heroin and Hepatitis-A

Topics: Abscess; Adult; Animals; Autopsy; Blindness; Brain Diseases; Cerebrovascular Disorders; Endocarditis; Haplorhini; Hepatitis A; Heroin; Heroin Dependence; Humans; Male; Muscular Diseases; Myelitis, Transverse; Nervous System Diseases; New York City; Peripheral Nervous System Diseases; Quinine; Substance-Related Disorders; Tetanus

The United States is currently in the midst of the worst drug epidemic in its history, with nearly 64,000 overdose deaths in 2016. In response, pharmaceutical companies have begun introducing abuse-deterrent painkillers, pills with properties that make the drug more difficult to misuse. The first such painkiller, a reformulated version of OxyContin, was released in 2010. Previous research has found no net effect on opioid mortality, with users substituting from OxyContin toward heroin. This paper explores health effects of the reformulation beyond mortality. In particular, I show that heroin is substantially more likely to be injected than OxyContin, increasing exposure to blood-borne diseases. Exploiting variation across states in OxyContin misuse prior to the reformulation, I find relative increases in the spread of hepatitis B and C in states most likely to be affected by the reformulation. In aggregate, the estimates suggest that absent the reformulation, we would have observed approximately 76% fewer cases of hepatitis C and 53% fewer cases of hepatitis B from 2011 to 2015. I find some suggestive evidence that the reformulation also lead to increases in HIV and hepatitis A, although these findings are less robust. These findings have important implications for future policies addressing the opioid crisis.

Topics: Analgesics, Opioid; Drug Administration Routes; Drug Overdose; Hepatitis A; Hepatitis B; Hepatitis C; Heroin; HIV Infections; Humans; Opioid-Related Disorders; Oxycodone; Prescription Drug Misuse; Substance Abuse, Intravenous; Technology, Pharmaceutical; United States

An epidemic of hepatitis A virus (HAV) among intravenous drug abusers in Oslo involved 144 serologically confirmed cases. Another 26 patients (non-drug abusers), of whom 14 were derived from a single nosocomial outbreak, were associated with the epidemic. Sequencing of the VP1/P2A junction revealed that viruses associated with the epidemic were completely identical, whereas other HAV samples collected during the same period differed by up to 10%. HAV was detected in the serum of 48 of 100 patients by a nested PCR. Viremia was observed as early as 25 days before the onset of clinical hepatitis, and up to 30 days after. The large number of patients within the drug abuser group, and the few secondary cases, raised the question of whether the virus could be transmitted by the use of needles. To establish whether viral contamination of drugs did contribute appreciably to maintaining the epidemic, we examined heroin and amphetamine confiscated during the period, using immunomagnetic separation coupled to nested PCR, but failed to detect any virus. Antibodies against hepatitis B virus and hepatitis C virus were common among the HAV infected drug abusers (43% and 81%, respectively), suggesting widespread sharing of needles. This observation and the large number of patients with a demonstrable viremia suggest that needle sharing may contribute to the dissemination of HAV.

Topics: Amphetamine; Base Sequence; Cross Infection; Disease Outbreaks; DNA Primers; Drug Contamination; Hepatitis A; Hepatovirus; Heroin; Humans; Molecular Epidemiology; Needle Sharing; Norway; Phylogeny; Polymerase Chain Reaction; RNA, Viral; Substance Abuse, Intravenous; Viremia

To determine the most prevalent forms of hepatitis in intravenous heroin addicts, 389 addicts consecutively admitted to outpatient treatment clinics throughout California were tested for antibodies to hepatitis A (anti-HAV), B core (anti-HBc), B surface (anti-HBs), C (anti-HCV), D (anti-HDV), and B surface antigen (HBsAg). The majority were also tested for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, lactic dehydrogenase, total bilirubin, globulins, albumin, and platelet count. The seroprevalence of each marker was: anti-HAV (40.7%); anti-Hbc (73.6%); anti-HBs (46.7%); anti-HCV (93.6%); anti-HDV (9.6%), and HBsAg (3.5%). No single case was positive for IgM, anti-HAV, or for both HBsAg and anti-HDV, indicating the presence of recent hepatitis A or hepatitis D infection. Abnormal liver enzymes, serum proteins, total bilirubin, and platelet count were found to be normal in 5.3 to 44.8% of anti-HCV cases indicating persistent infection. Among anti-HCV cases, elevated total bilirubin or a low platelet count was invariably associated with one or more liver enzyme and protein abnormalities. We conclude that while acute hepatitis may be frequent and caused by various viral types, hepatitis C is the primary form of chronic hepatitis found in intravenous heroin addicts. Almost half of hepatitis C cases demonstrate liver function abnormalities indicating persistent infection that has the potential to be contagious and progress to cirrhosis, liver failure, and hepatocellular carcinoma.

