Opioids
Infectious Disease

An estimated 0.3% of the U.S. population has injected drugs in the past 12 months. The current opioid overdose epidemic has, however, brought renewed attention to injection drug use (IDU). IDU is associated with a list of infectious diseases, including hepatitis C virus (HCV), hepatitis B virus, abscesses, bacterial endocarditis, and skin and soft tissue infections. A high profile example of the risk of infectious disease associated with IDU is the outbreak of human immunodeficiency virus (HIV) infection in rural southeastern Indiana associated with the sharing of needles and other injection equipment. Persons who inject drugs are at higher risk for HIV diagnosis. Although HIV diagnoses have decreased approximately 90% since the peak in the early 1990s, roughly 9% of HIV infections diagnosed in recent years are among persons who inject drugs. The National HIV/AIDS Strategy identifies persons who inject drugs as a priority population for HIV prevention.

Recent trends suggest heroin use and IDU are increasing and, coupled with high rates of syringe sharing, might challenge the decades of progress in HIV and HCV prevention among persons who inject drugs. White persons who inject drugs tend to begin injecting at younger ages than blacks or Hispanics and accounted for >50% of new persons who inject drugs in 2015. Further, although white persons who inject drugs in 22 cities reported increases in receipt of sterile syringes from syringe service programs similar to increases reported among blacks and Hispanics, they were least likely to receive all their syringes from sterile sources and most likely to have shared syringes. Rural areas, which are predominately white, include some of the most vulnerable populations for IDU and IDU–related HIV outbreaks and might have the greatest unmet need for risk reduction services provided by syringe service programs. An analysis of our own data in Minnesota showed that rural counties in Northeast and North Central Minnesota were at the highest risk of rapid dissemination of HCV among persons who inject drugs.

Recent increases in HCV infections, which are also frequently associated with injection drug use, suggest progress in HCV prevention could similarly be negatively affected by increases in opioid and heroin use. HCV has increased 294% nationally from 2010 to 2015; there has been a similar increase in HCV infection in rural areas, which saw a 364% increase from 2006 to 2012. The increase in acute cases of HCV is largely attributed to injection drug use and the current opioid epidemic. In fact, 80% of persons who inject drugs have HCV infection.

For those who do inject, provision of sterile syringes and services through syringe service programs can decrease risk for HIV transmission and other negative health outcomes. A need to address IDU and associated risk behaviors exists because of several factors, including recent increases in heroin addiction and overdose. The complex mix of infectious diseases that face persons who inject drugs and are a harbinger of health care utilization patterns to come among young adults in the throes of addiction.

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.