"Tamper-proof" OxyContin tied to spike in HCV infections

  • Powell D & al.
  • Health Aff (Millwood)
  • 1 Feb 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Introduction of "tamper-proof" OxyContin in 2010 may have compelled addicts to shift to heroin, thereby precipitating a dramatic rise in HCV rates, according to a study from the nonprofit RAND Corporation.

Why this matters

  • “While considerable policy attention is being given to managing the opioid epidemic—in particular, the rising mortality rates associated with heroin and synthetic opioids—a “silent epidemic” of hepatitis C has emerged,” the authors write, noting the possibility of a rise in other needle-transmitted infections such as HIV.

    Key results

    • States with above-median OxyContin misuse before the reformulation (2004-2009) experienced a subsequent 222% increase in HCV rates during 2011-2015 (0.350 to 1.128 per 100K population).
    • States with below-median misuse experienced only a 75% increase (0.260 to 0.455 per 100K).
    • HCV rates (per 100K) were similar for above- and below-median misuse states during 2004-2009 (P=.28), but the gap widened during 2011-2015 (P=.01).
    • The gap was initially small following discontinuation of original OxyContin in August 2010, widened rapidly in 2011, and continued to increase through 2013.
      • Pattern mimics that of heroin overdoses in high-misuse states.
    • HCV rates were similar when states were categorized based on non-OxyContin pain-reliever misuse, pointing to reformulated OxyContin as the driving force.

    Study design

    • Analysis of CDC state-level data for HCV infection rates during 2004-2015, cross-matched with data from the National Survey on Drug Use and Health.
    • Funding: None disclosed.

    Limitations

    • HCV under- or nonreported to surveillance system.
    • Self-reported survey data.

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