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Increases in HepC Infection Related to Injection Drug Use Among Persons Under 30 Years of Age in KY, TN, VA, and WV

The CDC reported on May 8, 2015, that the incidence of hepatitis C infection is on the rise among injection drug users in some states. According to the CDC:


"Surveillance data from four states (Kentucky, Tennessee, Virginia, West Virginia) showed a substantial increase (364%) in the number of cases of acute HCV infection from 2006 to 2012 among persons aged ≤30 years. Those affected were primarily non-Hispanic-white residents from both urban and nonurban areas, with more than double the rate of cases from nonurban areas. Urban and nonurban cases had the same distribution by sex. Among cases with identified risk information, IDU was most commonly reported (73%). Similar increases among persons with analogous demographic characteristics have been reported over the period (2006–2012) in Massachusetts (3), Wisconsin (4) and upstate New York (5).

"During this same period, these four states experienced an increase in the number of adolescents and young adults (aged 12–29 years) admitted to substance abuse treatment for opioid dependency (based on criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), with prescription opioid abuse accounting for about one third of all treatment admissions (compared with 8.3% of admissions for heroin). However, during 2011–2012, the proportion of heroin admissions increased (from 8.6% to 12.0%) at the same time as the proportion of prescription opioid admissions decreased. This regional increase in heroin use is consistent with national survey reports estimating an increase in first-time heroin use from 90,000 persons in 2006 to 156,000 persons in 2012, with three out of four persons who used heroin and prescription opioids in the past year reporting prescription opioid misuse before initiating heroin, and a doubling of the number of persons reporting heroin dependency from 214,000 in 2002 to 467,000 in 2012 (6). The concomitant increase in the proportion of treatment admissions for prescription opioid abuse, heroin abuse, and the number of admitted patients who report injecting suggests that the increase in acute HCV infections in central Appalachia is highly correlated with the region's epidemic of prescription opioid abuse (7) and facilitated by an upsurge in the number of persons who inject drugs in these four states. Increases in the incidence of HCV infection have the potential to thwart the nation's effort to control morbidity and mortality associated with HCV infection, in addition to undermining the U.S. Department of Health and Human Services' Action Plan for the Prevention, Care, and Treatment of Viral Hepatitis (8), which has set reducing HCV infections caused by drug use behaviors as a priority area."