappear into a considerably isolated world of addiction.
Where the kids come in often has to do with the friends, relatives, and other adults whose legitimate opioid prescriptions get unknowingly diverted by experimenting teens who inadvertently become addicted to the highly addictive substances. As a young adult living in a small city in Tennessee in the 2000s, virtually all any of my friends and co-workers wanted to do was find “pills” (primarily OxyContin). Whereas I grew up in the cocaine-fueled 80s and ecstasy-addled 90s, parties in the 2000s were, for my generation, comparatively somber affairs, with everyone pilled out on opioids and barely able to function. Once the U.S. Food & Drug Administration (FDA) started to catch on and legislators began tightening prescribing guidelines, they turned to cheaper and more readily available heroin.
With IDU comes a whole host of risks that, for much of the 80s and 90s – particularly as it related to HIV/AIDS – were made explicitly known. Every health and D.A.R.E. (Drug Abuse Resistance Education) I was made to attend as a child, pre-teen, and teenager included a very graphic section on the dangers of injecting drugs. Almost every school in the 90s had a rumor going around about some random person who was dancing at a nearby club and got stabbed with a used needle and got AIDS. While a lot of hyperbole was involved in these stories, the sense of horror we were expected to evince – “WHAT?!?! A DIRTY NEEDLE?!?!” – led a lot of us to become more risk averse, particularly in our younger years.
Twenty years later? A lot of those fears have been forgotten. We no longer see horrific images of people dying from AIDS – the treatments are amazing, tolerable, and don’t kill you. We aren’t afraid of diseases like HIV or viral hepatitis, anymore, because…well, HIV isn’t a death sentence, and HCV is curable. Hepatitis B is still a huge problem, as it has no cure. But, the reality is that neither the fear of becoming addicted, nor the fear of becoming infected are presently palpable enough to prevent people from even starting. What starts out as a way to kick back with your friends and loosen up can quickly turn into a daily habit and morph into a physical dependency. Once you’re dependent and addicted, the risks become less frightening.
- Digestive Health Team. (2018, March 07). Why Is Hepatitis C on the Rise in 20- to 29-Year-Olds?. Cleveland, OH: Cleveland Clinic: Digestive Health Team: Health Essentials. Retrieved from: https://health.clevelandclinic.org/why-is-hepatitis-c-on-the-rise-in-20-to-29-year-olds/
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.