Snorting Utensils & Hep C Risk

Last Straw
New research shows snorting utensils carry a high risk of transmitting HCV
by Larry Buhl

opioidThe risk of contracting the hepatitis C virus (HCV) and HIV from sharing syringes is well known. What’s less well known—almost unknown until now—is that other drug utensils, like straws used to snort drugs, when shared can transmit hepatitis C and HIV.

Researchers at University of Tennessee Medical Center (UTMC) have concluded that the sharing of utensils such as straws, rolled-up dollar bills, and even plastic pens when snorting heroin, oxycodone, or other drugs can transmit HCV and other blood-borne viruses.

The results of their research, the largest one of its kind, were published in August in Obstetrics & Gynecology, the official publication of the American College of Obstetricians and Gynecologists.

Dr. Craig Towers, professor and vice chair of obstetrics and gynecology at UTMC-Knoxville and lead physician on the study, tells A&U that the impetus for the study was the high number of opiate-addicted pregnant women he saw in his clinic.

“As part of our prenatal labs we started testing for hepatitis C, and found that two-thirds of these women were infected with hepatitis C,” Towers says.

“When I informed these women that they were infected, they were shocked. They said, ‘sure I use drugs but I don’t use needles.’”

But they did take opioids—usually oxycodone or hydrocodone—as well as crushed prescription drugs nasally.

In the sixteen-month study, conducted from March, 2014 through June, 2015, Towers set out to evaluate possible modes of HCV acquisition in HCV-infected pregnant patients in Eastern Tennessee through known common routes such as IV drug usage, blood transfusion, organ transplant, sexual contact, and tattoos, as well as possible transmission through straws or other nasal implements.

Towers and his first author, Noelle Ferandez, distributed an anonymous survey to 189 women who had tested positive for HCV during post-routine blood testing at the UTMC-Knoxville clinic.

The study showed that out of all hepatitis C-infected women, only half shared needles, but ninety-two percent reported sharing straws or other utensils to snort. Seventy percent of participants did not have any idea when they had become infected with HCV. Sixty-seven percent were first told they had HCV following the prenatal lab work that was obtained during routine prenatal care.

Towers says the use of crushed prescription drugs is evidence of the neonatal abstinence syndrome (NAS) epidemic in Appalachia, which was the basis of some of his previous studies.

Previous reports have shown a 364 percent increase in HCV infections between 2006 and 2012 in the central Appalachian region. But Towers’ study has implications for any region where opioid use is prevalent. HCV is the most common chronic blood-borne infection in the United States.

Towers concluded that sharing straws and other implements such as plastic pens as part of drug use is dangerous. “Any implement that can puncture mucous membranes can transmit blood to another user,” he says.

That’s a problem because, at least in eastern Tennessee and other parts of Appalachia, these drugs are often taken communally. Towers says that in drug busts in the region, police found that a quarter of snorting utensils confiscated had traces of blood on them.

The study did not track the prevalence of HIV in the population, but Towers tells A&U that if HIV were to enter the pool of users, it would spread quickly.

Towers explains this group of pregnant women was specifically chosen for the study because pregnancy provides a population that is often more motivated for healthcare intervention due to the potential effects on the unborn child.

Towers’ clinic routinely tests for HCV because it was established to serve high-risk women. But testing for hepatitis C is not standard practice in prenatal care in the U.S. The risk of passing HCV to the baby is five to eight percent. The bigger risk is to the mother, and to anyone who doesn’t get tested for hepatitis. That’s because the virus leaves most victims asymptomatic for years, even decades, while doing serious damage to the liver.

“These risks need to be communicated to the public and the healthcare community throughout the region,” Towers tells A&U. A public service campaign telling people to use their own straws when sharing drugs is essential, he adds.

Fortunately, straws are cheaper than syringes. But a public service campaign based around straws only addresses part of a larger issue, Towers says.

“The opioid epidemic is bad and it’s getting worse.”

Towers says the next phase of his research will study the risk of HCV being transmitted to babies during birth.

A summary of the study can be found here:

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles.