“In my day, kids would hide behind the bleachers and share a beer. Today they may be sharing pills. Kids say [the pills] are easy to get and think they are safe because they are prescribed. The scary statistic is that one in 15 kids who start abusing prescription opioids will become an IV drug [abuser],” warned Adams.

While HIV in PWID has leveled off, HCV in PWID has skyrocketed since 2010. 


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Rates are up by about 150%. This coincides with the increase in abuse of prescription opioids and could be the harbinger of a new and emerging HIV epidemic. 

“In most cases, HCV precedes HIV and is a marker for high-risk behavior. The HCV epidemic could be the canary in the coal mine,” said Adams.

“This has been called an iatrogenic epidemic. There is plenty of blame to go around, including pharmacies, drug companies, and insurance companies that would rather pay for a pill than a comprehensive approach to pain management. We need to change the perception that opioids are the best treatment for chronic pain,” said. Duwve.

Lessons for State Health Departments

“The first lesson is to know your baseline HIV and HCV numbers. If you don’t know what your baseline is, you could miss the outbreak. The second lesson is to increase testing,” said Adams. 

The CDC has issued these recommendations for state health departments:

  • Review statistics on HIV and HCV infections, overdose deaths, drug treatment admissions, and drugs arrests, especially in people younger than 35.
  • Trace and test all contacts of people with recent HIV or HCV infection.
  • Increase access for medication-assisted therapy, needle exchange programs, and other substance abuse services for all PWID.
  • Alert ERs, prenatal care, and community-based practices of the importance of opt-out HIV and HCV testing, and report any positive clusters to state health departments and the CDC.

“Opt-out testing is not the same as optional testing. It is the primary care provider’s role to make sure high-risk patients know how important this testing is for them and for everyone else. Finally, we need to change the way we all think about substance abuse. We need to start treating it as the chronic disease that it is,” said Duwve.