All U.S. adults are urged to get hepatitis C test, as opioid crisis-infections spike

cdcHepCopioidabuse-300x150The opioid-overdose crisis has not disappeared, not by a long shot, and there’s a new warning about its toll: A blue-ribbon expert panel has urged doctors to expand testing for hepatitis C to all adults, ages 18 to 79, and no longer limiting the screening to those born between 1945 and 1965. That’s because the risky conduct that goes with abusing opioids also bumps up the risk of this potentially deadly but treatable liver infection.

Hepatitis C is growing as a significant health concern, the New York Times reported:

“Despite substantial advances in treatment over the past five years, infections are on the rise. Roughly 44,700 new hepatitis C infections were reported in the United States in 2017, according to federal data. A major challenge for health officials is that a significant number of people have the virus but do not know they are infected … Hepatitis C leads to chronic liver disease in most people who contract it, and some eventually develop cirrhosis and liver cancer. It is spread primarily through the sharing of needles among people who use illicit drugs.”

The U.S. Protective Services Task Force, a national panel that weighs scientific evidence and advises on screening and medical procedures, has taken note of the perils posed by hepatitis C in revising for the first time in seven years its published recommendations on testing for the disease.

The task force said patients typically will need the infection test only once, unless they engage in risky behaviors. But public health officials have expressed concern that groups with the highest increases in infection — abusers ages 20 to 39 injecting drugs and opioid users — may not learn in time they have the disease to get treated for it.

Medical advances have allowed doctors to treat hepatitis C with good outcomes, though the virus takes an awful toll still, the New York Times reported:

“Hepatitis C is associated with more deaths than the other top 60 reportable infectious diseases combined. And yet treatments are highly effective; more than 95% of hepatitis C cases are cured with two to three months of daily oral therapy, and few side effects.”

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs, notably opioid painkillers. The opioid-overdose crisis — which became a leading cause of death for Americans younger than 55 — took time to take hold, and doctors, nurses, hospitals, insurers, and Big Pharma all share in the blame.

Prescription painkillers not only addicted and killed far too many Americans, they also created a path for abuse of powerful synthetics (including fentanyl) and illicit drugs (including heroin, cocaine, and methamphetamines). When users shoot up and have unprotected sex with multiple partners, their risk spikes for exposure to contagions like hepatitis C and HIV. Individuals may be unaware of their infection, the New York Times reported:

“About 2.4 million Americans are living with hepatitis C. A major challenge for health officials is that hepatitis C complications develop over a period of years, and many people who have contracted it have no symptoms and do not know they are infected.”

Although treatment for hepatitis C has shown itself to be effective, it is costly, carrying a price in the tens of thousands of dollars. The treatment regimen reduces the virus in patients to undetectable levels, and studies show this is cost-effective care, especially compared to the expense of long-term treatment of individuals increasingly debilitated by or dying from the disease.

While treatment costs often are covered by health insurance of public programs like Medicaid, let’s be frank: It is an expense that we all reckon with and foot in one way or another. We have a long way to go to attack the opioid-overdose crisis and to reduce its harms, including hepatitis C and HIV infections.

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