Should HCV Treatment Be Given To Injection Drug Users?

Even after decades of study and research, most people, including many working in healthcare, still view injection drug users as criminals – after all, possession of non-prescribed opiates and heroin is illegal in every U.S. state. Possession of syringes and other paraphernalia is also against the law, except in states where harm reduction and needle exchange programs exist. There are also states in which syringes can be purchased by diabetics without a prescription. However, in these situations, injection drug users trying to buy clean works often encounter stigma and ridicule. There's no denying: all injection drug users are criminals in this country. There is, however, another side to this story: a growing consensus among front-line clinicians that society needs to look beyond criminality and adopt, as with alcoholism, a disease model of injection drug use. This paints a different picture of addiction. It allows us to see the addict as a human being with a medical problem – a problem that can be treated.

It is estimated that up to 80% of injection drug users (IDUs) are infected with hepatitis C, which they continue to spread throughout the IDU community. This makes injection drug use more than an individual criminal problem. It's a matter of the public health. Those at risk for infection are other IDUs, and healthcare workers. Although the risk of infection among healthcare workers is currently low (1.8%, according to the CDC), new outbreaks like those in Indiana, Kentucky and Tennessee are appearing across the country, which may increase infections among healthcare workers, as well as occasional contamination of medical facilities, where it may become a risk to the general population.

The understated problem is that these new outbreaks of HCV tend to be epidemics of co-infection – of IDUs contracting HCV and HIV with a single injection from a shared, contaminated needle. This means a lot of sick people putting increasing pressure on our healthcare system. With breakthrough drugs for both viruses, and harm reduction programs that include needle exchange, we can not only reduce the rates of infection nationwide, we can make those who are infected healthier people, creating less need for expensive medical intervention.

Should people who are still using injection drugs be allowed treatment for hepatitis C? After all, there is currently no drug that confers immunity to HCV – the IDU can re-acquire the virus at any time through risky behavior, but no matter how long their cure lasts, it's that much time spent unable to spread the disease. Should re-infection should be met with re-treatment? How many times can we allow this? Who's going to pick the number? Can state and local governments be persuaded to institute harm reduction programs? Unfortunately, this is where it becomes political. Participation in harm reduction and needle exchange has been shown to dramatically reduce new infections of HCV and HIV in this underserved community, but as convincing as these statistics are, many in political office still view harm reduction programs as helping criminals. Why can't we turn over the institution of drug rehabilitation programs, as well as the dissemination of HCV and HIV treatment drugs to our supposedly nonpartisan healthcare institutions: the CDC, NIH, and VA, and keep politics as far away as possible? Isn't it time we made a choice for quality human life?

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