Letter to the Editor: Treating addiction as a healthcare issue, not a crime

By Cameron Foreman, Petra Hahn & Sarah Ziegenhorn

Our state, like many others, is suffering an opioid epidemic. Too many Iowans, of all walks of life, start with an injury, proceed with a visit to the doctor and end with an opioid addiction. In fact, one in five people is at risk for developing an addiction to prescribed opioids. When the prescription runs out, a growing number of Iowans, already hooked, are turning to a different opioid, heroin, because it is cheap and easy to access. 

Overdose deaths, whether from prescribed pain medication or from heroin, are preventable. As medical students, we begin our careers by taking the Hippocratic Oath, and pledging to “prevent disease wherever we can, for prevention is preferable to cure.”
Overdose is not the only harm of opioid use and addiction that is preventable. Hepatitis C and HIV infection are other serious consequences of injection opioid use. Hepatitis C (HCV) is a viral infection that causes severe liver inflammation and increases the risk of developing liver cancer. Currently, HCV is the leading reason for liver transplantation. It also directly causes a number of non-liver related illnesses which are estimated to amount to $1.5 billion in direct medical costs at the national level. Despite the recent development of curative treatments, HCV is still incurable for many patients who cannot afford costs of over $100,000 per course of medication. 

In Iowa, there are over 20,000 people reportedly living with HCV as of March 2016. The Iowa Department of Health reports that this number is likely a gross underestimate, and that as many as 110,00 Iowans may be unaware that they have the virus. Between 2000 and 2015, there was a 300 percent increase in HCV diagnosis among people 18-30 years old. Of these new HCV diagnoses, at least 55 percent occurred among people who inject opioids. This high rate of hepatitis among drug users is due to sharing needles, which allows for the transmission and spread of the disease.

The costs of HCV to human life, health care systems and the state Medicaid program are staggering. Fortunately, HCV is a preventable disease. Thirty-five states (plus the District of Columbia) operate successful syringe exchange programs, in which people who inject drugs may obtain new needles for free, and turn in needles they have previously used. These simple programs can make a big impact. Successful for over 20 years in some states, needle exchange programs are known to reduce the risk of disease transmission among drug users. Some critics suggest that needle exchanges encourage drug use; however, the Surgeon General of the United States and several major medical journals tell us that there is no data to support this claim. In fact, new syringe exchange program participants are five times more likely to enter into drug treatment than non-syringe exchange program participants. Former participants in syringe exchange programs are more likely to report significant reduction in drug use or to stop using altogether, and to remain in drug treatment programs. For people who are struggling with addiction, needle exchanges can be a way to keep them healthy until they choose to seek treatment. Such programs are reliable sources of support for folks who often have a hard time finding the help they want and need. 

We ask that our state legislators and health department work to ensure that people who use drugs can receive the health care and treatment they need for addiction, while preventing the development of additional diseases like HCV. While the opioid epidemic has had a slower onset in Iowa than in other states, experts suggest that Iowa has an opportunity to inoculate itself against further harm, and to prevent the spread of this epidemic. Allowing people who use drugs to access needle exchange is one tool we can use to address the harms that come along with an epidemic of opioid abuse. It is also a low-cost way to reduce the high costs of HCV infection to the state budget. We hope that our state can move quickly to prevent the rapid spread of HIV and HCV with which we are threatened. With the federal government approving funding for needle exchange programs in February of this year, it is time for Iowa to follow suit and legalize needle exchange. 

Cameron Foreman, Petra Hahn and Sarah Ziegenhorn are second year medical students at the University of Iowa Carver College of Medicine. This article was originally published in Little Village issue 208.