Positive HCV screening may reduce opioid use in substance abusers

By John Murphy, MDLinx
Published October 25, 2017

Key Takeaways

After testing positive for hepatitis C virus (HCV), people treated for opioid substance abuse were about 33% more likely to significantly reduce their use of non-prescription opioids, according to research (abstract 125) presented October 21 at The Liver Meeting®, held by the American Association for the Study of Liver Diseases (AASLD) in Washington, DC.

“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,” said lead investigator Hooman Farhang Zangneh, MD, MSc, postdoctoral research fellow, Toronto Centre for Liver Disease, Toronto General Hospital, Toronto, ON.

Injection drug use is the chief mode of HCV transmission in developed countries. And, nearly two-thirds of opioid-dependent people have HCV, Dr. Zangneh said. Thus, he stated, “many experts have started advocating for testing all people engaged in opioid substitution therapy for chronic HCV infection.”

To determine whether such testing would impact participants’ behavior, Dr. Zangneh and colleagues conducted a retrospective analysis using electronic health data, urine toxicology, and antibody-based HCV infection screening information from a network of 43 addiction treatment clinics in Ontario from 2000 to 2013.

They identified 2,406 individuals who were screened for HCV infection. Of these, 527 (21.9%) tested positive for HCV antibodies.

The researchers followed up with patients 1 year later and found that those who screened positive for HCV were 32.6% more likely to significantly alter their substance use. Urine toxicology results showed that these patients, compared to those who tested negative, had reduced their consumption of non-prescribed opioids since HCV screening. In fact, HCV-positive patients had not only significantly lower positive urine drug screens for non-prescribed opioids, but for benzodiazepines and cocaine as well.

“Our study showed [that] 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,” he added. “This way, we can provide enhanced support for them, which will have beneficial effects in both individual and societal levels.”

Dr. Zangneh is now planning a qualitative study to further investigate the effects of HCV screening in this population in the hopes of learning the best ways to link these patients to proper care.

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