HCV screening or diagnosis could lower non‐prescribed opioid use

Research presented this week at The Liver Meeting® – held by the American Association for the Study of Liver Diseases – shows people in treatment for opioid substance abuse significantly lowered their non‐prescribed opioid use after testing positive for hepatitis C virus.

Hepatitis C virus, commonly called HCV, is a liver disease that ultimately can cause cirrhosis (scarring of the liver), liver cancer and liver failure. HCV is mainly contracted when a person comes in contact with an infected person's blood. One of the most common ways to contract HCV is through needle sharing to inject drugs – thus making HCV an additional concern for those working to combat the opioid epidemic.

There are many complicated facets to the opioid epidemic. In Canada, the province of Ontario has more than 50,000 opioid‐dependent people who are engaged in opioid substitution therapy, using mainly methadone and suboxone.

"Hepatitis C – with an estimated prevalence of 0.3 to 0.9 percent among all Canadians – is more common among people who are opioid dependent (prevalence approaching 65‐67%), and many experts have started advocating for testing all people engaged in opioid substitution therapy for chronic HCV infection," says Hooman Farhang Zangneh, MD, MSc; post‐doctoral research fellow; Toronto Centre for Liver Disease, Toronto General Hospital, University of Toronto and lead investigator in the study. "To date, the impact of HCV infection diagnosis on the substance use behaviors of people engaged in opioid substitution therapy is largely unknown and not completely understood, and our team aimed to see if screening and/or diagnosis could impact their behaviors."

The researchers conducted a retrospective study looking at electronic health data, urine toxicology and antibody‐based HCV infection screening information from a network of 43 addiction treatment clinics in Ontario from 2000 to 2013. Across the 43 clinics, the researchers identified 2,406 patients who were screened for HCV infection. Of this group, nearly 22 percent tested positive for HCV.

Next, the researchers evaluated substance use for each one of these patients over the course of a year. They found that those who screened positive for HCV were 32.6 percent more likely to significantly alter their substance‐use. They also noted, through urine toxicology, those who tested positive for HCV reduced their consumption of non‐prescribed opioids – when compared to those who tested negative. In fact, this group had significantly lower positive urine drug screens for non‐prescribed opioids, benzodiazepines and cocaine.

"Our study showed awareness of HCV infection among this particular population may motivate them to reduce their consumption and hopefully high‐risk behavior," explains Dr. Zangneh. "Furthermore, bearing in mind that effective, accessible and durable curative options are currently available, it is highly advisable to screen these clients and use this opportunity as an appropriate time to share motivational and educational resources and information with them. This way, we can provide enhanced support for them, which will have beneficial effects in both individual and societal levels."

Dr. Zangneh plans to follow this study with a qualitative study to further research the effects of HCV screening in this population and to provide insights into the best ways to link them to proper care.​