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Pain Pill Injectors Have Higher Risk of Hepatitis Than Heroin Users

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We know that individuals who abuse intravenous drugs are at a much higher risk of contracting diseases such as hepatitis C. However, new research from the American Journal of Public Health now indicates that the type of drug they inject can also increase their hepatitis risk.
More surprising, it isn’t the typically heroin-addicted user who is most at risk. Instead, it is individuals who inject pain pills. This revealing study sheds new light on understanding the behaviors of this emerging group of drug abusers and the preventative measures that are necessary to stop secondary infection rates.

The Numbers

The October 2014 issue of American Journal of Public Health published a study indicating that those who inject prescription opioid analgesics, such as pain pills, are five times more likely to become infected with hepatitis C than those who inject other drugs, such as heroin or cocaine. The study also showed that geography played an important role in infection rates as well. Hepatitis C infection risks are much higher in certain geographical areas, primarily rural locations like the Appalachian mountains. These areas do not have access to education and needle exchange programs like drug abusers in urban centers do. In addition, the occurrence of prescription opioid injection is much higher in rural areas than it is in the cities. Kentucky, West Virginia and Tennessee are two of the fasted growing centers for abuse of these drugs.

Why the Increased Risk?

The numbers beg the question of why these opiate-based injectable drugs put individuals at a higher risk of hepatitis. So far, the answer has eluded researchers and physicians. There are some theories though, which mostly pertain to the preparation methods that opiate-based users employ in preparing their injections. One explanation is that those who inject pain killers must often inject themselves more often than a heroin user. This is due to the anti-tampering devices installed in many painkiller pills. Manufacturers insert inert ingredients into the pills that absorb water and cause the ingredients to gel together in hopes that it will stop individuals from injecting it. Instead, users often keep mixing the pills with additional water, making the solution too large for a typical syringe. Thus, they simply inject themselves more often, which puts them at a higher risk for contracting blood borne illnesses.
Another possibility is that abusers use syringes with a larger dead space; this means the plunger does not depress all of the way. Even when users replace the needles, the syringe itself is still contaminated with blood and fluid.

Educational Needs

These new findings indicate an increased need for educational outreach to individuals who at the highest risk of abusing opiate-based painkillers in an injectable format. Many drug prevention programs communicate the importance of not sharing needles, including implementing needle exchange programs. However, researchers say that it isn’t enough. In fact, HIV infections dramatically decreased through the needle exchange programs, while hepatitis C infections continue to rise. One theory is that hepatitis C is far more infectious when it is on preparation equipment or table surfaces. Hepatitis C can also survive outside of the body for a much longer period of time, raising the chances of infection.
There must also be an emphasis that infection can occur by sharing preparation equipment such as water, cotton, cookers, tourniquets and alcohol swabs. In the same study, 80 percent of Hepatitis C positive individuals  reported sharing preparation equipment during their drug use.



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