Dr. Ronald ValdiserriThroughout September’s observance of National Recovery Month, individuals, organizations, and communities across the nation celebrated recovery from mental health issues and addiction challenges. Given the significant role that drug-using behaviors can play in the transmission of viral hepatitis, and the fact that alcohol intake often worsens liver disease among persons with chronic viral hepatitis, National Recovery Month also served as a reminder of the interrelationship of these health issues and the importance of addressing behavioral health as we work to reduce the impact of viral hepatitis. Individuals making progress in their own recovery as well as the behavioral health care providers who work tirelessly to support recovery can contribute substantially to achieving the goals of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis .
Substance Abuse and Viral Hepatitis
Injection-drug use is a primary risk factor for both hepatitis B virus (HBV) and hepatitis C virus (HCV) infection. Sharing needles and drug preparation equipment, in addition to other drug-related behaviors increase the risk for HBV and HCV. Research shows that injection-drug users (IDUs) have high rates of viral hepatitis infection with an estimated 64% chronically infected with HCV and up to 11% chronically infected with HBV. In fact, the Centers for Disease Control and Prevention (CDC) reports that of all new cases of hepatitis C reported in the U.S., injection drug use is the most common risk factor identified. People who inject drugs are also more likely to have adverse hepatitis-related health outcomes compared to other infected populations, often because of inadequate access to and receipt of health services which result in late diagnosis and missed opportunities for medical care and treatment.
Hepatitis Action Plan
Given the disproportionate impact of viral hepatitis among persons who inject drugs, recovery from substance abuse through effective addiction treatment can also reduce the risk for acquiring or transmitting viral hepatitis. Drug treatment programs can also be important venues for viral hepatitis vaccination (for HAV and HBV), prevention education, testing, and, when necessary, linkage to hepatitis treatment. Thus, the Action Plan specifically calls for providing persons who inject drugs with access to care and substance abuse treatment to prevent viral hepatitis transmission and progression of disease. This is one of the several strategies detailed in the Plan to address its fifth priority, “Reducing viral hepatitis caused by drug-using behaviors.” Since the release of the Action Plan in 2011, federal partners have been working to integrate viral hepatitis prevention and care services as standard components of substance abuse treatment programs, promote integrated care and treatment approaches for the management of viral hepatitis and co-morbid health conditions, and advance research to improve prevention of viral hepatitis among persons who use drugs.
Some recent highlights of those activities include:
- The recommendation released in June of this year by the U.S. Preventive Services Task Force calling for screening for hepatitis C infection in persons at high risk for infection, which includes people who use injection drugs now or have used them in the past.
- The inter-agency consultation convened by the Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) in February of this year to address the emerging epidemic of hepatitis C infection among young persons who inject drugs. The meeting resulted in a call for community-led education and messaging strategies, youth-friendly substance use and HCV prevention interventions, and expanding community-based and science research activities to better understand how to effectively address this issue.
In a soon-to-be-released report, we will be sharing additional highlights of progress toward achieving the goals of the Viral Hepatitis Action Plan. Included are research highlights from NIH’s National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism as well as efforts to support expanded viral hepatitis prevention, screening and linkage to care in substance abuse treatment programs by the Substance Abuse and Mental Health Services Administration.
Reducing viral hepatitis associated with drug-using behaviors will remain a key priority of the renewed Action Plan, which is currently being developed for 2014-2016 by all of the federal partners. The renewed plan is also being informed by input from non-federal stakeholders, many of whom shared suggestions on actions related specifically to the topic of injection drug use.Although the national observance of Recovery Month has just passed, we are reminded that our year-round support of those in recovery and the behavioral health providers working with them, can make a real difference in reducing the spread of viral hepatitis and improving the health of individuals, families, and communities. I invite you to consider how you can join our efforts to reduce the incidence and prevalence of viral hepatitis in this heavily impacted population.