September marks the 23rd annual observance of National Recovery Month (Recovery Month). Our colleagues at the Substance Abuse and Mental Health Services Administration (SAMHSA) organize Recovery Month as an observance to educate Americans on the fact that addiction treatment and mental health services can enable people with a mental and/or substance use disorder to live healthy and rewarding lives. The main focus is to celebrate the gains made by those in recovery from these conditions, just as we would those who are successfully managing other health conditions such as hypertension, diabetes, and asthma. Recovery Month spreads the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover. Additionally, Recovery Month is a time to honor the service providers who help make prevention, treatment, and recovery available to millions of people across the nation. These providers are key partners in our efforts to prevent, diagnose, and treat viral hepatitis associated with drug use behaviors, which is an important part of the Action Plan for the Prevention, Care and Treatment of Viral Hepatitis.
Substance Abuse and Viral Hepatitis
Injection-drug use is a primary risk factor for exposure to bloodborne pathogens such as the hepatitis B virus (HBV) and hepatitis C virus (HCV) because of the sharing of needles and drug preparation equipment. Among new cases of hepatitis C reported to CDC, injection-drug use is the most common risk factor. Alarmingly, CDC has recently reported that new hepatitis C infections are highest in people ages 20-29 and are occurring in suburban and rural areas rather than in urban areas where rates have historically been highest. Research shows that injection-drug users (IDUs) have high rates of viral hepatitis infection with an estimated 64% chronically infected with HCV and up to 11% chronically infected with HBV. IDUs are not only disproportionately affected by these viruses, but they are also more likely to have more severe hepatitis-related health outcomes compared to other infected populations—primarily because of additional, related health problems and inadequate access to and receipt of needed health care services.
The good news is that research funded through our colleagues at the National Institute on Drug Abuse (NIDA) has found that drug abuse prevention and treatment are effective at preventing the spread of infectious disease, including viral hepatitis. With proper drug treatment, individuals can change the behaviors that put them at risk for contracting infectious diseases like viral hepatitis. And, for those who may have chronic viral hepatitis, substance abuse treatment and recovery can enable them to take full advantage of effective treatments for viral hepatitis.
The Viral Hepatitis Action Plan
The fifth goal of the Action Plan for the Prevention, Care & Treatment of Viral Hepatitis calls on us to ensure that persons who use drugs have access to viral hepatitis prevention, care, and treatment services. Chief among the ways we can advance this goal is by integrating viral hepatitis prevention and care services as standard components of all substance abuse treatment programs.
During the first year of implementing the multi-year Action Plan, significant achievements toward this goal have included:
- FDA’s approval of a new HCV rapid point-of-care test and CDC’s initiation of demonstration projects to study the use of these new diagnostics in activities targeting IDUs.
- SAMHSA’s development and dissemination of Treatment Improvement Protocol (TIP) 53, entitled “Addressing Viral Hepatitis in People with Substance Use Disorders.” TIP 53 is a comprehensive resource for behavioral health staff in substance abuse treatment facilities on integrating drug treatment and hepatitis prevention, care, and treatment. Disseminated to all 432 SAMHSA substance abuse treatment grantees, the TIP is available online, was also promoted in a blog post, and shared with grantees of the Office on Women’s Health and the Indian Health Service, also partners in implementing the Action Plan.
- Strengthening of technical assistance and training to help SAMHSA-supported prevention programs integrate both viral hepatitis and HIV prevention strategies.
- VA has incorporated education around models of care delivery for Veterans with hepatitis C and ongoing substance use into their training programs including those on end-stage liver disease, treatment of HCV, and Liver Health Initiative trainings.
- Both NIH and CDC are examining emerging evidence of HCV transmission of among young IDUs infected with HCV to inform the development of prevention interventions for this population.
While these important actions have advanced our efforts, we know that there’s more work to be done. During Recovery Month, I invite you to consider how you can join our continued efforts to reduce the incidence and prevalence of viral hepatitis in this heavily impacted population. How might you or your organization strengthen the link between viral hepatitis prevention and care services in substance abuse treatment activities? Each of us, from family members, to providers, to local, state, and federal partners, can make a difference in reducing the spread of viral hepatitis and supporting and sustaining the far-reaching benefits that long-term recovery can have on individuals, families, and communities.