SAMHSA Urges Focus on Synergistic Epidemics of Substance Use Disorder, HIV, and Viral Hepatitis

Cross-posted from the HHS.gov Hepatitis blog

In a “Dear Colleague” letter sent to grantees of the Substance Abuse and Mental Health Services Administration (SAMHSA) late last year, Elinore McCance-Katz, M.D., Ph.D., the Assistant Secretary for Mental Health and Substance Use, put a spotlight on HIV and viral hepatitis – the often hidden consequences of the substance use disorder epidemic – and called on the public health and substance abuse disorders communities to strengthen coordinated efforts to address them. She stated,

Fighting the opioid crisis and other substance use disorders is a national priority at the highest levels of the Administration and in communities across the country. The Federal Government has mobilized to take action to address these threats. As part of the ongoing and evolving national dialogue about these issues, the Office of the Assistant Secretary for Health – including the Assistant Secretary for Health, the Surgeon General, and the Office of HIV/AIDS and Infectious Disease Policy – has been raising awareness about the rapid increases in infectious diseases that are associated with drug use. Among the hidden casualties of the opioid crisis that we’ve worked to draw attention to are:

• An alarming increase in hepatitis C infections, which have seen a 3.5-fold increase in incidence between 2010 and 2016. Hepatitis C infections are increasing most rapidly among young people, primarily as a result of increased injection drug use, with the highest number of new infections among 20- to 29-year-olds.
• Despite the fact that hepatitis B is vaccine-preventable, progress toward hepatitis B elimination has stalled. In 2016, nine states had hepatitis B rates above the Healthy People 2020 goal, including several hard-hit by the opioid crisis.
• Since 2017, a series of hepatitis A outbreaks have continued to be reported in multiple jurisdictions across more than 17 states, primarily among people who use drugs, as well among people experiencing homelessness. As of January 23, 2019, these outbreaks totaled more than 12,000 infections leading to more than 7,000 hospitalizations and more than 100 deaths.  It is critical that anyone working with people who use or inject drugs ensure this population is vaccinated against hepatitis A.
• CDC and health departments have, over the past year, investigated several large clusters of reported HIV cases in communities that were also experiencing increasing injection drug use related to the ongoing opioid epidemic. If such outbreaks continue among populations experiencing substance use disorders, our substantial progress in reducing new HIV infections among people who inject drugs will be threatened.

These developments are extremely concerning. They are an indication that infectious disease prevention services are not reaching the growing number of people who use drugs, especially those who inject drugs. There is a need for patient-centered, comprehensive prevention services, including medication-assisted treatment of substance use disorder, syringe service programs, and behavior-change counseling that can prevent the spread of infectious diseases and overdose. These developments also indicate that testing, linkage to care, and treatment services are needed for a growing number of people with substance use disorders. Making these available to those who need them will require more coordinated and integrated approaches, as Dr. McCance-Katz calls for in her letter.

Read Assistant Secretary McCance-Katz’s letter - PDF.