A Transitioning Epidemic: How The Opioid Crisis Is Driving The Rise In Hepatitis C

Powell, David; Alpert, Abby; Pacula, Rosalie Liccardo

doi:10.1377/hlthaff.2018.05232

Cited by 67 publications

(55 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Leveraging this variation in the extent of OxyContin misuse in the pre‐period, I construct a difference‐in‐differences estimator for the effect of the reformulation on the outcomes of interest. Comparing states with differing levels of pre‐period OxyContin misuse before and after the reformulation, I illustrate that there were large and statistically significant increases in hepatitis C due to the reformulation of OxyContin, consistent with parallel work by Powell et al (). Furthermore, I present new evidence that the reformulation also led to significant increases in hepatitis B, which has not been considered in other work.…”

Section: Introductionsupporting

confidence: 76%

“…This paper is among first to examine the effect of abuse-deterrent opioids on these broader health outcomes beyond opioid-related mortality. Although Powell et al (2019) also study the effect of the reformulation of OxyContin on the transmission of hepatitis C, this paper also considers other infectious diseases such as HIV and hepatitis A and B. The findings in this paper suggest that the reformulation of OxyContin was a key contributor not only to the recent rise in the spread of hepatitis C, but also the stall in falling hepatitis B rates.…”

Section: Introductionmentioning

confidence: 92%

“…This paper is most closely related to the concurrent work of Powell et al (), who also examine the impact of the OxyContin reformulation on the spread of hepatitis C using the same identification strategy. This paper differs from the parallel work in three key ways.…”

Section: Introductionmentioning

confidence: 94%

“…Lastly, this paper contributes to the broader literature investigating spillovers from supply regulations in a variety of settings beyond opioids, including gun regulations (Knight, 2013), abortion regulations (Cunningham et al, 2017;Fischer et al, 2017;Colman & Joyce, 2011), cigarette taxes (Lovenheim, 2008), and marijuana regulations (Chu, 2015;Powell et al, 2018;Beheshti, 2017). This paper is most closely related to the concurrent work of Powell et al (2019), who also examine the impact of the OxyContin reformulation on the spread of hepatitis C using the same identification strategy. This paper differs from the parallel work in three key ways.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin

Beheshti

2019

Health Economics

View full text Add to dashboard Cite

The United States is currently in the midst of the worst drug epidemic in its history, with nearly 64,000 overdose deaths in 2016. In response, pharmaceutical companies have begun introducing abuse‐deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. In particular, I show that heroin is substantially more likely to be injected than OxyContin, increasing exposure to blood‐borne diseases. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation, we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011 to 2015. I find some suggestive evidence that the reformulation also lead to increases in HIV and hepatitis A, although these findings are less robust. These findings have important implications for future policies addressing the opioid crisis.

show abstract

Section: Introductionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 92%

Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin

Beheshti

2019

Health Economics

View full text Add to dashboard Cite

show abstract

“…Additional harms may be attributed to use of heroin, a prohibited drug with inconsistent quality and potency control. It has been argued that the heroin‐led second wave of the US opioid crisis was a direct result of the reformulation of oxycodone and resulted in the tripling of hepatitis C infection rates . We caution that this heroin trend should be closely monitored and proactive measures put in place urgently to prevent similar harms in Australia.…”

