I just read the Fall 2017 special issue of Hep featuring one of my heroes, Lynn Taylor, MD. Taylor is a primary care physician in Providence, Rhode Island who is doing battle on the front lines of America’s injection drug and hepatitis C crises. Since Hep already wrote about Taylor, I am not going to say much more about her, other than to suggest reading the Hep article. You may also want to check out Rhode Island Defeats Hep C.
Instead, I want to use Taylor as a segue to the topic of hope. People such as Dr. Taylor are making a huge difference. At times, the opioid and hep C crises can feel overwhelming. It may feel like we are drowning in pain, but the situation isn’t entirely bleak.
Recently, there was some more good news regarding hepatitis C and injection drug use. Robert Heimer, PhD, professor of epidemiology and pharmacology at the Yale School of Public Health, announced new research that contradicts everything we’ve been telling people for years. Heimer reported that sharing paraphernalia used to cook and prepare injection drugs does not directly lead to transmission of hepatitis C.
Yes, you read that correctly. For 20 years the harm reduction community has been saying that it isn’t just needles shared in injection drug use that transmits hepatitis C. It can be transmitted with everything that is shared: cookers, filters, syringes, etc. used in injection drug use. I’ve been one of those preaching this message.
In the lab, Heimer and colleagues found that transmission occurs via the needles used to prepare and inject drugs, and not through shared paraphernalia. These findings led Heimer to recommend that syringe access programs could save money by not providing cookers and filters, but rather focus on distributing more syringes with fixed needles, which are less prone to harbor hep C than those with detachable needles.
Robert Heimer is a renowned expert in his field. I have admired his work for as long as I’ve been in the hepatitis C field. But I must admit, this evidence feels radical and scary. However, Heimer and colleagues said that no evidence exists showing that providing clean cookers and filters reduces the incidence of hepatitis C.
Ultimately, this new evidence invites us to rethink our practices. Science can be frustrating, because we wonder what or who to believe. I trust Heimer. I’d like more evidence, but for now, this is what we have. We have an epidemic on our hands, and given the size of the problem, it seems sensible to concentrate on getting as many unused syringes with fixed needles into the hands of those who need them.