Rural areas ill-prepared to fight rising hepatitis C cases from increased use of intravenous drugs

Increased use of heroin and opioid painkillers in rural America is creating a hepatitis C epidemic that small towns—especially in Appalachia and the Midwest—are ill equipped to fight, Jeanne Whalen and Arian Campo-Flores report for The Wall Street Journal. Nationally, new hepatitis C cases rose 150 percent from 2010-13, and the largest increases were in rural areas, says the Centers for Disease Control and Prevention. In Central Appalachia, hepatitis C cases among young people rose 364 percent from 2006 and 2012, and two rural areas in Indiana—Austin and Fayette County—are facing a crisis brought on by shared needles.

While many areas have started a needle-exchange program to cut down on the number of shared needles, the costs of treating patients who have already contracted hepatitis C could be astronomical, Whalen and Campo-Flores write. "Left untreated, hepatitis C can lead to cirrhosis or cancer of the liver and ultimately to the need for a liver transplant. New drugs have high cure rates but can cost more than $80,000 per patient. Lifetime treatment of HIV can run as much as $400,000." (WSJ map)

"The injection of prescription painkillers such as OxyContin and Opana climbed more rapidly in rural areas than in urban ones between 2008 and 2012, the most recent year for which data are available, according to the Substance Abuse and Mental Health Services Administration," Whalen and Campo-Flores write. "Addicts liquefy and inject the pills for a stronger high."

The pharmaceutical industry tried to make it harder to inject drugs, but addicts found a way around those measures by cooking "tamper-resistant Opana into a viscous solution, which requires larger-gauge needles to inject," Whalen and Campo-Flores write. "Public-health officials say that spreads even more blood—and disease."

One of the main problems in rural areas is that a "spread out population makes it harder for public-health officials to track and contain outbreaks and for those in need to reach health services," Whalen and Campo-Flores write.