Oral Prescription Opioids as a High-Risk Indicator for Hepatitis C Infection: Another Step Toward HCV Elimination

Abstract

Background The opioid epidemic across the U.S. poses an array of public health concerns, especially HCV transmission. HCV is now widely curable, yet incident rates are increasing due to the opioid epidemic. Despite the established trajectory from oral prescription opioids (OPOs) to opioid use disorder (OUD), OUD to injection drug use (IDU), and IDU to hepatitis C virus (HCV), OPOs are not a defined risk factor (RF) for HCV infection. The objective of this study was to observe rates of HCV testing and Ab reactivity (HCVAb+) in patients receiving OPOs to substantiate them as a RF, ultimately contributing to HCV elimination. Methods Data from MedStar Health patients receiving OPOs from 1/2017 to 12/2018 were collected and analyzed using chi-squared or student t-tests and logistic regression for uni- or multi-variable analyses, respectively. Statistical significance was defined as P < .05; Epi Info and SAS v 9·4 were used for statistical analyses; IRB approval was received. Results There were 115 415 individuals prescribed OPOs over the study period. In this population, 8.6% (932) were HCVAb+ when tested and not previously diagnosed (10 900); 3.4% (3893) had an OUD diagnosis, 20.6% (803) of whom were HCV tested; 25.4% (361) of all HCVAb+ (1421) had an OUD diagnosis. OUD (ORadj 8.53 [7.22-10.07]) was an independent predictor of HCVAb+ in this population. Conclusions (1) In a large population prescribed oral opioids, HCVAb+ was 8.6%, higher than our previously published data (2.5%) and the US rate (1.7%); (2) only 20% of patients diagnosed with OUD were tested; and (3) only 25% of HCVAb+ patients were classified with OUD; this suggests underreporting of OUD in this population. Primary Care and Community Health Recommendations: (1) Re-testing for HCV in patients taking OPOs; (2) increased HCV testing among OUD patients; and (3) improved surveillance and reporting of OUD.

Evaluation of Structured, Semi-Structured, and Free-Text Electronic Health Record Data to Classify Hepatitis C Virus (HCV) Infection

“…Despite the established trajectory from oral prescription opioids to opioid use disorder, then to IDU, and IDU to HCV, oral prescribed opioids are not yet included in defined CDC and AASLD/IDSA risk factors. Previous work from our group associated this as a factor in HCV infection [27]. Our results add to the literature and make an additional case for including oral prescribed opioids in the risk factor guidelines.…”

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

“…Our findings may support the offer of an HCV test to people with a history of long-term prescription opioid therapy and may suggest interventions to reduce the risk of prescription opioid dependence (eg, more appropriate and informed opioid prescribing and increased access to multidisciplinary pain management programs) could prevent injection drug use initiation and HCV acquisition. However, interventions to promote appropriate prescription opioid use should consider that unmanaged pain or withdrawal (eg, due to abrupt tapering/discontinuation of therapy) could increase the risk of harm and may facilitate illicit drug use in some individuals .…”

“…42,43 In addition, owing to the inability to identify the exact date of seroconversion, some individuals who initiated prescription opioid therapy during follow-up may have done so after acquiring HCV; thus, prescription opioid therapy could be a proxy for HCV-related pain. 44 Our findings may support the offer of an HCV test to people with a history of long-term prescription opioid therapy 25,26,45 could increase the risk of harm and may facilitate illicit drug use in some individuals. 20,42 There is a need to support shared, patient-centered decision-making with regard to initiating, tapering, and discontinuing prescription opioid therapy.…”