Hepatitis C cases are surging in Maine, a trend that reflects the continuing public health threat of injection drug use, even as the number of drug overdose deaths has declined.
In response, the Mills administration will launch a $1.5 million expansion of syringe exchanges, a research-proven prevention method, to combat a hepatitis C rate that is running at nearly three times the national average.
“We are deeply concerned about hepatitis C cases in Maine,” said Dr. Nirav Shah, director of the Maine Center for Disease Control and Prevention. “It’s an unfortunate outcropping of the substance use crisis.”
Through October, Maine had 51 diagnosed cases of acute hepatitis C in 2019, already surpassing the 39 cases for all of of 2018. In addition, the state has about 1,600 confirmed cases of chronic hepatitis C, the Maine CDC reported.
The early stage of the disease – the first six months – is referred to as acute hepatitis C, and about 20 percent of patients fight off the virus without needing medications. After the first six months, the disease is called chronic hepatitis C, and treatment is needed.
Hepatitis C is a viral disease of the liver, with symptoms that include chronic fatigue, fever, nausea, vomiting, abdominal and joint pain, dark urine and jaundice. Left untreated, hepatitis C can lead to liver failure and death, although hepatitis C cure rates have improved substantially.
In 2017, Maine had the ninth-highest rate of acute hepatitis C among the states, the most recent year for a state-by-state comparison. In 2018, the Maine rate was 2.9 cases per 100,000 people, about 2 1/2 times the national average of 1.17 cases per 100,000 people.
Prevention will save lives and money, experts say.
The addition of at least five syringe exchanges – there are currently seven in Maine – as well as expanding hours and services at existing syringe exchanges, will go a long way to prevent hepatitis C.
“We can put a significant dent in hepatitis C cases,” said Kenney Miller, executive director of the Health Equity Alliance, which operates syringe exchange programs in Bangor, Ellsworth, Belfast and Machias. “This is hugely encouraging.”
Miller said the long-term goal is to have at least one syringe exchange in all of Maine’s 16 counties. The other existing syringe exchange locations in Maine are in Portland, Augusta and Waterville.
The cost of one syringe is 7.5 cents, compared to high-priced hepatitis C medications, which for Medicaid patients cost from $143 per day to $1,100 a day, according to the Maine Department of Health and Human Services.
Shah said that increasing the number of syringe exchanges is one of the top priorities of the Mills administration.
“We have our foot on the gas as hard as we can on this,” Shah said. “This is harm reduction at its best.”
Gordon Smith, director of opioid response for the Mills administration, said the Maine CDC will be spending about $1.5 million in 2020 on new syringe exchange locations, with a high priority of having sites in Lewiston and York, Oxford and Somerset counties.
Sharing needles for drug use also puts people at increased risk of other diseases, such as HIV and hepatitis B. Hepatitis B is also a viral disease of the liver, although usually it is less severe than hepatitis C, and most patients’ immune systems can clear the virus. There were 48 acute hepatitis B cases through October, according to the Maine CDC.
Incarceration is also a risk factor for hepatitis C, with more than 500 Maine prisoners – about one in every four in state prison – having been diagnosed with hepatitis C, according to a lawsuit filed against the Maine Department of Corrections. A Maine prisoner filed a federal lawsuit this summer because the Maine State Prison had refused to provide him with medications that could cure his hepatitis C.
Treatment for hepatitis C has vastly improved over the past 10 years, and 90 percent of patients can be cured with medications, according to the U.S. Food and Drug Administration. But the medications are expensive, and the uninsured would often have a difficult time getting it.
Among Maine’s Medicaid patients, 543 received treatment for hepatitis C from January 2018 to June 30, 2019, according to Maine DHHS.
Zoe Brokos, program coordinator for Portland Needle Exchange, said more people arrive at the Portland location who have Medicaid coverage since Gov. Janet Mills expanded the program in January. That helps the needle exchange connect people to testing and treatment.
Brokos said part of the increase in the incidence of the disease may be attributed to greater awareness and improved access to treatment now that people who fall ill have Medicaid. More than 40,000 Mainers have enrolled in Medicaid through the expansion.
The state also removed a barrier in October 2018 by eliminating a Medicaid requirement that a patient be opioid-free for six months prior to starting hepatitis C treatment.
“There are still a lot of gaps, and we know that there are many folks who travel to our needle exchange from York County and Lewiston-Auburn, and those are just the ones with transportation,” Brokos said.
While drug overdose deaths have declined, from 417 in 2017 to 354 in 2018, opioid use may not have. The decrease in deaths could be largely caused by a number of factors that have nothing to do with usage, such as the increased availability of naloxone, a life-saving antidote for opioid overdoses.
“Because we are seeing fewer overdose deaths doesn’t mean people are using less,” Miller said.
Beverly Reeves, 64, of Augusta contracted hepatitis C about 30 years ago, and she said she hates to see the increase in the disease in Maine.
She said how she contracted it is a mystery – she was not an intravenous drug user, and doctors were not able to pinpoint how she fell ill. At the time, treatment was nonexistent, and she spent decades with chronic fatigue and other symptoms. A decade ago, she received a liver transplant and now feels better.
“I’m very grateful to be alive,” Reeves said. “Back then, they didn’t know if I would live or die. It’s a devastating, terrible disease.”