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Health Aff (Millwood). 2019 Feb;38(2):287-294. doi: 10.1377/hlthaff.2018.05232.

A Transitioning Epidemic: How The Opioid Crisis Is Driving The Rise In Hepatitis C.

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David Powell ( ) is a senior economist at the RAND Corporation in Arlington, Virginia.
Abby Alpert is an assistant professor at the Wharton School, University of Pennsylvania, in Philadelphia.
Rosalie L. Pacula is a senior economist at the RAND Corporation in Santa Monica, California.


The hepatitis C virus is responsible for more deaths in the United States than any other infectious disease, and hepatitis C infections have been rising at an alarming rate since 2010. We evaluated the role of the opioid epidemic and, in particular, the 2010 introduction of an abuse-deterrent version of OxyContin. The OxyContin reformulation led some users of the drug to switch to heroin, which could have exposed them to the hepatitis C virus. We used difference-in-differences methods, using data for the period 2004-15, to assess whether states with higher rates of OxyContin misuse prior to reformulation-states where the reformulation had more impact-experienced faster growth in infections after the reformulation. States with above-median OxyContin misuse before the reformulation experienced a 222 percent increase in hepatitis C infection rates in the post-reformulation period, while states with below-median misuse experienced only a 75 percent increase. These results suggest that interventions to deter opioid misuse can have unintended long-term public health consequences.


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