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Is the US opioid epidemic affecting HCV rates among incarcerated people?
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The United States is in the midst of an opioid epidemic, which has led to an increase in acute hepatitis C virus cases. Infectious Disease News asked Mandy Altman, MPA, CCHP, director of the National Hepatitis Corrections Network and correctional health program manager for the Hepatitis Education Project, if the opioid epidemic is having an effect on the rates of HCV in U.S. prisons and jails.
The rates of opiate use in the United States have increased dramatically in the past decade. As divergence of prescription opiates has decreased, injection of heroin and other synthetic opioids has increased. These trends have fueled a syndemic of injection drug use and hepatitis C virus infection among people who inject drugs and the effects are felt across the country. One system significantly impacted by this syndemic is the criminal justice system, although the extent of that impact has proven difficult to measure.
Prisons and jails in the U.S. have no universal governing authority. States, counties and cities have independent facilities with a large variance in health care policy. The federal prison system houses less than 15% of the total incarcerated population, and there are nearly 2,000 prisons and 3,000 jails across the country.
The difference in populations between jails and prisons creates two radically different daily environments, with the average stay being only several days in jail to several years in prison. This creates two unique sets of challenges in creating testing and treatment protocols for each population.
In prisons, there are multiple HCV screening models, ranging from universal opt-out testing, universal opt-in testing, risk-based screening and patient-requested screening, whereas some prisons offer no testing at all. Testing in jails, which house one-third of incarcerated persons, is less extensive than prison with a similar range in protocols.
Beyond the lack of screening data available, there also is a lack of incentive for many correctional facilities to share information. Although some data have been shared voluntarily, through Freedom of Information Act requests, legal proceedings or other means, they are often outdated and incomplete. Often the information is provided without methodology, making comparisons with other systems inaccurate or impossible.
Although the rate of HCV continues to increase among people who inject drugs, and a significant portion of the incarcerated population has drug-related convictions, prisons and jails play an important role in eliminating HCV. Correctional systems and policymakers must continue to make progress to work toward HCV elimination, and further study must be done on the impacts of the opioid abuse epidemic within incarcerated populations.
Disclosure: Altman reports no relevant financial disclosures.