A life-threatening reality of injection drug use- hepatitis!

It keeps a person asymptomatic till it becomes chronic and causes liver failure cirrhosis (scarring of the liver) and is also associated with liver cancer.
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Representational Image Willy1943/Flickr

BY PROF (DR.) YASIR HASSAN RATHER

As we already are battling with the epidemic of Heroin Use in Kashmir, a life-threatening reality of injection use-Hepatitis is surfacing. 

What is Hepatitis?

Viral hepatitis is a systemic disease with primary inflammation of the liver. It has been seen that the major contribution to the global burden of disease due to infection by these blood-borne viruses is by Injection Drug Users. Injection drug use is a major public health problem that has drawn global attention.

What is the scenario of Kashmir?

To put it in one line and yet explain the gravity of the situation, it is an epidemic within an epidemic. Injection drug use is increasing in Kashmir. With the increase in the number of IDUs in the valley, the burden of blood-borne infections (Hepatitis C, Hepatitis B) has also increased to an alarming level.

These infections are spreading uncontrollably, just like fire. If on daily basis, we see 100 patients and screen them for Hepatitis approximately 70 patients test positive for it.

It is not just one complication associated to IDU it is a life altering and threatening condition for the injection drug user. What makes it an epidemic, is that it is a silent killer.

It keeps a person asymptomatic till it becomes chronic and causes liver failure cirrhosis (scarring of the liver) and is also associated with liver cancer.

About 80% of individuals exposed to Hepatitis C Virus develop chronic infection & 3-11 % with chronic Hepatitis C Virus develop liver cirrhosis within 20 yearsIts infectivity rate is high.

It not only causes health burden but also causes economic burden -as the treatment process for the same is expensive.The cost of treatment for these infections will cause a further strain to our already fragile healthcare sector.

This new emerging threat in our society is destroying and will destroy the most beautiful years of an individual i.e., adolescence and early adulthood as these years are most productive and are most healthy years of life but unfortunately, they are exposed to multiple anti-viral medications for a long term which also affects their mental health.

What makes Hepatitis C more dangerous is that there is no preventive vaccine for it, like in early years of childhood preventive vaccines for Hepatitis B is given which reduces the health burden of it.

One of the reasons for the increased prevalence of Hepatitis C among Injection Drug Users is that it is found to be 10 times more transmissible than HIV, per unit of blood.

Even if the needle is shared once, it can transmit the Hepatitis C virus. It can also spread silently to other family members and silently it can get transmitted to the baby from an infected mother.  These all factors make it an EPIDEMIC which has silently creeped in our society and is engulfing substance users of the valley.

What are the statistics?

A per the survey conducted by the Ministry of Social Justice and Empowerment, Government of India on the extent and pattern of substance use in India it has been estimated that India has 8.5 lakhs IDUs. The most common drug that is injected is heroin which belongs to the class of opioids. Highlighting the statistics of Kashmir, it was also seen that the current use of opioids in Jammu and Kashmir is 4.9 % of the total population and most ofthem are using these drugs by injecting it into their veins.

How does it occur?

Injection drug users inject drugs into veins and this carries a substantial risk of transmitting hepatitis virus. IDUs are at high risk ofcontracting blood-borne infections because of unsafe injection practices like sharing a needle, reuse of the needle, and indulgence in various high-risk behaviors like unprotected sexual intercourse, sex under the influence of drugs, and sex with multiple partners.The Hepatitis C virus is very infectious and it can easily spread when a person comes into contact with surfaces, equipment, or objects that are contaminated with infected blood, even in amounts too small to see. The virus can survive on dry surfaces and equipment for up to 6 weeks.

What needs to be done?

Active screening for Hepatitis should be done once diagnosed with IDU.

IDUs should be involved in Harm Reduction-oral substitution therapy as you are involving them in treatment, they get an easy access to health care system. This substitution is an evidence-based approach for HCV prevention and treatment.

IDU users should be educated about how its caused and what preventive measures to take for breaking the chain of transmission.

Parents and schools should actively watch out for signs of IDU

Injection marks on arms, forearms, hands, feet and swelling.

Redness and tenderness on hands, arms, and feet.

Insulin syringes in their bags and rooms.

=  Change in behaviour.

= Sleeping too much.

= Drowsiness.

= Recurrent aches and pains.

= Excessive sweating.

= Recurrent flu like symptoms.

= Asking for money with different excuses or complaining of losing their expensive gadgets and other things.

Conclusion:

Denialwon’t bring a change. Radical acceptance is the way forward. Help a person with IDU, your support, timely intervention can save a life. Don’t stigmatize and criminalize substance use. Seek help.

Author: Prof (Dr.) Yasir Hassan Rather

Professor in Institute of Mental Health And Neurosciences and is the In charge of De-addiction Services SMHS and IMHANS.

Disclaimer: The views and opinions expressed in this article are the personal opinions of the author.

The facts, analysis, assumptions and perspective appearing in the article do not reflect the views of GK.

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