Addicts in Rural Areas Often Aren’t Screened for Hepatitis C
Intravenous (IV) drug users have increased risks for developing a serious viral infection called hepatitis C. In a study published in January 2014 in the Harm Reduction Journal, researchers from several U.S. institutions investigated the factors that could potentially stop an IV drug user from going through screening procedures designed to detect the presence of hepatitis C. These researchers concluded that three potentially overlapping factors help explain a lack of appropriate screening.
IV drug use is a specific form of injection drug use. Substances commonly injected during IV drug use include the opioid narcotic heroin, sedative medications called benzodiazepines, sedative medications called barbiturates and the stimulants cocaine, amphetamine and methamphetamine. People typically inject drugs intravenously because of the rapid onset of drug intoxication associated with this method of substance intake. However, IV drug use comes with a well-known set of serious, potentially fatal complications. Chief among these complications is exposure to microorganisms that cause infectious disease; forms of disease very closely associated with IV drug intake include HIV/AIDS and hepatitis C.
Hepatitis is the common name for several forms of viral infection that result in liver dysfunction and a range of other accompanying health problems. People with hepatitis C are infected with the hepatitis C virus. If left undetected or untreated, potential long-term complications of this infection include liver scarring (cirrhosis) and the onset of liver cancer. Unfortunately, many people affected by hepatitis C experience no clear symptoms that correspond with the changes going on inside their bodies. When symptoms do occur, they may include such things as appetite loss, the skin-yellowing condition called jaundice, fever, abdominal pain in the liver region, fluid buildup within the abdomen, nausea, vomiting, excessive tiredness and unusual changes in the color of both urine and feces. IV drug use is noted as the single most common cause of hepatitis C infection in the U.S. and across the world.
Since hepatitis C often produces no symptoms, screening for the disease is critical for its detection and the prevention of chronic or potentially fatal associated complications. In the study published in the Harm Reduction Journal, researchers from the University of Wisconsin, the Medical College of Wisconsin, the AIDS Resource Center of Wisconsin and the Veterans Administration used an examination of 553 IV drug users to help uncover the factors that can determine whether a user undergoes a hepatitis C screening procedure. These individuals came from seven large and small Wisconsin cities and took part in free needle exchange programs designed to decrease the risks of IV drug-related disease transmission.
Each participant filled out a detailed questionnaire that probed issues such as general patterns of drug intake, involvement in specific practices that make hepatitis C transmission more likely and past history of involvement in hepatitis C screenings. In addition, 362 study participants answered more questions designed to elicit their opinions on the factors that make access to hepatitis C screening procedures either easier or more difficult.
The researchers found that nearly nine out of 10 of the IV drug users enrolled in the study had undergone hepatitis C screening at some point in the past. Three-quarters of those with a previous history of hepatitis C testing had undergone a screening at some point in the year prior to the beginning of the study. However, despite the fact that the needle exchange programs they were involved in offered hepatitis C screenings, less than 20 percent of the participants had gotten a screening through such a program. The IV drug users most likely to have undergone a screening procedure were relatively well-educated, had access to a primary physician, had previously experienced an opioid drug overdose and lived in large cities. Conversely, the IV drug users least likely to have undergone a hepatitis C screening lived outside of large cities, were relatively poorly educated and did not have access to a primary physician.
Significance and Considerations
The authors of the study published in the Harm Reduction Journal concluded that poor educational status, residency outside of a large city and lack of access to a primary doctor appear to pose substantial barriers for hepatitis C screening in IV drug users. They believe that widening access to primary healthcare, especially for people who live outside of highly urbanized areas, could offset these barriers.