Increasing Cases of Hepatitis C in Appalachia


The Centers for Disease Control and Prevention (CDC) released information last month about the increased incidence of Hepatitis C in four states: Kentucky, Tennessee, West Virginia, and Virginia. From 2006 until 2013, acute Hep C cases in those states increased by 364%, in people younger than 30 years old. Seventy-three percent of those new cases occurring in people who injected drugs. The incidence in non-urban areas rose more than in urban areas.

Because many new Hep C infections occur in patients who have few symptoms, the incidence reported by the CDC likely underestimated the true number of true cases.

The authors of the study reminded us that HIV is transmitted the same way as Hep C, and increased incidence of HIV could potentially increase as well. The authors emphasized the importance of making effective addiction treatment available for intravenous drug users, as well as preventive efforts to stop the spread of infectious diseases like HIV and Hep C.

These facts are scary. The surge in opioid addiction over the last fifteen years could be followed by a surge in HIV and Hepatitis C infections. In a recent post (May 7, 2015), I described a micro-epidemic of HIV in a small Indiana town, where 140 new HIV cases were diagnosed in a town of only 4200 people. I don’t want to see this happen again and again in small towns in the U.S.

Let’s learn from the 1980’s, when the AIDS epidemic first emerged. The U.S. did not strongly and immediately support measures that could have limited the spread of this disease. Think how many cases could have been prevented with good information, condoms, needle exchange, and addiction treatment.

Let’s not wait until the situation worsens to do something. We must get serious about harm reduction measures and increased access to addiction treatment.

Needle exchange, where intravenous drug users are provided with clean needle in exchange for used needles, reduces the risk of infectious diseases like HIV and Hep C. Naloxone kits can reverse otherwise fatal opioid overdose deaths. Of course, the ultimate harm reduction measure readily available addiction treatment for addicts who want it.

I know many people at federal and state levels are aware of this problem and have been working on it. Let’s help change happen by giving harm reduction measures our support. For more reading on harm reduction, check out this website:
This is our excellent harm reduction organization here in North Carolina. Click on the “Advocacy” tab to find out what you can do to help.

Even if you don’t care about what happens to drug addicts, it is in your personal best interest to keep other people in our population from contracting infectious diseases that can affect us all.

7 responses to this post.

  1. Posted by Neil Goldberg, M.D. on July 5, 2015 at 6:17 pm

    Hi Jana. Another great blog. I agree that many have an angry view of drug users, but the problem is so big, I think empathy is increasing. Certainly it is in the Northeast (or seems to be) where I came from. I was not a fan of them until I started working with patients, learning their incredible stories and realizing what a tough psycho-chemical-social issue this is. I am FAR from a liberal, but recognize the morbidity and mortality tied to drug use is monstrous. You set a wonderful example, are a true leader and help save people. Much admiration, Neil Goldberg, M.D.


  2. Posted by dbcaae10218aajz998 on July 5, 2015 at 7:20 pm

    Scary stats, and wishful thinking for this area. I *had* Hep C, which I can say in past-tense sense my treatment over 10 years ago has continued to leave me with a 0 viral load (cured). I hear the treatments today are even better with fewer side-effects.

    Anyway, so when I mention this to any doctor, including an orthodontist who was removing a wisdom tooth, they immediately change their behavior towards me as stigma sets in. I can ‘feel’ it, and I know their discrimination/judgement is real. Granted, there have been cases also where doctors have been fine and sympathetic, but there are still plenty in the healthcare field who treat those with Hep C as if they hopeless substance abusers who causes their own condition. Ironically, they don’t, yet, look at obese people the same way.

    So I’d say the chances of the bible belt adopting harm reduction practices such as needle exchanges is near zero. They barely tolerate Buprenorphine you know, and wouldn’t if they could stop it. I know you know this, I’ve read you grumble about it many times ;).

    But there is hope, as like I said, sprinkled out there in the world are good and sympathetic healthcare professionals. We, as patients, just have to be *certain* to fully assert our right to quality healthcare, and not allow ourselves to be treated any less than a person without substance abuse history on their medical charts.


    • Many baby boomers who have never injected drugs have Hep C; that’s why the CDC recommended all of us “boomers” to be tested for hep C at least once. So your doctor doesn’t understand that many folks with the diagnosis have no idea how they got it.


  3. Posted by nspunx4 on July 6, 2015 at 2:49 am

    And this is why methadone treatment should be more available as a harm reduction model like used in some European countries and patients should be retained in treatment regardless of other symptoms of thier disease (alcohol or benzo use) or QTc issues.

    How many deaths have come from hep C vs. Torsades? (Hint: torsades arythmias are often not fatal)


    • As much as I believe in medication-assisted treatment, not all patients are able to take methadone or buprenorphine. I agree that fear about the QT interval have been overblown, but it can be deadly. A cardiologist seeing one of my patients told me that a significantly prolonged QT interval (greater than 500 msec) is associated with 1% risk of death per year.
      That’s not nothing.
      But we do need more information about risks


  4. Posted by Alexander D. on July 10, 2015 at 3:10 pm

    I live in Indiana and have been on suboxone for several years now. (since I was 16; now 20) and I can tell you the perception here is awful of people who are addicted. It’s interesting that the first thing they did during the HIV outbreak was suspend the needle exchange program. Honestly, the crack down in Indiana has lead to these conditions. I had suboxone on me the other day and was threatened to be charged because I carry just a few films and not my prescription boxes/bottles on me. The understanding of the significance of recovery.. negligible. I live right next to Indianapolis and the influx of heroin on the streets has increased so dramatically, I see people who are 13, 14 years old already addicted to a substance they don’t understand. It’s much to blame Chicago, and the reduction in substances like OxyContin which used to be so popular around here but since they redid the formula, the users don’t exist.


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