Section: Discussionmentioning

confidence: 94%

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

et al. 2019

View full text Add to dashboard Cite

Aims To characterize the trajectory in the years leading up to 2018 in pharmaceutical opioid and heroin morbidity in Victoria, Australia, and to assess the effect on that trajectory of reformulation of oxycodone to a form that could not be easily snorted or injected. Design Interrupted time-series analyses of population-level data before versus after reformulation of oxycodone, stratified by sex. Setting Victoria, Australia. Participants The population of Victoria aged 12+ years. Measurements Ambulance patient care and emergency department (ED) records were examined using both fixed-code and free-text fields, with each record manually cleaned and checked by trained coders. These were used to derive the output variables providing an index of harm: rates of opioid-related ambulance attendances and ED attendances for pharmaceutical opioids and heroin. The input variable was pre-versus post-oxycodone reformulation. Findings There were 30 045 opioid-related ambulance attendances from January 2012 to October 2018 (54% heroin-related), and 10 113 ED attendances from July 2008 to June 2018 (39% heroin-related). There was an increase in the rate (events per 100 000 people per year) of all opioid ED attendances from 2008 to 2018 [increase = 0.063; 95% confidence interval (CI) = 0.049, 0.078]. Pharmaceutical opioid ED attendances decreased from 2014 onwards (slope change = -0.083; 95% CI = -0.108, -0.059). Heroin-related ED attendances increased from 2014 to 2018; 11 324 heroin-related ambulance attendances and 1980 ED attendances were observed from April 2014 to June 2018, compared with the respective estimates of 8176, and 1661 had the pre-April 2014 trend continued (ambulance slope change = 0.296, 95% CI = 0.104, 0.489; ED slope change = 0.026, 95% CI = 0.005, 0.046). The inflection point of 2014 coincided with the re-formulation of oxycodone. Conclusion In Victoria, Australia, there appears to have been a trend starting around mid-2014 of increasing heroin-related harm, and a flattening of the increase or a decrease of harms relating to pharmaceutical opioids. These changes may, in part, reflect reformulation of oxycodone to reduce the extent to which it can be injected or snorted.

show abstract

Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion

et al. 2022

View full text Add to dashboard Cite

IMPORTANCE Initiation of injection drug use may be more frequent among people dispensed prescription opioid therapy for noncancer pain, potentially increasing the risk of hepatitis C virus (HCV) acquisition.OBJECTIVE To assess the association between medically dispensed long-term prescription opioid therapy for noncancer pain and HCV seroconversion among individuals who were initially injection drug use-naive. DESIGN, SETTING, AND PARTICIPANTSA population-based, retrospective cohort study of individuals tested for HCV in British Columbia, Canada, with linkage to outpatient pharmacy dispensations, was conducted. Individuals with an initial HCV-negative test result followed by 1 additional test between January 1, 2000, and December 31, 2017, and who had no history of substance use at baseline (first HCV-negative test), were included. Participants were followed up from baseline to the last HCV-negative test or estimated date of seroconversion (midpoint between HCV-positive and the preceding HCV-negative test).EXPOSURES Episodes of prescription opioid use for noncancer pain were defined as acute (<90 days) or long-term (Ն90 days). Prescription opioid exposure status (long-term vs prescription opioid-naive/acute) was treated as time-varying in survival analyses. In secondary analyses, longterm exposure was stratified by intensity of use (chronic vs. episodic) and by average daily dose in morphine equivalents (MEQ). MAIN OUTCOMES AND MEASURESMultivariable Cox regression models were used to assess the association between time-varying prescription opioid status and HCV seroconversion. RESULTS A total of 382 478 individuals who had more than 1 HCV test were included, of whom more than half were female (224 373 [58.7%]), born before 1974 (201 944 [52.8%]), and younger than 35 years at baseline (196 298 [53.9%]). Participants were followed up for 2 057 668 person-years and 1947 HCV seroconversions occurred. Of the participants, 41 755 people (10.9%) were exposed to long-term prescription opioid therapy at baseline or during follow-up. The HCV seroconversion rate per 1000 person-years was 0.8 among the individuals who were prescription opioid-naive/acute (1489 of 1947 [76.5%] seroconversions; 0.4% seroconverted within 5 years) and 2.1 with long-term prescription opioid therapy (458 of 1947 [23.5%] seroconversions; 1.1% seroconverted within 5 years). In multivariable analysis, exposure to long-term prescription opioid therapy was associated with a 3.2-fold (95% CI, 2.9-3.6) higher risk of HCV seroconversion (vs prescription opioid-naive/acute). In separate Cox models, long-term chronic use was associated with a 4.7-fold (continued) Key Points Question Is long-term prescription opioid therapy for noncancer pain associated with hepatitis C virus (HCV) seroconversion among individuals who initially had no history of injection drug use? Findings In this cohort study of 382 478 individuals who had a baseline negative HCV test followed by at least 1 additional test, long-term prescription opioid therapy among those who were initi...

show abstract

A Transitioning Epidemic: How The Opioid Crisis Is Driving The Rise In Hepatitis C

Cited by 67 publications

References 26 publications

Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin

Adverse health effects of abuse‐deterrent opioids: Evidence from the reformulation of OxyContin

Recent trends in heroin and pharmaceutical opioid‐related harms in Victoria, Australia up to 2018

Association Between Prescription Opioid Therapy for Noncancer Pain and Hepatitis C Virus Seroconversion

Contact Info

Product

Resources

About