Can a Needle Exchange Program Help Quell Kentucky's Hepatitis C Outbreak?

A burgeoning outbreak of hepatitis C virus (HCV) in northern Kentucky, once again, has political and healthcare officials debating the merits of a needle exchange program for injection drug users.

This is due to the fact that a spike of cases in 4 counties in the northern part of the state (Boone, Kenton, Grant, and Campbell) has been linked with a growing problem of opioid abuse (particularly heroin) in the region. Although exact figures are not available—given that not all of those who have been infected are seeking treatment—it is estimated that some 30,000 people statewide have hepatitis C, and that the incidence of the virus has increased threefold over the past decade or so.

Not coincidentally, over the same period, a Centers for Disease Control and Prevention (CDC) report identified Kentucky as part of a corridor of 4 states (Virginia, West Virginia, and Tennessee are the others) that has seen a 20% increase in injection opioid abuse over the same period. Another CDC report, published earlier this year, identified 220 primarily rural counties across the country as being at high risk for outbreaks of either HIV or HCV, or both, due to high levels of injection drug use. Kentucky’s Campbell County was among those listed.

“The growing epidemic of injection drug use is driven primarily by misuse of opioids, which is a term that broadly encompasses the drugs that are derived from the opium poppy like morphine and heroin, as well as all the synthetic drugs that have been designed to relieve pain by acting on the same receptor in the brain, such as oxycodone and fentanyl,” Ryan Westergaard, MD, PhD, assistant professor, infectious diseases, University of Wisconsin School of Medicine and Public Health, told Contagion. “A striking feature about the current epidemic of injection drug use is how disproportionately young people are being infected with HIV and hepatitis C. Adolescents and young adults seem dramatically more vulnerable to develop patterns of unhealthy opioid use when they use them as pain killers or as party drugs.”

Although experts in addiction and its effects on individuals and their families, as well as the communities in which they live, hardly want to be seen as “enabling” drug abuse, needle exchange programs—in which drug users are allowed to exchange used needles for clean, new ones—have proved effective in multiple studies in containing the spread of infectious diseases linked to injection drug use. The programs also have the added benefit of controlling costs.

“Needle exchanges are one of the most cost-effective ways to prevent infectious disease [outbreaks],” Kris Clarke, PhD, associate professor, Department of Social Work Education, Fresno State University, told Contagion. Dr. Clarke is not familiar with the ongoing issues in Kentucky, but has published an article on the efficacy of needle exchange programs in managing disease outbreaks.

“Most objections about needle exchange are based in a misunderstanding of harm reduction as enabling drug abuse rather than an intervention to reduce the harm of addiction to the community,” Dr. Clarke continued. “Politicians often respond most to the emotions surrounding addiction rather than the rational ways to minimize the harm of addictive behaviors.”

Indeed, given that treating individuals with hepatitis C can cost tens of thousands of dollars, and that many of those infected do not have insurance coverage and/or are not receiving public assistance (such as Medicaid), the financial burden for communities, such as those affected by the northern Kentucky outbreak, are significant.

“Harm reduction efforts need to be enhanced and made more accessible,” Dr. Clarke said. “Needle exchange is one of the most cost-effective ways to prevent HIV and HCV infections. In California, one HIV infection (in California) can run upwards of $75,000 to manage. One clean syringe runs about $1.”

Brian P. Dunleavy is a medical writer and editor based in New York. His work has appeared in numerous healthcare-related publications. He is the former editor of Infectious Disease Special Edition.