Topics: Adult; Female; Hepatitis A; Hepatitis B; Hepatitis C; Heroin; Humans; Liver; Liver Function Tests; Male; Middle Aged; Substance Abuse, Intravenous

Topics: Acute Disease; Adult; Chronic Disease; Female; Hepatitis A; Heroin; Humans; Injections, Intravenous; Liver Diseases; Liver Diseases, Alcoholic; Male; Substance-Related Disorders

Two episodes of acute viral hepatitis occurred in each of 34 patients. One episode in each patient was serologically diagnosable as type B hepatitis on the basis of tests for hepatitis B surface antigen or antibody. The other episode was classified as "non-B" on the basis of seronegativity, reinforced by seropositivity in an alternate bout. An epidemiologic background appropriate to "serum" hepatitis, either transfusion (one bout) or illicit self-injection (46 bouts), was associated just as frequently with serologically non-B episodes as with identified type B disease. The diagnosis of type B hepatitis, therefore, should be made only on the basis of serologic tests specific for hepatitis B virus infection. Other cases of sporadic diseases in adults must be labeled "viral hepatitis, type unspecifiable."

Topics: Acute Disease; Adolescent; Adult; Age Factors; Blood Transfusion; Cell Membrane; Female; Hepatitis A; Hepatitis B; Hepatitis B Antibodies; Hepatitis B Antigens; Hepatovirus; Heroin; Humans; Male; Middle Aged; Serologic Tests

Topics: Acute Kidney Injury; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Electrocardiography; Female; Fetal Diseases; Fetus; Heart Diseases; Hepatitis A; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intramuscular; Injections, Intravenous; Injections, Subcutaneous; Lung Diseases; Male; Maternal-Fetal Exchange; Methods; Neurologic Manifestations; Pneumonia, Aspiration; Pregnancy; Pulmonary Edema; Pulmonary Embolism; Respiratory Insufficiency; Skin Diseases

Topics: Acanthosis Nigricans; Acne Vulgaris; Dental Caries; Dermatitis, Contact; Drug Eruptions; Edema; Gangrene; Hepatitis A; Heroin; Humans; Impetigo; Life Style; Pigmentation Disorders; Pruritus; Psychophysiologic Disorders; Purpura; Skin Diseases; Skin Manifestations; Substance-Related Disorders; Thrombophlebitis; Urticaria

Topics: Adult; Cross Infection; Dentists; Hepatitis A; Heroin; Humans; Male; Maxillofacial Injuries; Occupational Diseases; Substance-Related Disorders; Surgery, Oral; Tooth, Impacted

Topics: Adult; Alcoholism; Child; Female; Hepatitis A; Heroin; Humans; Liver Cirrhosis; Liver Diseases; Lung Diseases; Male; Middle Aged; Oxygen Inhalation Therapy; Pneumonia; Respiratory Insufficiency; Syndrome

Topics: Alcoholism; Chemical and Drug Induced Liver Injury; Hepatitis A; Hepatitis B; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Diphenhydramine; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Male; Substance-Related Disorders; Urticaria

Topics: Adult; Anesthesia; Cellulitis; Female; Hepatitis A; Heroin; Humans; Male; Maternal-Fetal Exchange; Menstruation Disturbances; Physician-Patient Relations; Pregnancy; Pulmonary Edema; Substance-Related Disorders; Surgical Procedures, Operative; Tetanus

Topics: Adolescent; Adult; Crime; England; Female; Hepatitis A; Heroin; Hospitalization; Humans; Injections, Intravenous; Male; Methadone; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Autopsy; Chemical and Drug Induced Liver Injury; Female; Hepatitis A; Hepatitis B; Heroin; Humans; Liver; Liver Diseases; Lymph Nodes; Male; Morphine Dependence; Necrosis; Pulmonary Edema

Topics: Adolescent; Female; Florida; Hepatitis A; Hepatitis B; Heroin; Humans; Male; Substance-Related Disorders

Topics: Adolescent; Adult; Attitude to Health; California; Codeine; Educational Status; Female; Hepatitis A; Heroin; Humans; Hypnotics and Sedatives; Injections, Intravenous; Lysergic Acid Diethylamide; Male; Meperidine; Morphine; Opium; Self Mutilation; Socialization; Socioeconomic Factors; Student Dropouts; Substance-Related Disorders

Topics: Amphetamine; Barbiturates; Condiments; Drug Synergism; Hallucinations; Hallucinogens; Hepatitis A; Heroin; Humans; Lung Diseases; Lysergic Acid Diethylamide; Mental Disorders; Petroleum; Psychomotor Disorders; Psychoses, Substance-Induced; Substance Withdrawal Syndrome; Substance-Related Disorders

Topics: Abscess; Hepatitis A; Heroin; Humans; Injections; New York City; Sepsis; Substance-Related Disorders

Topics: Adolescent; Adult; Alcoholism; Amphetamine; Barbiturates; Cannabis; Cocaine; Hepatitis A; Hepatitis B; Heroin; Humans; Lysergic Acid Diethylamide; Male; Middle Aged; Opium; Phenothiazines; Prisons; Psychotic Disorders; Sepsis; Smoking; Substance-Related Disorders; United Kingdom

Topics: Carrier State; Hepatitis A; Heroin; Heroin Dependence; Humans; Liver Diseases; Substance-Related Disorders

Topics: Hepatitis A; Heroin; Heroin Dependence; Humans; Narcotics; Substance-Related Disorders

Topics: Hepatitis; Hepatitis A; Hepatitis, Viral, Human; Heroin; Humans