Hepatitis C Cases Skyrocket as Heroin Use Proliferates on Upper Cape

Like a domino effect, one health epidemic is leading to another on the Upper Cape.

As local towns grapple with increased opiate abuse, particularly heroin, which has led to a wave of overdoses in recent weeks, new statistics suggest that the region is now facing a new health crisis with an outbreak of Hepatitis C infections.

Hepatitis C virus is transmitted primarily through blood-to-blood contact, and through shared drug injection equipment. Infection can lead to inflammation of the liver, which often progresses to cirrhosis and liver failure.

The State Hepatitis C Virus Report was released in May 2013 by The Center for Health Law and Policy Innovation at Harvard Law School, and it is not good news for the Cape.

The report indicates that in 2011 Barnstable County, particularly the four towns on the Upper Cape, has experienced infection rates among adolescents and young adults, ages 15 to 25 years, nearly double that of the county with the second highest infection rate. According to the most recent statistics cited in the report, the Barnstable County infection rate was 251.8 cases per 100,000 population followed by Plymouth County with 130.32 cases per 100,000 population. In comparison, Suffolk County, which includes Boston, had only 49.242 infections per 100,000 population.

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Hampshire and Nantucket experienced the lowest infection rates among the 14 counties in Massachusetts.

A color-coded map shows that in Barnstable County, Falmouth has the highest rate of Hepatitis C infection, with Sandwich, Mashpee, and Bourne reporting elevated rates as well. Towns east of Dennis showed the lowest rates of infection, if any.

A more recent report, issued three months ago by the Massachusetts Department of Public Health, shows that in 2012 the Hepatitis C infection rate among the 15- to 25-year-old age group in Barnstable County had risen dramatically to 344.3 cases per 100,000 population.

“The situation has only gotten worse since those statistics were compiled, as surveillance for the disease has improved on the Cape. When data becomes available for 2013, we will be seeing an increase to what degree we don’t yet know, but it will be significant,” Max Sandusky, director of prevention and screening for the AIDS Support Group of Cape Cod, said.

In an interview earlier this week, Valerie Al-Hachem, Cape Cod Healthcare Infectious Diseases clinical services manager, called the Hepatitis C infection rate on the Cape “astonishing” and “pretty scary.”

“It’s a short trip from being prescribed a Vicodin prescription for a toothache or a sports injury to moving on to heroin,” she said.

Ms. Al-Hachem said that the virus is often transmitted by the use of shared drug equipment, which, in addition to needles, includes syringes, spoons, water in the cooker, and cotton swabs. It can also be transmitted by sharing objects such as a toothbrush or a razor with an infected person.

While the infection rate among young adults on the Cape is staggering, there is also concern that the Hepatitis C epidemic may be even more widespread than thought, especially among baby boomers who may not even know they are infected. Ms. Al-Hachem highly recommends that people in this age group get tested, especially if they shared straws for nasal cocaine ingestion, had tattoos or piercings in unprofessional non-sanitary settings, or ever injected steroids.

To combat the continued high transmission rates of Hepatitis C here, Cape Cod Healthcare is taking the lead in conducting proactive screening measures. Ms. Al-Hachem said that because of the high rate of drug use in the area, the organization is partnering with methadone clinics in Wareham and West Yarmouth, family planning agencies, AIDS groups, substance abuse centers, and the county correctional facility to screen clients, patients, and inmates to help stem the tide of virus transmission. According to Ms. Al-Hachem, the screening at the Barnstable County Correctional Facility in Bourne, which is conducted by the AIDS Support Group of Cape Cod, often yields positive results in 40 to 50 percent of the inmates tested for Hepatitis C.

It is this aggressive screening initiative which, in fact, could explain some of the particularly high infection rates in certain towns. The numbers in Falmouth, for example, may be skewed higher because it is home to the Gosnold substance abuse clinic.

While some people may be surprised at the drug addiction crisis and high rate of Hepatitis C infection on the Cape, Ms. Al-Hachem is not one of them.
“It’s not all golf and sailing here,” she said.

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