The accelerating death rate due to drug overdose has been widely publicized in the popular media, yet there lurks an underlying veiled scourge of death and morbidity due to emergent infectious disease epidemics that are a consequence of the opioid epidemic. In the United States in 2016, there were more than 60,000 drug overdose deaths. To that toll must be added the nearly 20,000 additional deaths from viral hepatitis. Deaths in the U.S. due to the opioid epidemic exceed those due to HIV at the height of the AIDS epidemic in the U.S. Reported cases of acute hepatitis C increased nearly 3-fold from 2010 to 2015, largely due to increases in injection drug use. There was a more than 20% increase in acute hepatitis B, a vaccine preventable disease, from 2014 to 2015. The toll of opioid related death and morbidity is even greater if one considers the impact of bacterial endocarditis, septic arthritis, and other infectious complications of intravenous drug use. Opioid-associated infectious disease epidemics are emerging in areas of the United States that have historically not been infectious disease hotspots. Acute hepatitis C amongst persons < 30 years of age who inject drugs has been demonstrated to be greater in nonurban compared with urban areas and is occurring in predominantly white persons. The incendiary nature of injection drug use, viral hepatitis, and HIV, the emergence of these synergistic epidemics in rural America, and implications for stemming the tide will be discussed.
CROI Conference
