It’s no secret Portland has a drug problem. Anyone who rides the MAX regularly or walks around downtown can see the area’s drug problem as plainly as the weather. Injectable drugs like heroin and methamphetamine are among the worst, not only because of the addictive propensity of the drugs themselves, but also because of the use and disposal of needles and overdose rates.
The biggest problem with heavy drug use in Portland is the city itself. According to NorthPoint Recovery, “In 2014, more than half of all heroin-related deaths in Oregon occurred in Multnomah County, in and around Portland…Deaths related to methamphetamine use are almost triple the number that occurred in 2001.”
Right now, Multnomah County has a sharps collection box on the East Bank Esplanade and a sharps exchange program for drug users, but how effective are they? What about those who use needles and throw them on the ground in parks and sidewalks? What about those who carry HIV or hepatitis C and share needles?
PROVIDENCE, R.I. [Brown University] — As public health officials worry that the increase of opioid use among young adults has helped to spread the hepatitis C virus to a new generation, a study in Rhode Island finds that while screening is common, the follow-up measures needed to stop the spread of the virus are significantly less so.
Hepatitis C virus (HCV) can linger for decades before causing any symptoms, but eventually it can severely damage the liver, leading to death without treatment.
“Many young people who are at risk for hepatitis C may acquire the infection and then not know it, and then through drug injection practices may transmit it to others,” said Brandon Marshall, associate professor of epidemiology in the Brown University School of Public Health and corresponding author of the new study in the Journal of Adolescent Health. “For this reason, we need to not only be screening, but also providing care to young people who test positive for hepatitis C.”
Patients who were treated for hepatitis C virus infection through an opiate addiction program overwhelmingly achieved SVR even though many of them injected drugs, according to researchers.
The results counter widely entrenched policies in the United States denying HCV treatment coverage to those who inject drugs on the presumption that they will not adhere to therapy. Studies have shown that injection drug use has driven the current HCV epidemic.
Alain H. Litwin, MD, hepatitis C treatment network lead and attending physician at Montefiore Health System, and professor of medicine in psychiatry at the Albert Einstein College of Medicine, presented the findings at the sixth International Symposium on Hepatitis Care in Substance Abusers in New York City.
People with hepatitis C virus infection and a recent or current history of drug use who were enrolled in a multidisciplinary care program responded well to direct-acting antiviral therapy and achieved a high rate of SVR, according to data presented at the International Symposium on Hepatitis Care in Substance Users.
The findings support the feasibility of prioritizing people who use drugs (PWUD) to receive treatment for HCV, according to Arshia Alimohammadi, clinical researcher at Vancouver Infectious Diseases Centre, and colleagues.
“The number of people around the world dying from hepatitis C is increasing,” Jason Grebely, MSc, PhD, associate professor at the Kirby Institute, University of New South Wales in Australia, and president of the International Network of Hepatitis C in Substance Users, said in a press release. “We have the tools to reverse this trend, to eliminate this disease and save millions of lives. But it will not happen until people who use drugs become a focus of our efforts.”
People who inject drugs and are coinfected with hepatitis C and HIV more often initiated treatment with innovative strategies, such as peer mentoring or cash incentives, compared with those who received standard care only, according to data presented at the International Symposium on Hepatitis Care in Substance Users.
Kathleen Ward, senior research program coordinator of the Johns Hopkins Medical Institutions, Baltimore, presented findings from the CHAMPS study, in which researchers enrolled 144 HIV/HCV coinfected people who inject drugs. All patients had genotype 1 and were treatment-naive, and no patient had hepatocellular carcinoma or decompensation.
Thirty-six patients received usual care, which consisted of an HIV clinic-based nursing model with pharmacy support. Fifty-four patients received usual care and peer-mentor care, in which the patients had contact with HIV-infected persons who achieved sustained virologic response for HCV and received training as peer mentors. An additional 54 patients received usual care and an offer of cash incentives contingent on attendance with a maximum possible compensation of $220.
Most people who inject drugs were not aware of currently available, highly effective hepatitis C treatments, according results of a national survey in Scotland presented at the International Symposium on Hepatitis Care in Substance Users.
From 2015 to 2016, researchers surveyed 2,623 individuals who attended injection equipment provision sites to assess the awareness of new direct-acting antivirals and their efficacy among injection drug users and to determine the factors associated with awareness.
Overall, 879 of the participants had chronic HCV, 36% of whom were unaware of their infection. While 90% of all participants were treatment naive, 79% were aware of HCV treatment.
Women are at a significantly greater risk for Hepatitis C (HCV) infection via drug injection than men, according to a new study that draws questions to the role of hormones in infectious disease contraction.
Researchers found in data of 1,868 people that women who inject drugs are at a 38% greater risk of contracting HCV than men who inject drugs. Although HCV can be commonly contracted through the sharing of syringes and other injections equipment, noted differences in these behaviors did contribute to the greater rate of women contraction found in the study.
An adjusted female-to-male hazard ratio (HR) for HCV infection was found with a Cox proportional hazard model. Calculated behavioral and demographic risk factors used to adjust the HR had little change on the disparity, researchers noted.
Article: Outcomes from a large 10 year hepatitis C treatment programme in people who inject drugs: No effect of recent or former injecting drug use on treatment adherence or therapeutic response—A Elsherif et. al.
Study Aims and Results: People who inject drugs (PWID) are usually denied HCV treatment because of preconceived attitudes that they will not adhere to treatment. The aim of the current study was to assess adherence of PWID over a period of 10 years. There were 1000 patients treated with pegylated interferon plus ribavirin. The group was divided into two groups—608 former injection drugs users (no injection drug use for 6 months of therapy) and 85 recent (injecting drug use within 6 months), and 307 non-drug users.
The non-adherence was 8.4% in the people who injected drugs; 6.8% in the people who did not inject drugs. The cure rates were also similar—64% in the people who injected drugs; 61% in the people who did not inject drugs.
Conclusion: The adherence and cure rates were similar between the two groups—those who injected drugs and those who did not inject drugs.
Editorial Comments: This long-term study has proven that people who inject drugs can adhere as well as people who do not inject drugs. This is even more impressive with the severe side effects of pegylated interferon and ribavirin.
The bottom line is that people who inject drugs can adhere to treatment as well as people who do not inject drugs.