To avoid larger epidemic, evidence-based drug preventive and treatment services needed: study
Vancouver, BC July 24, 2014 – The high prevalence and incidence of hepatitis C virus (HCV) infection found among Vancouver street youth underscores the need for new health care interventions, says a new BC Centre for Excellence in HIV/AIDS study published in the British Medical Journal (Open).
HCV infection is a leading cause of illness and death worldwide. Death from HCV has recently surpassed that from human immunodeficiency virus (HIV) in the United States. According to the study published today, Vancouver street youth are a particularly vulnerable population at elevated risk for HCV acquisition owing to a high prevalence of injection drug use.
From September 2005 to November 2011, 940 youth were recruited into the At-Risk Youth Study (ARYS), a cohort of street-involved youth in Vancouver. All youth completed baseline HCV testing. Onehundred youth (10.6%) were found to be HCV positive at study enrolment. Of 512 HCV-negative youth who were retested during the study period, 56 (10.9%) were later found to be HCV infected.
“The risk for HCV acquisition among street youth in this setting was alarmingly high. This population should be a critical focus for evidence-based strategies to prevent and treat drug addiction and mitigate injection-related harm to avoid making the HCV epidemic worse than it is now,” says Dr. Scott Hadland, lead author of the study and researcher with BC-CfE’s Urban Health Research Initiative.
Researchers observed that daily injection of heroin, cocaine and crystal methamphetamine were all strongly associated with risk of HCV infection. The study was one of the first to also examine the association between the injection of prescription opioids (such as, for example, OxyContin or morphine) and HCV infection. Contrary to the observations of researchers in other settings where prescription opioids have emerged as a primary concern, findings from this study reveal that in Vancouver, the risk of HCV infection from injection of prescription opioids was less than that of traditional street drugs, including heroin, cocaine and crystal methamphetamine.
The study highlights challenges in making drug prevention, treatment and harm reduction services accessible to street youth, who are a transient and difficult-to-reach population. Also effective services are often developed for adult drug users and may be less accessible to this population. Barriers for young drug users include excessively long waiting lists and locations that are inconvenient for youth. Existing drug treatment and harm reduction services should be extended in a way that is sensitive to the
unique circumstances of youth.
During the study, the prevalence of prescription opioid injection remained relatively unchanged during the study period. That being said, researchers stress that prescription opioid injection should be the focus of further study to explore this emerging and poorly understood practice.
The study, Prescription opioid injection and risk of hepatitis C in relation to traditional drugs of abuse in a prospective cohort of street youth, is available here: http://bmjopen.bmj.com/content/current.
Last year, the Province of BC announced one-time funding for BC-CfE to explore ways to better address both hepatitis B and C epidemics in the province. BC-CfE is applying the infrastructure and learning developed to successfully treat and prevent HIV infection in the province to hepatitis. BC-CfE is focused on: determining vulnerable individuals; identifying the best ways to prevent new infections; learning how best to engage those at risk for living with hepatitis in testing, treatment and support; and assessing how improved reach and effectiveness of new antiviral treatments could affect those living with the viruses, and ultimately change the course of the hepatitis epidemics.