Injection opioid use among young people was the biggest contributor to a near tripling of new hepatitis C infections between 2010 to 2015, federal data out Thursday show,
The Centers for Disease Control and Prevention (CDC) said confirmed hepatitis C cases rose from 850 in 2010 to 2,436 in 2015. The disease has few symptoms and testing is so limited, however, that CDC estimates about 34,000 people had hepatitis C in 2015.
Nearly 20,000 U. S. deaths in 2015 were attributable to hepatitis C,
The hepatitis C virus causes inflammation of the liver. If left untreated, it can cause liver cancer or scarring of the liver. It can lead to liver failure. Acute hepatitis C, which begins within six months of exposure, can move into a long-lasting stage, chronic hepatitis C.
The trend isn't only destroying families, it's devastating state health care budgets. Sky high hepatitis C drug costs have led states to restrict coverage of drugs to treat it. Free needle exchanges, which minimize the sharing of needles that transmit the disease, also face challenges with funding and opposition among those who believe it encourages drug use.
Louisiana health secretary Rebekah Gee is exploring ways to obtain a generic form of a drug to fight hepatitis C to treat the 73,000 people in her state who now have the disease. At current prices, her state's Medicaid program can only afford to treat about 300 patients a year.
"The harm that it will cause to not be able to treat this disease is only going to multiply the longer we wait," Gee said Thursday.
The national trend has alarming effects in already-struggling parts of the United States. Last summer, CDC reported that widespread drug abuse led hepatitis C diagnoses in young women to rise nearly 10 times faster in Kentucky than across the country.
Meanwhile in that state, the proportion of babies born to infected moms surged 124% to one in 63.
Daniel Raymond, policy director for the national Harm Reduction Coalition, said the best way to stop the spread of hepatitis C is through needle exchange programs. That’s because hepatitis C is commonly spread when injection drug users share their needles and other equipment. In addition, people who are pricked with discarded, contaminated needles or emergency responders who are poked can get the disease.
“Needle exchange is our first line of defense against the spread of hepatitis C and HIV among people who inject,” Raymond said. “It’s also our best on-ramp to healthcare and treatment for this population.”
But even Raymond is concerned about the rampant spread of the disease.
“Nobody can say that the warning signs weren’t there,” he said, “but the big question is, can the start-up and set-up of syringe exchange programs outpace the spread of hepatitis C?”
In general, Raymond said he’s seeing greater acceptance of needle exchange in some states, including Kentucky, North Carolina and West Virginia. But, he said, “I think there’s a broader sense of urgency that’s missing.”
The Northern Kentucky Health Department has one syringe access program, at its rural Grant County health clinic site. The effort to provide more exchanges has stalled in the more populated Campbell, Boone and Kenton counties. Hepatitis C rates continue to rise, even since 2014, when Northern Kentucky’s rate beat the nation’s by nearly 20 percentage points.
Dr. Lynne Saddler, district director of the Northern Kentucky Health Department, noted that the region is seeing hepatitis C primarily in young adults, with the biggest age range for infection being 25 to 34.
"Actions to reverse these trends must be intensified. We need to continue to improve access to testing and treatment for hepatitis C,” Saddler said. “We need to educate people about risk factors, and be permitted to offer programs, like syringe exchange, to reduce the transmission of this disease.”
New hepatitis C virus infections are increasing fastest among young people, with the highest overall number of new infections among those 20 to 29 years old.
It's baby boomers who are the hardest hit by the disease, however. About 75% of the 3.5 million Americans already living with hepatitis C were born between 1945 and 1965. The increase young people is also putting their babies at risk.
Hepatitis C treatment not only cures the vast majority of people living with the virus, but also prevents transmission to their partners and children. That presents a strong economic argument for paying the price of current treatments, says former Obama administration health official Jonathan Gruber,
"How can we afford not to save people's lives at $84,000?" says Gruber, now an economics professor at Massachusetts Institute of Technology. "If you can’t afford to give a drug that saves their life, what is health care for?"
State Medicaid budgets are already straining to meet rising health costs and additional enrollees, even in states such as Georgia that didn't expand Medicaid under the Affordable Care Act. Gee says she been forced to cut most mental health treatment services in the Medicaid program.
"I can’t spent the $760 million (drug makers) Gilead and Merck want to charge me," said Gee. "We just can’t do it."