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Hepatitis C Treatment Rather than Prevention is More Profitable


Hepatitis C Treatment Rather than Prevention is More Profitable critiques the recenly released The 2014 - 2016 Action Plan for the Prevention, Care and Treatment of Viral Hepatitis.


Hepatitis C Treatment Rather than Prevention is More Profitable

The following observations are being put forth in response to the letter posted on the ONDCP blog entitled In Recognition of World Hepatitis Day and to the recently released The 2014 - 2016 Action Plan for the Prevention, Care and Treatment of Viral Hepatitis. We realize that Mr. Botticelli is stuck in a political quagmire plagued by economic interests and neoliberalism. Simple definition of neoliberalism is that profits supersede human interests. This action plan is nothing short of an annuity for corporate America.

We also understand that people are dying as a result of the inability of the current congress to implement policy and appropriate sufficient funding to create and support programs that are the gold standard in preventing the transmission of blood borne diseases since the 1970's. These programs are known as syringe exchange programs (SEPS) needle exchange programs (NEPS) and needle and syringe exchange programs (NSP) and they have been in operation for over forty years in some countries.

Hepatitis C (HCV) is transmitted primarily by means of contaminated drug use paraphernalia used in injecting drugs. The action plan addresses education, research, screening and treatment but does not once endorse syringe exchange as an option to reduce the incidence and prevalence of Hepatitis C and B amongst persons who inject drugs (PWIDS). PWIDS are the largest and most persistent cohort of new Hepatitis C cases and the prevalence of chronic infection amongst PWIDs is estimated at 64% nationally with some urban areas reporting over an 80% chronic infection rate. Over the last three years, the incidence of new HCV cases has risen 45% primarily amongst young white adolescents and young adults who were previously using prescription opioids.  The largest at risk population is the new, inexperienced injection drug user (IDU) who will not initially seek treatment in the beginning stages of use.

The Action Plan calls for "Innovative, effective, multi-component hepatitis C virus prevention strategies for PWID and other drug users should be developed and evaluated to achieve greater control of hepatitis C virus transmission" and neglects to emphasize the key variable which is prevention. There is only one mention of sterile syringe exchange programs but no implementation action. Simply put, we need to discard moralism and adopt a harm reduction ideology that emphasizes that we must meet people where they are and engage them. It is widely acknowledged and accepted that addiction is a disease not a volitional act of misconduct and as such our policies should be informed by medical science rather than moralism, economic interests and law enforcement. A dirty (used needle) contaminated by HCV transmits the disease.. a sterile needle does not. It is that simple. If the members of congress were concerned with the welfare of this highly stigmatized population, then they would appropriate the funding to establish syringe exchange programs.

Although the plan is extremely comprehensive and addresses research, education and treatment, it fails miserably in regards to prevention leaving us with a horse has already left the barn scenario.

The bottom line:

  • IDU's will be at risk in communities that have no syringe exchange program.
  • Infected IDU's will continue to transmit HCV to other IDU's.
  • There are currently approximately 200 syringe exchange programs nationally to serve over 1 million IDU's which translates to an average caseload of 5,000 per exchange.
  • Many states either do not allow or have syringe exchange programs.
  • Syringe exchanges should be available to all IDU's.
  • Prevention education is meaningless to an addict in withdrawal.
  • There is no federal funding since 2011. No money translates to inadequate service levels and elevated rates of infection.
  • The economics - An average price for a clean syringe is .08 and the average lifetime cost for treatment of HCV depending on genotype and medication ranges from 60,000 - 250,000. This figure does not include secondary health problems resulting from the infection nor loss of productivity.
  • Syringe exchange programs are recognized as best practice for disease transmission prevention by the CDC, NIDA, AMA, United Nations, and the World Health Organization.
  • Screening, research and treatment are important but will not significantly impact incidence in the PWID population.
  • The true beneficiaries of the action plan are the pharmaceutical companies. Prevention (syringe exchanges)  should be should be a funding priority.
  • Discretionary allocations in Federal Substance Abuse Prevention and Treatment Block Grants should include syringe exchange programs.
  • There is more money in treating viral Hepatitis than in preventing it.



In Recognition of World Hepatitis Day



  " If we continue to box people in because of their medical conditions, to stigmatize individuals because of their health, and treat diseases as discrete conditions, we will never reach our common goals of health and wellbeing."
Michael Botticelli, Director of National Drug Control Policy 
Today, as we observe World Hepatitis Day, it is important to consider the relationship between infectious disease and substance use disorders.  Both viral hepatitis and HIV can be transmitted by injection drug use; in fact, injection drug use is the major driver of hepatitis C virus (HCV) infections.  A recent outbreak of HIV infection in Scott County, Indiana attributed in large to injection drug use behaviors, and increases in HCV infections nationally from 2010 to 2013 underscore the adverse health outcomes of substance use. 
These outcomes are not inevitable: infectious diseases and substance use disorders are both preventable and treatable.  Evidence-based strategies, such as the provision of medication-assisted treatment and integrated screening and treatment service, are needed to better and more comprehensively address the intersection of substance use disorders and viral hepatitis infections to help reduce drug use, bend the curve in HCV infections, and avoid more HIV outbreaks like that in Scott County.  
HCV infection causes inflammation of the liver and is a major cause of liver disease and cancer.  It affects an estimated 3.2 million Americans and studies indicate a high prevalence of HCV among people who inject drugs. HCV can be transmitted by sharing syringes and other equipment used to inject drugs. 
A number of important advances provide an unprecedented opportunity to address HCV among persons with substance use disorders. These include:
  • Enhanced access to HCV testing based on the availability of rapid point-of-care tests and US Preventive Services Task Force recommendations for HCV screening among individuals at high risk for infection; 
  • Improved access to health coverage based on provisions of the Affordable Care Act and Federal parity protections; and,
  • New HCV therapies that are effective in curing HCV in the majority of people who complete treatment.  
The Action Plan for the Prevention, Care, & Treatment of Viral Hepatitis from the Department of Health and Human Services (HHS) calls for ensuring that persons who inject drugs have access to viral hepatitis prevention, care, and treatment services through the integration of behavioral health and viral hepatitis services.  These efforts to prevent and treat HCV infection must be coupled with initiatives that help people who inject drugs get treatment for their substance use disorders, reduce risk of disease transmission from sharing syringes and other injection equipment, and prevent drug use initiation.  
ONDCP and HHS are committed to reducing the rising rates of HCV infection in the United States.  Access to prevention services and treatment should be evidence-based and available to all individuals.  An individual’s substance use status should not affect his/her ability to get treatment for HCV infection.  Only by ensuring equality and the highest standards of care to all individuals can we be successful in making concrete strides against viral hepatitis.