Addressing the dual epidemics of hepatitis C and opioid use

Hepatitis C and opioid use disorder are both chronic but treatable conditions. Yet many Americans living with this deadly combination aren’t offered treatment. Imagine going to your doctor with strep throat and instead of being prescribed an antibiotic you are told it isn’t urgent and you can wait to treat it.

A solution is within reach: It starts with recognizing the power of integrating hepatitis C treatment with addiction care.

People with hepatitis C (HCV) and substance use disorders are often marginalized in traditional medical settings. These individuals are at much higher risk for liver cancer, liver cirrhosis, liver failure, and premature death, as well as diabetes, kidney disease, thyroid disease, and autoimmune disorders. All of which beg the question: In a country with more than 2,000 opioid treatment programs and more than 17,000 addiction treatment centers, why aren’t these health facilities providing broader access to a cure for the nation’s most common blood-borne infection?

As addiction and internal medicine doctors at the Greenwich House Center for Healing, a New York City-based opioid treatment program, we believe that addiction treatment facilities are the perfect delivery system for hepatitis C treatment. Utilizing all types of addiction treatment programs, withdrawal management and stabilization programs, outpatient programs, opioid treatment programs, sober houses, residential programs, harm reduction centers, etc. could be one of many effective interventions in the nation’s effort to eliminate hepatitis C for the nearly 4.7 million people infected with HCV nationwide. Most new hepatitis C infections in the U.S. occur in people who inject drugs, making addiction treatment centers an increasingly important place for people to access hepatitis C treatment.

Stigma, however, is a major barrier to increased prescription of hepatitis C treatment. Currently, nearly 49 million people in the U.S. aged 12 or older have been diagnosed with a substance use disorder. Despite scientific evidence showing high rates of successful hepatitis C treatment in people who inject drugs, medical providers mistakenly assume that people with substance use disorders will not take their medication correctly, do not care about their health, are not ready to treat their hepatitis, and must stop using drugs completely to start treatment.

Research doesn’t support those assumptions. In fact, multiple studies show that being cured of hepatitis C improves overall health and reduces person-to-person transmission. Unfortunately, while 80% of HCV–infected people who use drugs want to be cured of hepatitis C, only 1% to 2% receive treatment annually. This is an appalling health inequity that must be addressed if there is any chance of eliminating this curable infection.

The cost of a course of HCV treatment, which is around $20,000, is often cited as a barrier to eliminating this disease. The cost of these lifesaving medicines, however, pales in comparison to the cost of liver transplantation, liver cancer treatment, and multiple hospitalizations for liver failure from untreated hepatitis C. If people who use drugs received timely treatment, transmission of hepatitis C would decline, lowering health care costs.

Reimbursement of HCV-related medical care, including doctor’s visits, lab testing, peer services, and care coordination, is also essential to affordability and expanding treatment in these settings. New York State took steps to offer Medicaid reimbursement of hepatitis C treatment in some outpatient addiction treatment centers and opioid treatment programs. Replicating this program across the country would be a major contributor to successfully eliminating hepatitis C in the United States, resulting in reductions in liver transplants and deaths from liver cancer and liver failure. By using telehealth and the current addiction treatment infrastructure, impact of treatment could be maximized without the expense of creating new clinics.

Workforce shortages present another barrier to providing HCV treatment. While many addiction programs feel they lack sufficient staff, or that treating hepatitis C is too complex, the reality is different. Compared to managing severe alcohol withdrawal or opioid use disorder, hepatitis C has a simplified treatment protocol that allows for quick medical evaluations and decisions. With proper training, institutional support, and insurance coverage, medical professionals can effectively treat people with hepatitis C.

Peer navigation services and telehealth visits with providers are powerful interventions for settings without onsite medical services, such as sober houses and intensive outpatient therapy programs. Overcoming barriers to treatment by investing in the addiction treatment workforce is essential for addressing the dual public health crises of overdose and hepatitis C.

Aggressive hepatitis C treatment and elimination will save countless lives and, in the long run, save health care systems money. Major scientific advances that are easy to implement and drastically reduce suffering come along once in a generation. We urge policymakers, health care providers, and community leaders to expand hepatitis C treatment and elimination efforts. Once clinicians are given the resources and the training they need, we believe that all addiction treatment settings — outpatient treatment, withdrawal management and stabilization programs, opioid treatment programs, sober houses, residential programs, harm reduction centers, and hospitals — can provide immediate access to hepatitis C treatment.

Expanding access to hepatitis C care in addiction treatment settings, leveraging existing infrastructure, and addressing systemic barriers like stigma, cost misconceptions, and workforce shortages can turn the tide against these two epidemics.

Sara Lorenz Taki, M.D., is the chief medical officer at Greenwich House, a community-based organization that provides addiction treatment and mental health care in New York City. Lipi Roy, M.D., M.P.H., is an addiction medicine physician at Greenwich House, a media health communicator, and founder of SITA MED.