273 Prevalence of Hepatitis C and Needle/Syringe Sharing in Emergency Department Opioid Overdose Patients

Abstract

In the midst of the devastating opioid epidemic, drug overdose deaths are at an all-time high. Drug overdose is now the leading injury-associated cause of death in the United States. In 2017, 403 accidental drug overdose cases were identified in Marion County, Indiana, which represents a 17% increase from 2016. ED visits due to opioid overdose increased from 1,856 in 2011 to 2,977 in 2015 and 8,297 in 2016 in Indiana. Along with the dramatic increase in overdose deaths, Hepatitis C virus (HCV) infection rates have spiked, creating an epidemic within an epidemic. The aim of this study was to determine the prevalence of HCV infection and needle/syringe sharing in emergency department (ED) patients presenting after an opioid overdose. We extracted risk factor and HCV status data from a survey conducted in the course of routine clinical care in a large urban ED (N=384) over 7.5 months. 32.7% of opioid overdose patients were HCV-positive, 64.7% of whom had a history of needle/syringe sharing. We identified a higher prevalence of needle/syringe sharing (64.7% versus 22.9%; χ2=20.2991, p-value=0.000007) and injection drug use (88.2% versus 51.4%; χ2=12.3636, p-value=0.000438) in HCV-positive versus HCV-negative patients. HCV-positive patients were less likely to have access to take-home naloxone (11.8% versus 67.1%; χ2=28.762, p-value<0.00001) compared to HCV-negative patients. 67.6% of HCV-positive versus 37.1% of HCV-negative patients expressed interest in having access to clean needles. 85.3% of HCV-positive patients expressed interest in and received a treatment referral. This high-risk population has a high prevalence of HCV infection and high rates of high-risk injecting behavior. HCV-positive status was positively correlated with injection drug use, history of needle sharing and interest in clean needles. These results emphasize the scope of the public health crisis, the need for harm reduction interventions such as syringe service programs (SSPs) to restrict the spread of HCV infection, and the willingness of overdose survivors to use these resources and be connected to ongoing care after an overdose. The analyzed survey data showing a link between the recent spike in HCV cases and high-risk injection behavior served as a key factor in establishing point-of-care HCV testing in the ED and identifying cases in patients who, although qualified for testing, were not screened for HCV infection. These newly detected cases were key in the declaration of a public health emergency and call for SSP implementation by the Marion County public health department.