A growing number of young, suburban New Jerseyans with opiate addictions are also infected with hepatitis C, according to a new study. These findings reflect a national trend that has prompted healthcare providers to seek more effective ways to connect patients with treatment and reduce the spread of the disease.
A hep-C screening program at Princeton House Behavioral Health, a healthcare network in central New Jersey, found more than 41 percent of the heroin addicts they tested in recent years were positive for the blood-borne virus, which can lie dormant for years but eventually destroy the liver and even cause death.
More than half of these patients did not know they were infected with the disease, and — despite the efforts of dedicated staff and the existence of highly-effective medicines — few of them were treated successfully, researchers discovered.
A national study released earlier this year, under the leadership of a Rutgers University epidemiologist, predicted 90,000 deaths could be prevented nationwide by 2030 if there were better hep-C screening and treatment. The disease kills more people than HIV, traffic accidents, and diabetes, the study noted.
‘A silent epidemic’
“It’s really a silent epidemic,” said Kathleen Seneca, an advanced practice nurse with ID Care, a private practice specializing in infectious diseases, who is a leader on the Princeton House study. “We’re losing patients to hep-C because of barriers to treatment.”
The findings at Princeton House, the behavioral healthcare arm of the Princeton Healthcare System, which has screened more than 800 intravenous drug users since it started in 20014 — most of them between the ages of 17 and 35 — illustrate what infectious disease experts are calling hep-C’s second wave. While the disease is usually associated with baby boomers, who make up three out of four of those infected, the rate of new infection is growing faster among young drug users.
According to the federal Centers for Disease Control and Prevention, which published the Princeton House data, new infections among this younger age-group ticked up at 13 percent a year nationwide between 2006 and 2012. As many as nine out of 10 new infections are tied to IV drug use, the CDC noted. In 2015, more than 8,000 New Jersey residents were diagnosed with the virus, according to state officials, and an estimated 150,000 more are carriers unaware of their status.
While HIV rates are dropping, the incidence of hep-C has tripled in the past five years, explained Ruth Homer, a social worker and the research coordinator of the Princeton House project. And hep-C’s often quiet, insidious nature makes it especially hard to treat, Homer said. Carriers are often unaware they are infected and, unlike many other diseases, the virus can survive in a cotton ball for days and live in a water bottle for weeks; both items are used by IV drug users in the process of shooting up.
Saving lives through education
Educating drug users and others about the nature of hep-C and how to avoid contamination are key parts of the program, Homer said. It is also important that healthcare providers understand the new viral infection trend among younger individuals, actively screen for the disease, and refer those who test positive to treatment — for both the virus and the addiction, she added.
“In the last five years the ability to cure hep-C has just exploded,” Seneca said, noting new classes of drugs, direct-acting antivirals, that have proven highly effective in combatting the virus. While these new medications are extremely costly, older treatments only addressed the diseases’ symptoms. “You’re going to bend the curve of the disease with the treatment of both (addiction and hep-C),” she added.
Sen. Joe Vitale (D-Middlesex), chair of the health committee, has pushed for legislation that would require healthcare providers to offer to test baby boomers for hep-C in an effort to identify more disease carriers and connect them with care; patients can decline the test. The measure passed the Senate last year but still awaits a hearing in the Assembly.
Vitale also led efforts to expand access to clean-needle exchange programs in New Jersey to help addicts, like those in the Princeton House study, avoid infection and transmission. Five needle-exchange programs are now operating and two other locations hope to launch similar efforts. Last year Gov. Chris Christie signed a bill to provide the first state funding — a total of $200,000 — to these programs, which have been fueled largely by private donations.
An uphill battle
But Princeton House research has shown that even when patients are diagnosed, ensuring they receive effective treatment is an uphill battle. Homer said they identified five basic categories of barriers to care: logistical problems like homelessness, lack of transport, and legal status; limitations on insurance coverage or ability to pay; difficulty managing the underlying addiction; communication challenges, including a lack of phone access; and patient perception. Too often, Homer said, individuals don’t feel sick and don’t know they are passing the blood-borne infection on to others.
To help clear these hurdles, Homer and Seneca suggested the disease needed stronger advocates, similar to the efforts made during the HIV crisis of the 1980s and 1990s, to ensure patients have better access to affordable treatment. They are also working to educate their provider colleagues on the importance of screening and treatment and the critical role direct-acting antiviral drugs play in the process. The team also advocates for medication-assisted treatment for opiate addiction, an effective approach that can also help patients connect with a primary-care provider who can properly manage their hep-C care.
Homer, who works directly with patients, also seeks to reconnect them with family members and other support services that can help them stay on track in treating their addiction and hep-C. In addition, she makes sure they know how to reach her at all times, whenever they face struggles with either disease. She hopes the community of drug users will help Princeton House spread the word about the dangers of hep-C and help them connect more patients with care.
“Word is starting to get out there,” Seneca said.