MACHIAS, Maine – Public health agencies and drug treatment centers nationwide are scrambling to battle an explosive increase in cases of hepatitis C, a scourge they believe stems at least in part from a surge in intravenous heroin use.
In response, authorities are instituting or considering needle exchange programs, but are often stymied by geography – many cases are in rural areas – and the cost of treatment.
In Washington County, Maine, the rate of the acute form of hepatitis C last year was the highest in a state that was already more than triple the national average. The problem, health officials there agree, is spurred by the surge in the use of heroin and other injectable drugs, and the sharing of needles.
Ryan Kinsella’s story is sadly typical. He was badly hurt in a rock climbing accident and became dependent on opioid painkillers several years ago. But when his prescriptions ran out, he sought drugs from the street, finding heroin cheaper and easy to get, replacing one addiction for another. He’s now recovering from hepatitis C.
“It’s tough getting medical professionals to look at you as … not a junkie,” said Kinsella, 33, who runs a bicycle shop in tiny Penobscot, next door in Hancock County. “There’s a little bit of social stigma and there’s a little bit of ‘There’s nothing we can do for you’ that’s hard to hear.”
Maine is undergoing its worst outbreak of acute hepatitis C since it started to record cases in the 1990s. In Washington County, the rate is about 6 cases per 100,000 residents, well above the national rate of about 0.7 per 100,000.
But the problem has afflicted other areas where heroin use is a growing concern, such as:
- Springfield, Mo., where the disease is on the rise and police have already confiscated more than five times the amount of heroin as in 2013.
- Madison County, Ind., which had 70 new cases of hepatitis C in 2013, followed by 130 in 2014, and where health officials expect current rates to at least match or surpass last year’s. (Indiana’s Scott County is also grappling with an HIV outbreak among injection drug users.)
- Massachusetts, where cases of acute hepatitis C grew from 10 in 2009 to 174 in 2013.
- Large swaths of Appalachia. Kentucky leads the nation in the rate of acute hepatitis C, with 5.1 cases for every 100,000 residents, more than seven times the national average, according to 2013 data from the Centers for Disease Control and Prevention.
Hepatitis C, which can result in liver failure, liver cancer and other serious complications, is the nation’s most common blood-borne infection. About 3 million Americans are infected, according to federal statistics. It presents as either acute, or short-term, or chronic, which can last a lifetime. Both forms are most closely linked to needle-sharing, although hepatitis C is less commonly spread through unprotected sex or other contact with infected blood.
Nationwide, the number of cases of acute hepatitis C grew 273 percent from 2009 to 2013, the CDC reported in its most recently available statistics. Tracking similarly is heroin use; the CDC reported that the number of users nationwide rose nearly 150 percent from 2007 to 2013 and that use also more than doubled among ages 18 to 25 in the decade that ended in 2013.
More than 19,000 people died from hepatitis C in 2013, up from 16,235 in 2009, according to the CDC. Although the agency hasn’t established a causal link between individual hepatitis C outbreaks and injected drug use, it notes that injected drug use is the primary risk factor for hepatitis C infection in this country.
Many local health agencies and health care providers have made the connection or are confident there is one, and are allowing users to turn in dirty syringes in exchange for clean ones. But many states disallow the practice and federal funding for it is banned.
Madison County in central Indiana won approval in June to run a needle-exchange program to fight the spread of hepatitis C among intravenous drug users. Clallam County, Wash., public health program manager Christina Hurst calls the local needle exchange program “one of the best interventions we have … ” and a key tool to prevent dirty needles being discarded in public.