Opioids Driving Infectious Disease Rates

Richard Wolitski of the HHS Office of HIV/AIDS and Infectious Disease Policy hosted a webcast series called Hidden Casualities that takes a deeper look at the consequences of the opioid crisis.
Richard Wolitski of the HHS Office of HIV/AIDS and Infectious Disease Policy hosted a webcast series called Hidden Casualities that takes a deeper look at the consequences of the opioid crisis.

 

HHS and the National Institute for Health Care Management Foundation – a non-profit research arm of the health insurance industry – have initiated an ongoing discussion of experts nationwide who say evidence now links narcotic drug misuse to local outbreaks of infectious diseases.

In recent months, the National Governors Association has reported that at least 15 states have seen increases of 500 percent or more in hepatitis C infections over a decade – and six states have infection increases of 1,000 percent or higher. Further, the CDC has warned 220 counties in 26 states that they are vulnerable to outbreaks of HIV and hepatitis from narcotic needle sharing.

Richard Wolitski of HHS noted that hospitalizations for a range of other injection-related diseases skyrocketed at about the same time: Endocarditis cases – destructive infections of the heart lining -- jumped 46 percent; osteomyelitis, a previously uncommon bone infection, 115 percent; and septic arthritis and epidural abscesses, over 160 percent.

 Parallel tracks:  Rates of hepatitis-C among younger Americans have surged in the past decade on track with increases in opioid and opiate injection, the CDC has found.
Parallel tracks: Rates of hepatitis-C among younger Americans have surged in the past decade on track with increases in opioid and opiate injection, the CDC has found.

 

In Boston, recent increases in syphilis, chlamydia, gonorrhea and a range of bacterial infections are "intertwined" with rising IV drug use, said Dr. Alysse Wurcel of Tufts University, often compounded by behavioral health problems common among substance abuse patients.

Among a host of new studies, she noted, cases of endocarditis increased 12-fold in just five years in North Carolina; and recent outbreaks of infectious disease across at least three states have been linked to injection drug use.

Said Dr. Jonathan Mermin of the CDC: "There are probably places in every single state" where local increases in certain diseases and infections are bellwethers of a narcotics epidemic in a town or county. Likewise, local law enforcement officials should be aware that an uptick in narcotics arrests may be an early warning of an impending public health threat.

Dr. Judy Steinberg of HRSA's Bureau of Primary Health Care – which provides funding to 1,400 health centers nationwide – added that 75 percent of new hepatitis C cases are "are associated with injection drug use" and that health centers now employ teams of specialists to manage those patients' co-occurring health problems.

RADM Dr. Jonathan Mermin, Dir., CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Dr. Alysse Wurcel, Tufts University Medical Center and  the Infectious Diseases Society of America;  Dr. Judy Steinberg, Chief Medical Officer,  HRSA/BPHC.
RADM Dr. Jonathan Mermin, Dir., CDC National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention; Dr. Alysse Wurcel, Tufts University Medical Center and  the Infectious Diseases Society of America;  Dr. Judy Steinberg, Chief Medical Officer,  HRSA/BPHC.

 

HRSA awarded $200 million in September to more than 1,000 health centers to bolster mental health and substance abuse services – in addition to $94 million in 2016 to increase treatment at some 270 health centers.

One such grantee, the 12-clinic PCC Wellness Center of Chicago, straddles a west side drug corridor known as "Heroin Highway." A new chemical dependency unit there more than tripled its patient base in little more than a year and more than doubled the number of clinicians licensed to prescribe the opioid-replacement drug Suboxone .

"What we're seeing," said PCC Behavioral Health Manager Kelli Bosak, "is really high rates of (narcotics) use and really limited ability to provide treatment."

Cause and effects: At left, the Agency For Health Research and Quality has found that opioid-related emergency room visits and  hospital admissions have been steadily increasing in nearly every state over the past decade. Bosak recounted how the  limited  availability of treatment has translated into increasing pressure on hospitals.
Cause and effects: At left, the Agency For Health Research and Quality has found that opioid-related emergency room visits and hospital admissions have been steadily increasing in nearly every state over the past decade. Bosak recounted how the  limited  availability of treatment has translated into increasing pressure on hospitals.

 

Meanwhile, a nascent "Harm Reduction" movement is under way in several states – including West Virginia, Maryland and Washington State – that combines infectious disease prevention, medication-assisted treatment and mental health counseling, often in specialized clinics.

Maryland is on track to open such sites in 10 counties – including one in partnership with bordering West Virginia.  

Watch the latest installment of the webcast series.

Date Last Reviewed:  April 2018