Opioids and hepatitis C: How OxyContin fed a new epidemic

Purdue Pharma’s 2010 reformulation of OxyContin as an abuse-resistant pill was supposed to be a breakthrough in battling the burgeoning opioid epidemic. Purdue executives and policymakers touted the reformulation as a way to dampen the supply of abusable drugs, thereby reducing opioid addiction and death. Nearly a decade later, it appears that the policy had several serious unintended consequences. Reformulated OxyContin led to large-scale substitution to more dangerous opioids, including illegal heroin and fentanyl. By 2017, opioid-related deaths more than doubled to over 47,000.

But the true cost of the heroin epidemic goes beyond overdose deaths and opioid addiction. A new study from Leonard Davis Institute senior fellow Abby Alpert of the Wharton School, with David Powell and Rosalie Pacula of RAND, links OxyContin reformulation to a national epidemic of hepatitis C, which kills more than 20,000 Americans a year and infects tens of thousands more.  

Exhibit 1: Trends in OxyContin misuse, hepatitis C infections, and heroin deaths, 2004-15
(Graphic courtesy: A Transitioning Epidemic: How The Opioid Crisis Is Driving The Rise In Hepatitis C. Health Affairs, February 2019)

Hepatitis C is a highly infectious liver disease that causes cirrhosis, liver failure, and death over several decades. Like HIV, the hepatitis C virus (HCV) spreads through blood contact, but HCV is 10 times more infectious than HIV. The most common mode of infection in the United States is injecting drugs with contaminated needles. The Centers for Disease Control and Prevention estimates that about 1 percent of the adult population—2.4 million people—are living with hepatitis C. Half do not know they are infected. The lifetime treatment costs exceed $200,000 per patient.

Policymakers and researchers have long noted a spike in new hepatitis C cases since 2010. In 2016, the CDC estimated that there were 41,200 acute Hep C cases in 2016, an incidence rate that more than tripled since 2010.

It isn’t hard to connect the dots. When OxyContin becomes difficult to abuse, people who are addicted may switch to injectable heroin, which exposes them to hepatitis C, causing a rise in Hep C transmission through intravenous needles. In 2017 the CDC linked increasing hepatitis C infections to the worsening opioid crisis. But how significant is the relationship?

Read more at Penn LDI.