Hidden Casualties: Consequences of Opioid Epidemic on the Spread of Infectious Diseases

Cross-posted from the Department of Health and Human Services' Viral Hepatitis Blog

The opioid crisis in the United States has reached epidemic levels with a public health emergency declared by President Trump. Drug overdose is now the leading cause of death among individuals under 50 years of age. According to the Centers for Disease Control and Prevention (CDC), more than 90 Americans die each day from opioid overdose, including heroin. A lesser known consequence of the opioid epidemic is that increases in injection drug use are driving rates of infectious diseases and related conditions: hepatitis C virus (HCV) rates have increased almost 300 percent, and increases have been seen in some areas in hepatitis B virus (HBV), HIV, endocarditis, septic arthritis, epidural abscess, osteomyelitis, and infants exposed to hepatitis C. As rates of opioid use have risen, so have the rates of related infections.

To address this severe health threat, we held a meeting of federal stakeholders at the U.S. Department of Health and Human Services (HHS) on Monday, October 23, 2017. The event, Hidden Casualties: Consequences of the Opioid Epidemic on the Spread of Infectious Diseases, was facilitated by our own Dr. Richard Wolitski, Director, Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) and Corinna Dan, RN, MPH, Viral Hepatitis Policy Advisor, OHAIDP. It was broadcast live, recorded, and is available to watchExit Disclaimer.

We were honored to be joined by a group of distinguished presenters: Dr. Don Wright, Acting Assistant Secretary for Health (OASH); Dr. Jerome Adams, U.S. Surgeon General; Dr. Jonathan Mermin, Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, CDC; Dr. Christopher Jones, Acting Associate Deputy Assistant Secretary, Science and Data Policy, Office of the Assistant Secretary for Planning and Evaluation (ASPE); and Dr. Vanila Singh, Chief Medical Officer, OASH.

In his opening remarks, Dr. Wright said, “The opioid epidemic is one of the top priorities for the Department and for the Administration.” Regarding the rise in infectious diseases, Dr. Wright also commented, “For the most part, this has flown under the radar in comparison to opioid use and overdose deaths. I and other leaders in OASH have grown more concerned about this problem in recent years. And I see important opportunities where we can improve the efficiency, effectiveness, and impact of the work we do to reduce opioid use and infectious diseases.”

Dr. Mermin echoed this call and urged communities to “think big and act fast,” stating that, “Comprehensive, community-wide programs can prevent infections, reduce drug use, save lives, and save money, all at the same time.” He said that the rise in infectious disease rates across the country is connected to the rise in rates of opioid use and pointed to CDC data that indicate increases in new HCV and HBV infections.

Dr. Singh discussed the recently established Pain Management Best Practices Inter-Agency Task Force, which was authorized by the Comprehensive Addiction and Recovery Act of 2016 [PDF, 3.99KB]. The Task Force, a collaborative effort with the Department of Defense and the Department of Veterans Affairs, is now in the process of selecting members and planning its first meeting. Its goal is to “improve the way opioids are prescribed so patients have access to safer, more effective chronic pain treatment while reducing the number of people who misuse, abuse, or overdose from these drugs.”

Surgeon General Adams identified multiple interventions that can be part of an effective prevention approach, including education about the risks of opioid use and infectious disease, naloxone distribution to prevent overdose; HBV, HCV, and HIV testing; preventive measures such as hepatitis A (HAV)/HBV vaccination; substance use disorder treatment; and sterile syringe access under certain circumstances. He described a successful effort in Indiana where governmental and community organizations partnered to address the opioid and infectious disease epidemics together in an integrated approach. By coming together and talking about hepatitis C, he said, we can lower stigma by helping others realize that this is an infectious disease that we can treat and cure.

Dr. Adams said that eliminating hepatitis B and C can be achieved by bringing together a broad group of stakeholders including the federal government, state and local governments, clinical care providers, health plans, industry and local businesses, community organizations, and faith-based organizations. ”Everyone has a role to play in eliminating viral hepatitis in the United States.”

Dr. Richard Wolitski described the response to the proposed integrated, collaborative approach. “We have been overwhelmed by the level of support and concern from HHS leadership and our nonfederal colleagues and we’re energized to take on these issues which are a major priority for our work in 2018,” he said.

ASPE’s Dr. Christopher Jones, a nationally recognized expert on opioid misuse and overdose, said he appreciated the meeting’s focus on the infectious disease angle of the opioid problem. “I really appreciate shining a spotlight on this particular issue...those individuals are the people who are experiencing those other consequences.” It’s important, he added, that we consider “what… policies we’re putting in place broadly within our opioid response within the Department that are touching those individuals.” His experience has highlighted the fact that the opioid response is evolving. “Our policy response has to be nimble to changing facts on the ground,” he said.

The National Viral Hepatitis Action Plan outlines strategies that can be implemented by a variety of stakeholders and partners working together to mutually leverage resources and individual funding streams to develop efficient, effective patient-centered approaches to the infectious disease challenges presented by the opioid epidemic.