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Opioid tampering by providers who use drugs increases risk for HCV transmission

Health care providers with unknown hepatitis C virus infection who injected drugs had a high risk for contributing to nosocomial outbreaks of the infection due to tampering with anesthetic opioids, according to findings published in Hepatology.

Researchers including Chong-Gee Teo, MD, PhD, of the division of viral hepatitis at the CDC, analyzed data collected from various reports of health care-related HCV outbreaks in developed countries between 1990 and 2012. The outbreaks were categorized into four groups: anesthetic opioid tampering, surgery, anesthesia provision not associated with opioid tampering and infection control breaching.

“To estimate risks of HCV transmissions that underlie hepatitis C outbreaks from opioid tampering, probabilistic modeling was incorporated in this study,” the researchers wrote. “A risk-assessment model was constructed to estimate risks of provider-to-patient HCV transmission from tampering — per exposure and over time — and compare the risks from surgery.”

According to the study, the risk-assessment model was used to gain insight into how opioid tampering may have led to a recent HCV outbreak in Colorado.

Overall, 46 nosocomial outbreaks were included in the final analysis. Of these outbreaks, eight were due to anesthetic tampering, seven due to surgery, seven due to anesthesia provision and 24 due to breaching of infection control. Tampering was associated with 17% of outbreaks and 53% of the total number of cases (438/833). Of the tampering outbreaks, 75% involved fentanyl (n = 6), 63% occurred in the United States (n = 5) and one outbreak occurred each in Australia, Israel and Spain.

Through the risk-assessment model, researchers found that HCV transmission risk was highest in a provider who had unknown HCV infection status, was a person who injects drugs (PWID; 0.62%; standard error [SE] = 0.38%) and was a person that tampered with opioids compared with surgery performed by a surgeon with unknown HCV status (0.000037%; SE = 0.000029%) and a surgeon who knew they had HCV (0.0046%; SE = 0.0033%).

“HCV transmission risk from exposure to an opioid preparation tampered by a provider of unknown HCV infection status who is a person who injects drugs exceeds 16,757 times the risk from surgery by a surgeon of unknown HCV infection status and 135 times by an HCV-infected surgeon,” the researchers wrote.

For a surgeon infected with HCV to pose a 50% patient transmission risk it would take 30 years, compared with a PWID who tampered with opioids, which would take less than a year to pose a risk; it can sometimes take even days or weeks for the same PWID who may have high access to opioids to pose a risk, according to the researchers.

“Medical providers who tamper with anesthetic opioids are responsible for a large portion of nosocomial hepatitis C transmissions,” Teo told Healio.com/Hepatology. “In order to protect patients, we recommend raising greater awareness among health care staff regarding provider substance abuse and treatment options, screening health care providers periodically for opioid use, employing computerized dispensing and charting systems to monitor controlled drug access and carefully verifying past criminal history during background checks for all health care professionals. In addition, it is beneficial to offer providers testing and treatment for hepatitis C infection.” 

The researcher concluded: “In the era of highly efficacious anti-HCV therapy, providers should feel less threatened by being found HCV-infected and be more willing to avail themselves to testing and curative treatment.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.