(USA Today)--Rates of hepatitis C are soaring, largely driven by an epidemic of prescription pain killer abuse, a new report shows.
The incidence of acute hepatitis C infections among young people in rural areas of four Appalachian states more than tripled from 2006 to 2012, according to a report released today by the Centers for Disease Control and Prevention. New hepatitis cases among people age 30 and younger rose from 1.25 per 100,000 in 2006 people to 4 per 100,000 in 2012 in Kentucky, Tennessee, Virginia and West Virginia.
About 73% of these hepatitis C patients said they injected drugs, which can spread the virus when people share needles. The report is the first CDC study to link the rise in hepatitis C to an increase in injection drug use, says John Ward, director of viral hepatitis prevention at the CDC, who calls the rising infection rates "staggering."
Although the CDC focused this study on the four states with the highest hepatitis C rates, the agency plans to study the disease in other states, as well, Ward says.
"We're in the midst of a national epidemic of hepatitis C," Ward says. Nationwide, more than 20,000 Americans die from hepatitis C a year, which is more than the number who die from AIDS, he says. "The CDC views hepatitis C as an urgen public health problem."
The rate of new hepatitis C infections has risen nationwide, more than doubling from 0.3 cases per 100,000 people in 2010 to 0.7 cases in 2013. Kentucky had the highest rate that year, with 5.1 cases per 100,000, according to the CDC. Delaware and South Carolina had no reported cases that year.
The boom in abuse of prescription pain killers also has been blamed for an outbreak of 149 cases of HIV, the virus that causes AIDS, in rural Indiana. Most of the newly diagnosed HIV cases had injected a powerful prescription painkiller called Opana.
The HIV outbreak led Indiana Gov. Mike Pence to declare a public health emergency in March, allowing for a one-month program allowing injection drug users to exchange their old syringes for new ones. Pence has extended the program to May 24. He signed a law Tuesday allowing Indiana localities with health emergencies to begin their own needle exchanges.
Some acute hepatitis C infections go away without treatment within a few months, but about two-thirds turn into long-term, chronic infections, which can cause liver damage, liver cancer and death.
A newly approved drug, Sovaldi, cures hepatitis C in 90% of patients, but it's very expensive: A 12-week course of treatment costs $84,000.
The CDC estimates that there were nearly 30,000 acute hepatitis C infections nationwide in 2013 and that of 3.2 million Americans are infected.
Many people with hepatitis don't know they're infected, Ward says. The CDC recommends that Baby Boomers get tested for hepatitis C, because many undiagnosed cases of hepatitis C occur in the generation that came of age in the 1960s and 1970s.
Now, with the epidemic of prescription drug abuse, "a new generation of people in this country are getting infected," many of whom are much younger, Ward says.
Hepatitis C infections are concentrated in areas with high rates of opioid abuse. In the new CDC study, rates were twice as high in rural areas as in cities.
About 4.5 million Americans older than 12 abused prescription painkillers in 2013 and 289,000 used heroin, according to the Substance Abuse and Mental Health Services Administration.
Heroin use also has grown as people addicted to prescription painkillers switch to heroin because it's cheaper and easier to get, says Nora Volkow, director of the National Institute on Drug Abuse, part of the National Institutes of Health. About 75% of new heroin users previously abused opioid painkillers.
The number of first-time heroin users grew from 90,000 people in 2006 to 156,000 in 2012, according to the CDC.
Several studies have found that needle exchanges dramatically cut the rate of HIV transmission among injection drug users without increasing illegal drug use, says William Schaffner, an infectious disease expert at the Vanderbilt University School of Medicine in Nashville. Needle exchanges also give public health workers a chance to educate drug users and provide other health services. That's important, because people addicted to drugs may not get any other medical care.
Research shows that needle exchanges have helped to reduce HIV infections.
In New York, 52% of newly diagnosed AIDS patients were injection drug users in 1992. Ten years later, after the implementation of needle-exchange programs, only 3% of new HIV cases were injection drug users, according to the New York State Department of Health AIDS Institute.
The most successful needle exchanges also offer counseling, disease testing and referrals to places where patients can get treatment, Ward says.
There are 225 needle exchange programs in the USA, according to the North American Needle Exchange Network. The exchanges are found in 33 states, the District of Columbia and Puerto Rico.
The USA needs to offer more needle exchanges in order to reduce hepatitis and HIV infections, says Paul Samuels, president and director of the Legal Action Center, which advocates on behalf of people with HIV or substance abuse disorders.
"It is critically important that needle exchange programs like the temporary one in Indiana be replicated across the country, and be permanent," Samuels says. "Studies have repeatedly proven that needle exchange programs reduce HIV, hepatitis and other infections among people who use intravenous drugs without increasing intravenous drug use, and indeed they are a bridge to treatment for some participants. Substance use prevention and treatment, including treatment with medications, and harm reduction -- including needle exchange -- are all necessary components of a comprehensive strategy for combatting the opioid epidemic and addressing the many ways it can harm people with addictions."