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BACKGROUND: The majority of hepatitis C virus (HCV) infections occur among persons 45 to 64 years (the Baby Boomer generation). However, the rates of newly reported HCV infections in this population have leveled off since 2008 while the rate among Florida’s young adults (YA) aged 18 to 30 years has accelerated since 2009. This trend is of concern because while older adults were likely infected years or decades ago, HCV infections in YA represent more recent, possibly acute infections resulting from recent or current risk behaviors. In 2012, the Florida Department of Health (DOH) began to prospectively collect risk factor information for a sample of YA with HCV infection. Early analysis identified the most common risk factor as injection drug use (IDU) and oxycodone as the drug most used. In 2013 the HCV in YA interview tool was modified to collect specific information on prescription opioid use.
METHODS: DOH staff attempted to contact YA with HCV infection reported in 10 counties. Changes were made to the state’s reportable disease surveillance system to capture the data electronically. Data were analyzed using SAS 9.3 (Cary, NC). Proportions were calculated using a denominator that excluded missing responses.
RESULTS: Between January 1 and September 30, 2013, DOH staff investigated 2,177 newly reported HCV cases aged 18 to 30 years; 770 of those investigated (35%) completed an interview. Of those, 588 (79%) reported using street drugs and 456 (78%) reported IDU. Excluding marijuana, oxycodone was the most commonly reported drug. The most commonly used prescription drugs were opioids: oxycodone (76%), hydromorphone (Dilaudid) (34%) and oxymorphone (Opana) (19%). Of those reporting IDU, 35% named a prescription opioid as the first drug ever injected (26% oxycodone, 12% Dilaudid). Dilaudid was named as the drug injected most often (47%), followed by oxycodone (46%), and heroin (38%). Of those reporting use of prescription pain medication, 13% reported having had a valid prescription in their name when first using the opioids.
CONCLUSIONS: The 2012 report Drugs Identified in Deceased Persons by Florida Medical Examiners states that prescription drugs accounted for 81% of all drugs associated with overdose deaths in Florida in 2012. In addition to overdose deaths, prescription opioids are often the first drugs injected, leading to more IDU, which in turn is the primary driver of HCV infections. To reverse the trend of increased HCV infections in Florida’s YA population, actions are needed to prevent the introduction of prescription opioid use.