Confronting Co-occurring Battles: Hepatitis C and Addiction
CleanSlate has been a pioneer in Hepatitis C treatment for those struggling with addiction. We understand the challenges of overcoming addiction while managing a chronic illness. That’s why we are proud to offer on-site testing and treatment for Hepatitis C to our patient population.
Hepatitis C infection is a serious condition and early screening and treatment can be key in preventing the virus from causing long-term harm. The good news is that Hepatitis C is highly treatable with antiviral medications and has over a 95% cure rate. Our trained medical staff provide Hepatitis C treatment alongside our addiction treatment programs, allowing our patients to achieve a healthier life in recovery.
Today we are privileged to have with us Dr. Phyllis Losikoff, a leading authority in this field, who brings invaluable insights from years of experience in researching and treating these co-occurring conditions.
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What inspired your interest in addiction treatment?
Dr. Losikoff: My background is in pediatric infectious disease, which I pursued as a professor at Brown University, where my research dealt with early Hepatitis C. The initial study I did with one of my students demonstrated that in young IV drug users, Hepatitis C actually cleared at higher rates than in other populations. The more I investigated Hep C, the more I came into contact with people using IV drugs. I did a lot of my work in prisons, and my research became part of my larger compassion for marginalized populations.
Could you explain the relationship between Hep C infection and substance use disorders, particularly among injecting drug users?
Dr. Losikoff: It’s helpful to look at the course of Hep C since the early 1980s. It used to be called “non-A and non-B hepatitis” because we didn’t know what it was. We identified it by the late 80’s/early 90s as a particular blood-borne pathogen. Given that, the first thing to do is clean the blood supply and treat all the doctors, nurses and dentists—the people who got in contact with blood products. By the early 2000s, the incidence of the disease had gone way down, following the CDC’s recommendation of screening all baby boomers. Then in the 2010s there was a huge uptick, which hasn’t gone down yet. What we see there is the synergy between opioid use disorder and blood borne pathogens. That’s why we refer to this as a syndemic—the synergy between two epidemics that exacerbate each other. So when you look at the United States today, the vast majority of new cases of Hepatitis C are among people who have used IV drugs.
Are there unique challenges in treating hepatitis C in patients with substance addiction?
Dr. Losikoff: Yes, they’re unique but they’re not insurmountable. Ten years ago in every state in the country, there were all kinds of restrictions from payors who did not want to treat IV drug users or anyone really with a substance use disorder. It was ridiculously expensive, and the insurance companies’ stated rationale was that these patients were not going to adhere to treatment or they would get reinfected, and so on.
Now we have the substantial backing of clinical trial data demonstrating that neither retention nor drug use is an issue. Patients with substance use disorders get cured of Hep C at the same rate as those who don’t use drugs. It’s not a matter of getting them ‘clean’—it’s a matter of getting them engaged in care.
The rates of reinfection are in fact surprisingly unimpressive. We found in our 2016 pilot that when people get treated for Hepatitis C, they do better in their addiction treatment, they stay in care longer (in fact, they are 13 times more likely to stay in our care), they have fewer positive tests for both opiates and cocaine, and they feel better overall.
If you look at recovery as journey of self-actualization, it’s all about little jumps, with the primary goal being a life lived without drugs. Treating Hepatitis C is one of the milestones on that journey. Once achieved, people feel better about themselves and push forward in their recovery.
Despite that progress, are there still key barriers that remain for Hep C treatment?
Dr. Losikoff: Absolutely. Many potential patients have internalized the message that they’re not going to get treatment, because it’s too expensive. Others have difficulty managing getting it from a primary care doctor referring them to a hepatologist. That’s a big part of the reason we started offering Hep C treatment in our clinics—precisely to overcome these barriers. Having addiction providers trained to do this is win/win for everybody. CleanSlate providers like to do it because it yields a clear cure, which is rare in addiction treatment at large.
Part of the challenge now is convincing our colleagues elsewhere that they should be treating these patients too. There are many who don’t want to. What we strive to do now is train addiction providers who are trusted by this population, rather than having to go to a specialist and face potential stigma and other barriers to treatment. So there are still hurdles, and every day I encounter them, but the people at CleanSlate are all on board.
Can you share some individual success stories where integrating Hep C and addiction treatment led to improved patient outcomes?
Dr. Losikoff: One patient comes to mind who was very stable, doing wonderfully in his recovery. Little did I know that once I treated his Hepatitis C, he said, “Now it’s gone.” All the remnants of his using days, as he saw it, were resolved.
Countless patients, starting with our first pilot in New Bedford, MA in 2016, affirmed their trust and satisfaction in our care. Since then, we’ve expanded our treatment to over 60 CleanSlate Centers across the country.
I’m also inspired by our providers, who take pride in treating our patients for Hep C. Not only did they acquire new skills, but they were also able to offer the patients something they really appreciate. That’s a big deal.
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