Hepatitis C Screening Boosts Efficacy of Opioid Misuse Treatment

A new wave of hepatitis C virus (HCV) infections are the direct result of the opioid epidemic and an increased prevalence of injection drug use, according to data presented at the National Association of Specialty Pharmacy (NASP) Annual Meeting and Educational Conference. Younger individuals contracting HCV related to injection drug use has forced screening and prevention strategies to be revisited.

New findings from a study recently presented at The Liver Meeting suggest that HCV screening may be able to help patients who are receiving treatment for opioid use disorder to reduce their drug use.

One of the most common ways HCV is contracted is through injection drugs and needle sharing, with more than 70% of new HCV cases attributable to injection drug use, according to the study authors.

Current estimates indicate that one-third of people who inject drugs (PWID) aged 18 to 30 years have HCV, while up to 90% of older PWID have the infection, according to the session presented at NASP.

These statistics and changing patient population make fighting the opioid epidemic even more complicated.

“Hepatitis C—with an estimated prevalence of 0.3% to 0.9% among all Canadians—is more common among people who are opioid dependent (prevalence approaching 65%‐67%), and many experts have started advocating for testing all people engaged in opioid substitution therapy for chronic HCV infection,” said lead investigator Hooman Farhang Zangneh, MD, MSc. “To date, the impact of HCV infection diagnosis on the substance use behaviors of people engaged in opioid substitution therapy is largely unknown and not completely understood, and our team aimed to see if screening and/or diagnosis could impact their behaviors.”

In the retrospective study, the investigators analyzed electronic health data, urine toxicology, and antibody-based HCV screening information from 43 substance use treatment centers in Ontario, Canada. Between 2000 and 2013, 2406 patients were screened for HCV, with 22% testing positive. Patients’ substance use was examined for 1 year.

The authors discovered that patients with HCV were 32.6% more likely to change their substance use habits. Specifically, these patients reduced their intake of non-prescribed opioids compared with HCV-negative patients, according to the study.

Notably, patients with HCV had a reduced incidence of positive urine screening for non-prescribed opioids, benzodiazepines, and cocaine compared with HCV-negative patients, according to the study.

These results suggest that being diagnosed with HCV may be useful in reducing substance use and may be beneficial for overall health, according to the study.

The authors said they plan to conduct a qualitative study to further determine the effects of HCV screening and how to link patients with proper treatment.

“Our study showed awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high‐risk behavior,” Dr Zangneh said. “Furthermore, bearing in mind that effective, accessible and durable curative options are currently available, it is highly advisable to screen these clients and use this opportunity as an appropriate time to share motivational and educational resources and information with them. This way, we can provide enhanced support for them, which will have beneficial effects in both individual and societal levels.”