Hepatitis C cases in Southwestern Pennsylvania skyrocket over 10 years
As the opioid epidemic took root in rural Pennsylvania a decade ago, sending overdose fatality rates soaring in Westmoreland and surrounding counties, another serious health threat bubbled up.
Hepatitis C, a potentially fatal liver disease, increased by more than eight-fold in the 10-county Southwestern Pennsylvania region — climbing from 335 cases in 2003 to 2,818 in 2014, the latest year for which figures are available from the state Department of Health. The spike in intravenous drug use and shared needles helped the blood-borne disease spread rapidly.
In Westmoreland County, hepatitis C cases skyrocketed from 42 to 354 during that time.
Those numbers, coupled with the high cost of treating the disease, shocked some on the front lines of the opioid war.
Westmoreland County District Attorney John Peck said efforts to stem so-called collateral damage should become part of the conversation in the opioid fight that largely has focused on shutting down supply lines, arresting sellers and rescuing drug users in the throes of overdoses.
Dr. Neil Capretto, medical director of Gateway Rehab, is at ground zero of the outbreak.
Gateway is one of the region's oldest and largest addiction-treatment facilities, with inpatient facilities in Mt. Pleasant, Aliquippa and Youngstown, Ohio, and outpatient centers throughout the area.
“We have seen for years an astounding increase in the number of hepatitis C cases,” Capretto said. “Rarely a day goes by here in treatment that we don't detect a new person with hepatitis C. ... Within one week, I had three ninth-graders diagnosed. They were doing (intravenous) heroin, experimenting and injecting.”
Westmoreland County's health system has reported an increase of 10 percent each of the past five years for hepatitis C diagnoses, said Kate Rosatti, Excela Health's director of medical outcomes, patient safety and infection control.
The sharp increase in hepatitis C in rural counties comes when rates declined or slowed in some urban areas. Hepatitis C cases in Philadelphia, for example, declined from 5,066 in 2003 to 1,121 in 2014.
It came as no surprise to experts, however.
Philadelphia and Pittsburgh, which have battled intravenous drug abuse for decades, have needle exchanges that provide drug users with clean syringes.
No rural county in Pennsylvania does.
Needle exchanges originated in urban areas in the 1980s, during the early years of the AIDs/HIV epidemic. Like hepatitis C, HIV is a blood-borne virus that can be transmitted through shared needles.
Experts have seen no spikes in HIV in Southwestern Pennsylvania but worry it could mushroom if one or two infected people start sharing needles.
Dr. Donald Burke, dean of the University of Pittsburgh Graduate School of Public Health, was involved in AIDs surveillance in the early years of that epidemic. Today, the infectious disease specialist worries about the impact of the opioid epidemic.
In the November issue of the journal “Science,” Burke argued for a national program to correlate data on opioid abuse — including heroin and prescription painkillers — that is collected by public health agencies, law enforcement and commercial vendors.
He fears scenarios such as what erupted last year in Austin, Ind., a town of 4,000 people which has been dogged by poverty, unemployment and drug abuse. Last year, it clocked 190 new HIV cases among intravenous drug users.
“The conditions are ripe for transmission of needle-associated infections,” Burke said.
Hepatitis C and HIV can be asymptomatic for months or years, meaning many infected people may not know they are passing it along.
Pennsylvania's drug laws consider needles to be prohibited drug paraphernalia. Anyone openly distributing them without a prescription could be arrested.
Authorities in Philadelphia and Allegheny County decided public health trumped state law. They passed local ordinances permitting distribution of syringes by approved providers, and authorities looked the other way.
Prevention Point Pittsburgh, the city's needle exchange, started 21 years ago. Aaron Arnold, its executive director, called providing clean syringes “a no-brainer” and a way to keep one epidemic from blossoming into a second.
“We know (hepatitis C) is common, and it is acquired fairly early on in drug use — usually during the first six months,” he said. “We definitely know there has been an explosion of hepatitis C among younger users.”
Straight to the point
Clean needles cost about 7 to 10 cents each when purchased in bulk. That is nearly insignificant compared to the cost of treating hepatitis C — which can range from $50,000 to $80,000.
Peck said he would support a discussion of such options.
“We already know we aren't going to be able to arrest or prosecute our way out of this,” he said.
In May, state Rep. Ed Gainey, D-Allegheny, introduced a bill calling for a statewide needle exchange. His bill proposed changing the drug paraphernalia law to exclude syringes provided to drug addicts by an authorized agency.
Although studies suggest needle exchanges do not encourage or increase drug abuse, old stereotypes die hard.
Though Gainey's bill did not come up during Gov. Tom Wolf's special session this fall to address the opioid epidemic, Wolf's spokesman Jeffrey Sheridan said the administration is “exploring legislative and regulatory changes to enable communities to implement syringe-service programs, similar to programs in Philadelphia and Pittsburgh, which can help reduce the spread of disease.”
Change can't come quick enough for Arnold.
“The only reason this is not being implemented is the stigma against people who use drugs,” he said. “What we have now is people who need services appropriate for the risk they face.”
Debra Erdley is a Tribune-Review staff writer. Reach her at 412-320-7996 or firstname.lastname@example.org.