Hepatitis C: The Silent Struggle of the Opioid Epidemic

The fatal results of the opioid epidemic are widely recognized. Anyone involved in substance abuse rehabilitation, and even many outside of it, knows of opioids’ deadly impact in the United States. Officially declared a Public Health Emergency in 2018, the opioid crisis continues its devastating push despite ongoing efforts to combat it.1

However, two more deadly conditions also ride the third wave of the opioid epidemic: hepatitis C (HCV) and human immunodeficiency virus (HIV). While substance abuse experts were grateful to see a steady decline in HIV transmission over the last 25 years, HCV infections took their place and are quickly rising. 

How do HCV and HIV affect substance users, particularly those in rural communities? What can be done to interrupt the upward trend in both HCV diagnoses and opioid misuse?

Hepatitis C and Substance Abuse

Hepatitis C (HCV) is the most common bloodborne infection in the United States and is responsible for more deaths than any other infectious disease.2 New cases of HCV declined during the 1990s and remained steady throughout the 2000s. However, a sharp increase in cases started around 2010 and drew the attention of clinicians and experts alike.

Researchers discovered a correlation between the rise of HCV cases and the quickly-expanding opioid epidemic. Injection drug use is one of the ways that HCV passes from person to person, and both increases followed a similar upward pattern around the same time. 

Between 2004 and 2014, the CDC noted a 400% increase in new HCV cases and a 600% increase in emergency admissions for heroin addiction among 18- to 29-year-olds. 30- to 39-year-olds showed similar alarming surges, with a 325% increase in new HCV cases and a 77% increase in heroin injection-related emergency admissions.3

HCV’s Impact on Idaho

Idaho is not immune to the effects of hepatitis C. Research suggests that one in five Idahoans who use injection drugs were infected with HCV. Additionally, 20% of Idahoans with HIV reported intravenous drug use. These significant numbers reveal a silent problem among the population in Idaho that clinicians must address.

However, stigma against substance abuse as well as misunderstanding surrounding HCV and HIV makes it difficult to provide and receive adequate support. Some people believe HIV is a “gay disease” and HCV is a “junkie’s disease.” Substance abuse is too often seen as a problem of “weak will.”These harmful ideas and beliefs contribute to the increasing number of lives lost to these preventable and treatable conditions every year. 

LGBTQ+ Populations Are Especially At Risk

Research has revealed higher rates of substance abuse among LGBTQ+ individuals for years. The common experience of losing family, friends, and cultural ties puts them at a greater risk of turning to drugs and alcohol. As a result, the LGBTQ+ population is also more likely to contract HCV.4

However, the combination of public opinion associated with addiction and HCV compounds with the stigma against LGBT+ individuals, especially in Idaho. People already struggling to find community and support are too often left to fend for themselves as they try to overcome substance abuse and manage a chronic infectious disease, both of which are treatable with access to the right resources.

Combating the Rise of HCV

Thankfully, HCV is a treatable condition. An 8- to 12-week round of antiviral medication can cure the infection, keeping people from developing long-term HCV-related complications and preventing further spread. Accessing and adhering to this treatment plan is another story, though, especially for people with active addiction. It’s challenging to take medication consistently for 56 to 84 days when staying high is the main priority. 

As Jonathan Mermin, M.D., M.P.H., of the CDC explains, “Hepatitis C is a deadly, common, and often invisible result of America’s opioid crisis.”3 The long-term effects of hepatitis C include liver damage, liver failure, cirrhosis, liver cancer, and possible death. But with few noticeable symptoms, many people in active addiction carry on without even realizing they have the disease which perpetuates its survival. 

A crucial first step to combating the rise of HCV includes rapid HCV testing as part of both routine medical care, as well as upon admission to a substance abuse treatment program. Identifying individuals with HCV makes it easier to not only provide them with life-saving treatment services but to prevent the further spread of the disease.

Other methods like harm reduction sites are another way to limit a person’s exposure to infected syringes or keep individuals with HCV from passing along to others. Unfortunately, many regions are still far from considering harm reduction site implementation. Access to these services is limited in most areas, including Idaho.

The Emerge Recovery Difference

While conversations about curbing the opioid epidemic are vital, they must also consider HCV and HIV prevention among people who inject drugs (PWID). Since access to legal pain medication continues decreasing, chances are more people could turn to IV use. As care providers in the substance abuse space, providing effective care means involving all aspects of a person’s health, including potential infection.

In our ongoing efforts to do rehab differently, Emerge Recovery involves HCV consideration and care as part of its services. When we discuss comprehensive substance abuse care, we know that HCV treatment and prevention is a critical part of the equation. To learn more about our approach, schedule a no-fee Recovery Activation Call today.


1. Centers for Medicine & Medicaid Services. (2022). Ongoing emergencies & disasters.

2. Health Affairs. (2019). A Transitioning Epidemic: How the Opioid Crisis is Driving the Rise of Hepatitis C.

3. Centers for Disease Control and Prevention. (2017). Increase in hepatitis C infections linked to worsening opioid crisis.

4. Health & Social Care in the Community. (2013). At the intersection of marginalised identities.

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