HCV infection surging, but treatment is lacking, among young opioid abusers

While young adults who use prescription opioids non-medically are being screened for hepatitis C virus (HCV) at a moderately high rate, follow-up care is inadequate when their test results are positive. The finding, published in the Journal of Adolescent Health, comes from the Rhode Island Young Adults Prescription Drug Study.

There is an emerging epidemic of HCV infection in Americans younger than 30 years, in particular among those who use prescription opioids non-medically. This type of opioid abuse is often a precursor to injection drug use and sharing of syringes, both of which increase transmission of HCV, noted the study’s authors, led by Ayorinde I. Soipe, MBBS, MSc, Brown University School of Public Health, Providence, RI.

Other researchers have shown that the rate of HCV infection is increasing among young injection drug users who transitioned from oral opioid abuse.

In the Rhode Island Young Adults Prescription Drug Study, 196 users of non-medical prescription opioids who were 18 to 29 years old (mean age: 24.5) were asked if they had ever been tested for HCV and offered treatment and support services. Of the 196 study participants, 154 (78.6%) reported ever being screened for HCV.

Screening was associated with a history of injecting drugs and a history of ever being hospitalized for psychiatric illness or depression. Younger participants aged 18 to 23 were less likely to be screened (59.7%) than participants aged 24 to 29 (89.5%).

Of the 154 screened, 18 (11.5%) reported testing positive for HCV. Thirteen of the 18 (73.2%) had a confirmatory blood test, 12 (66.7%) were referred for specialty HCV care, 9 (50%) were offered education about living with HCV, and 10 (55.6%) received instructions on preventing transmission of their HCV to others.

The findings “reveal gaps in current follow-up strategies for HCV management in young adults who screen positive, and indicate suboptimal referral to treatment for young people who use opioids,” the investigators wrote.

“Establishing case management programs focusing on HCV-positive young adults and involving trained case managers may improve referral and linkage to care while also ensuring adequate supervision of patient follow-up,” they noted. “Further, strategies may be needed to encourage young individuals to receive HCV screening and testing early in the course of illicit drug use.”