New research has unveiled a troubling connection between the use of illicit fentanyl and the rising incidence of hepatitis C virus (HCV) infections. A study conducted by an international team from the University of California San Diego and el Colegio de la Frontera Norte in Mexico has established a significant association between illicit fentanyl use and HCV transmission among people who inject drugs in San Diego and Tijuana. This comprehensive analysis delves into the study’s findings, the underlying factors contributing to this association, and the broader public health implications.
Study Findings and Statistical Insights
Association Between Fentanyl Use and HCV
The study, published in Clinical Infectious Diseases, followed a cohort of 398 people who injected drugs over two years. It found that illicit fentanyl use was associated with a 64% increased risk of acquiring HCV. This is the first evidence linking illicit fentanyl use to an elevated risk of hepatitis C infection, a condition that disproportionately affects people who inject drugs.
According to the study’s senior author, Steffanie Strathdee, Ph.D., professor of medicine at UC San Diego School of Medicine, “Our study provides the first evidence that illicit fentanyl use is linked to an increased risk of acquiring hepatitis C infection, which disproportionately affects people who inject drugs.”
Rising HCV Prevalence
HCV is a type of hepatitis that causes liver inflammation and is most often transmitted through blood. People who inject drugs are at particularly high risk of acquiring the disease. Symptoms of HCV often do not manifest until months or years after the initial infection, making it easy to transmit unknowingly. About half of those infected are unaware of their condition, according to the U.S. Department of Health and Human Services (HHS).
Recent years have seen a rise in HCV prevalence. The Centers for Disease Control and Prevention (CDC) reported that the number of acute hepatitis C cases has doubled since 2014, with a 5% increase from 2020 to 2021.
Factors Contributing to Increased HCV Risk
Fentanyl’s Short Half-Life
One of the key factors contributing to the increased risk of HCV transmission is fentanyl’s short half-life—the time it takes for half the dosage of a drug to metabolise. This short half-life leads to more frequent dosing and sharing of syringes and smoking materials, thereby heightening the risk of HCV transmission. The study found that this relationship between fentanyl use and HCV was not confined to those who inject the drug but was also noted among those who smoke it.
Joseph Friedman, M.D., Ph.D., the study’s first author and a resident physician in the Department of Psychiatry at UC San Diego School of Medicine, stated, “The broad shift from heroin to illicit fentanyl may be playing an important role in sharply rising HCV incidence among young people in recent years.”
Complex Lifestyle Factors
The study also highlights various complex lifestyle factors that could be contributing to the rise in HCV infections among non-injecting users. Given how long HCV can go undetected, these factors complicate the landscape of HCV transmission and underscore the need for comprehensive public health strategies.
Public Health Implications
Need for Accessible Testing and Treatment
The study’s findings have significant implications for public health policy and practice in both the United States and Mexico. One of the immediate steps suggested by the researchers is to make fentanyl testing kits more accessible to people who use drugs. Many individuals are unaware they are using fentanyl due to the widespread contamination of the illicit drug supply.
Increasing access to accurate point-of-care HCV tests is also critical. These tests are used in other countries but have only recently started gaining approval for use in the United States. Early detection and diagnosis are vital for reducing the spread of HCV and ensuring timely treatment.
Gudelia Rangel, Ph.D., a professor at el Colegio de la Frontera Norte and a co-author of the study, emphasised, “Since hepatitis C can be cured with a short course of antiviral treatment, efforts are needed in both the U.S. and Mexico to make these treatments more widely available.”
Policy Recommendations
To tackle the rising incidence of HCV, the researchers recommend several policy measures. These include expanding the availability of fentanyl testing kits, increasing the deployment of point-of-care HCV tests, and making antiviral treatments more accessible. Both the U.S. and Mexico have government programs aimed at eliminating hepatitis C, but the study’s findings indicate that more robust actions are needed to meet these goals.
The association between illicit fentanyl use and the increased risk of hepatitis C infection is a major public health concern that requires immediate attention. The study underscores the importance of accessible testing and treatment, coupled with targeted public health interventions, to curb the spread of HCV among people who use drugs. Addressing this issue is critical for both the United States and Mexico to achieve their HCV elimination goals.
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