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The introduction of OxyContin dissuasive in 2010 in 2010 may have played a key role in the rapid rise of hepatitis C infections, some drug addicts having gone from opioid Prescription injectable heroin, new research suggests
While hepatitis C infection rates generally increased in the United States in the years following the reformulation of OxyContin, investigators found that states where OxyContin misuse rates were above average before reformulation increased three times faster than in other states.
The findings suggest that efforts to discourage the misuse of opioids may have "unintended long-term consequences on public health," said David Powell, senior investigator and senior economist at RAND Corporation. Medscape Medical News.
"Policies that limit the supply of opioids are a great idea, but they can pose more problems than they actually solve." The interventions on the supply side , which are kind of our way of fighting the opioid crisis, may have limited substitute impact available, such as heroin, "added Powell.
The study was published online February 4 in the journal Health Affairs.
Increase "alarming"
In the United States, new acute hepatitis C infections declined during the 1990s to stabilize around 2003, but have increased at an "alarming" rate since 2010, the authors note.
Previous studies suggest that OxyContin, which has a chilling effect on abuse, may have led some non-medical users of the drug to switch to injectable heroin, which then resulted in a surge heroin overdoses after 2010.
Given that injecting drug use is the predominant risk factor for hepatitis C, Powell and his colleagues sought to determine if the opioid epidemic could be the only way to prevent it. one of the factors behind the recent rise in new infections.
They examined rates of hepatitis C infection in each state from 2004 to 2015, examining the differences between states based on the level of misuse of the drug before reformulation.
The results showed that conditions with abuse greater than the median of OxyContin before reformulation had an 222% increase in hepatitis C infections in the post-reformulation period, while states with lower than median use of OxyContin had a 75% increase in hepatitis C infections compared to the same period. period.
Before the reformulation, there was almost no difference in the rate of hepatitis C infection in the two groups of states. The increase in hepatitis C infection rates was not badociated with the initial rates of abuse of other badgesics, suggesting that the source of the 39; differential increase in hepatitis C infection rates was peculiar to the reformulated OxyContin, according to the authors.
"It is important that strategies that limit the supply of abusive prescription opioids be badociated with measures to mitigate the harms badociated with the switch to illicit drugs, such as improving the quality of prescription drugs." access to drug treatment and increased efforts to identify and treat diseases badociated with injecting drug use, "co-author of the study, Rosalie Liccardo Pacula, was appointed in a press release. She is also co-director of RAND's Opioid Information Center and Policy Tools and RAND's Center for Drug Policy Research.
Interpret with caution
Commenting on the study, David Murray, PhD, principal investigator at the Hudson Institute, warns against the conclusion that the only reformulation of OxyContin is responsible for the proliferation of Hepatitis C.
"The question is very complex and it is very difficult to explain what the anti-abuse form did exactly in the context of several major political changes," he said in an interview with Medscape Medical News. "You will obviously see a correlation between an opioid crisis and an increase in injecting drug use and therefore exposure to hepatitis C. The link with the reformulation of Oxycontin is however a little narrower, "said Murray.
"There is no clear indication that the rewording was sufficient to lead to hepatitis C if we consider the policy changes that are occurring at the time and in the future. the dramatic rise in the availability of heroin and its use.The reformulation of OxyContin is a factor, but this is not the factor consider all the other contributing factors.This is a bridge too far in my opinion, "added Murray.
The National Institute for Combating Drug Abuse supported this study. The authors did not reveal any relevant financial relationship. Murray served as Chief Scientist at the Office of National Drug Control Policy (ONDCP) from 2006 to 2009 and Deputy Deputy Minister of Supply Reduction at ONDCP until 2014. .
Health Aff. Posted online 4 February 2019. Summary
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