In a study tracking numbers of new infections of hepatitis C and rates of sharing syringes among people injecting drugs over two and a half decades, differences in infection trends emerged across cities in North America, Australia and the Netherlands, researchers report in a recent Clinical Infectious Diseases. While rates of new infections remained high in Baltimore, San Francisco and Montreal, they dropped in Sydney, Melbourne and most precipitously in Amsterdam.
Authors of the study, who say theirs appears to be the first study of hepatitis C incidence and injecting behavior across cities and over 25 years, say the differences in incidence reflect differences in policies to reduce the harm of injecting drug use. The Netherlands, which introduced to needle and syringe provision for people who injected drugs in 1981, had expanded its efforts to ensure that sterile needles and syringes, along with health information and services were available throughout the communities where they were needed to discourage needle sharing. Australia had legalized and provided funding for needle and syringe provision accessed by 80 percent or more of people injecting drugs. In all three cities, opioid substitution therapy also was readily available, reducing needs to use and share injecting equipment. In the U.S. cities, where federal funding for needle and syringe programs only became available under limited conditions in the last year, 40 percent or more of people who injected drugs continued to share injecting equipment, while opioid substitution therapy access remained stymied by restrictions and long waiting lists. Both harm reduction measures — Needle and syringe provision, as well as opioid substitution therapy were much more readily available in Montreal, but there, researchers suggest, those measures were insufficient in the face of higher rates of cocaine injection.
The findings, the authors, led by Meghan Morris of the University of California, San Francisco write, indicate needs for research and development of new therapies for non-opioid injected drug dependence, for sustained support for harm reduction measures in the Netherlands and Australia, to expand efforts in Canada and an “aggressive public health approach” against hepatitis C. In addition they point out that expanding existing needle and syringe provision programs to include access to new medicines that cure hepatitis C would be beneficial to public and individual health.