Opioid Crisis’ Silent Killer on Rise in Appalachia

In April 2016, a young man entered a hospital in rural Kentucky complaining of abdominal pain. The doctor on call observed scars usually associated with injection drug use and might have attributed the patient’s symptoms to an overdose. But after further examination, it became clear that the cause of his pain wasn’t an overdose — but chronic liver disease associated with hepatitis C infection. Anecdotes like this are common all across America, but particularly frequent throughout central Appalachia, where hepatitis C infection rates have risen dramatically since 2010.

In the last year, over 120,000 news articles have focused on the nation’s opioid crisis, and rightly so. The Centers for Disease Control and Prevention reports that, on average, 130 people die every day of an opioid overdose. But a mere 1 percent of those stories mention the sharp rise in new hepatitis C virus infections — a growing epidemic that is related to, and fueled by, the nation’s addiction to opioids.

Since 2010, there has been a 350 percent increase in hepatitis C infections nationwide. It’s no coincidence this steep rise occurs as opioids ravage vast swaths of our country: New infections are most common among those who inject drugs and share contaminated needles and equipment.

The disease is often referred to as a “silent killer”: It’s believed that upward of 50 percent of the 2.4 million people infected don’t know their status, because symptoms of the HCV are often non-specific. The CDC estimates that in 2016, over 41,000 people were newly infected with HCV. HCV is now the leading cause of death by an infectious disease — surpassing deaths caused by HIV, pneumococcus, tuberculosis and 60 other diseases combined.

Those newly infected are largely under the age of 30, Caucasian and live in rural areas. National surveillance data shows that between 2006 and 2012, rural communities in Kentucky, Tennessee, Virginia and West Virginia experienced a staggering 364 percent increase in HCV infections.

For those who inject drugs, it is often a long and arduous journey to address addiction. That journey is made more difficult when they are also fighting an illness — in the case of HCV, a preventable and treatable one — that can exacerbate a person’s physical pain; incur huge costs to themselves, their families and the public health system; and produce feelings of isolation, depression and stigma.

We believe we have the tools and knowledge to address the growing threat of HCV. Proven and effective strategies adopted during the fight to combat HIV/AIDS can make a remarkable difference, especially when local and national leaders invest in safe and wildly effective awareness and prevention interventions. And unlike the HIV/AIDS crisis — at least to date — there is an HCV cure for those who suffer from HCV infection.

Some of these investments are already taking shape and helping to combat HCV. For instance, last year, the University of Kentucky received a $15 million grant from the federal government to eradicate HCV in one of the state’s highest HCV-prevalent counties. The grant program supports a needle exchange program, opioid abuse treatment and assistance with finding housing and employment opportunities.

To further scale innovative, proven and effective programs like this, our organizations launched HepConnect to address the rise of HCV in five greater Appalachian states: Indiana, West Virginia, Kentucky, North Carolina and Tennessee, all of which have experienced some of the highest rates of new HCV infections in the nation. HepConnect will focus on expanding testing opportunities, support harm reduction and community education programs and strengthen medical infrastructure for those who largely live in rural areas.

HCV is a growing threat, but we have many tools to prevent new infections and treat those already infected. Harm reduction interventions that deal with stigma and discrimination of those who use and inject drugs are an important part of any successful response to confront an epidemic like HCV. If we are to succeed in ending the high rates of HCV infection, it will also require broad support from federal and state policymakers, public and private investment and a collective recognition that together we can and must end this crisis.

Many of the challenges related to the opioid epidemic feel intractable. This one isn’t. It can and must be addressed.

Donald Davis, a former HCV patient and injection drug user who now works in Kentucky at a mobile clinic, perhaps said it best: “If we turn our backs on HCV, then we turn our backs on our community. Our community needs help to address issues not merely of a virus but of drug abuse. That’s how we’ll solve HCV.”


Monique Tula is the executive director of the Harm Reduction Coalition.

Gregg H. Alton is the chief patient officer at Gilead Sciences.

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