A Transitioning Epidemic: How the Opioid Epidemic is Driving the Rise in Hepatitis C

Hepatitis C virus (HCV) is the nation’s most common blood borne infection, killing more Americans than any other infectious disease despite effective treatments that can cure the disease if it is diagnosed early. HCV infections had been declining steadily since 1994 until a sharp uptick in infections appeared in 2010. The dramatic increase in HCV infections closely parallels the recent surge in fatal overdoses involving heroin, a drug that is frequently injected when used. Thus, understanding whether the two phenomena are causally linked is vitally important for informing our public health response, particularly as it pertains to HCV.

In this paper we empirically test if the recent rise in HCV infections can be causally linked to the opioid epidemic by exploiting a pivotal transformation in the opioid epidemic that occurred with the reformulation of OxyContin that was entirely unexpected but affected specific regions of the country differentially. Using this differential exposure to OxyContin abuse prior to the reformulation as our key instrument, we use event study analysis to show that the rise in HCV infections can be directly tied to reformulation of OxyContin, which other research has shown led many opioid abusers to shift to heroin use, particularly injecting heroin. While considerable policy attention is currently being given to managing the opioid epidemic and rising mortality rates associated with it, this study shows that a more silent epidemic has also emerged due to a transition in mode of administration of opioids. This more silent epidemic has received considerably less attention and could have enormous implications on the health care system if testing and treatment is not included in the nation’s response to the opioid epidemic.