Young heroin addicts who checked into a Princeton detox facility had a 2-in-5 chance of having hepatitis C - especially a very aggressive strain that is unusual, a survey showed.
Two out of every five young suburban heroin users in New Jersey are likely to be infected with hepatitis C - creating a "second wave" of the disease.
That's the conclusion reached by doctors who looked at more than 800 patients admitted to Princeton House, a psychiatric facility for heroin detoxification, over a nine-month period.
A study released Wednesday of Princeton House clients ages 17 to 35 showed those with hepatitis were far more likely to have a more aggressive strain of the virus, according to Ronald G. Nahass, an infectious disease specialist with ID Care, a Hillsborough-based practice.
Hepatitis C3 is more likely to produce liver cancer, fibrosis or cirrhosis down the line, he said. More than 25 percent of the Princeton House hepatitis patients had that type - more than double the national average.
The finding points to a distinct "reservoir" of a type of hepatitis C that suburban heroin addicts pass among themselves. The findings appear in the U.S. Centers for Disease Control and Prevention's journal "Emerging Infectious Diseases."
Chronic hepatitis is the prolonged inflammation of the liver, which can eventually lead to cirrhosis, liver failure, or liver cancer. Most of the current cases involve people born between 1945 and 1965, although the recent surge in intravenous drug use might produce a "second wave" years from now, said the journal article.
It is spread through the exchange of blood - in studied cases, most likely via shared needles.
Getting those patients treated for hepatitis proved difficult, said Nahass. Of 187 patients who tested positive and were evaluated, just 16 came to follow-up appointments for their hepatitis, and just three started taking the curative medicine.
Nahass cited several obstacles to treatment:
In the emergency atmosphere of acute heroin detox, it's hard to get addicts to focus on other, more long-term health problems. "If you're a 28-year-old, or a 23-year-old, or even a 16-year-old...they've got lots of stuff going on in their lives," he said.
Health insurers often refuse to pay for treatment - an expensive pill taken every day for either eight or 12 weeks - unless the patient has developed advanced liver disease. Since that typically takes two or three decades to develop, young hepatitis-positive adults can be denied coverage.
There is a widespread feeling among both doctors and insurers that it's pointless to treat a heroin user, given the likelihood they could at some point become re-infected.
"That reasoning should go away," Nahass said firmly. He noted that eliminating the virus in one user will prevent it from spreading to other users. That means there's a chance of "bending the curve" of the increase in hepatitis cases.
"Denying treatment to these people is a self-fulfilling prophecy," he said.
Kathleen O'Brien may be reached at kobrien@njadvancemedia.com. Follow her on Twitter @OBrienLedger. Find NJ.com on Facebook.