1. Addressing the Intersection of Substance Abuse and Viral Hepatitis
CDC’s National Hepatitis Coordinators Conference
San Antonio, TX
January 28, 2003
H. Westley Clark, M.D., J.D., M.P.H.
Director, Center for Substance Abuse Treatment (CSAT)
Substance Abuse and Mental Health Services Administration (SAMHSA)

2. and Hepatitis C

3. Background: Hepatitis C in the United States
The leading cause of chronic liver disease
4 million are estimated to be infected in the United States with 25,000 deaths annually
Alter, M.J., Kruszpn-Moran, D., Nainan, O.V. et al, 1999

4. Background
Estimates from various studies indicate that as many as 80% of injecting drug users (IDUs) are HCV+ within first year of injecting drug use and 90% of all users are chronically infected.

5. Background Liver Transplantation
17,300 patients were on the OPTN national patient waiting list as of October 11, 2002
Only 30% of the patients on the waiting list were transplanted in 2001
Hep C liver failure is leading cause of transplantation in the U.S.
The expected demand for transplantation will no doubt increase in 2003 given current trends.
OPTN: Organ Procurement and Transplantation Network

6. SAMHSA/CSAT Hepatitis C Activities
Educate Opiate Treatment Program (OTP) (Methadone) staff
Working with HRSA on Liver Transplantation and Methadone Issues
CSAT/CDC/HRSA Training Projects
HCV/SA Treatment Improvement Protocol (TIP) and related publications
HRSA= Health Resources and Services Administration

7. Education of OTP staff on Hepatitis C
Pilot Project with AATOD
Onsite training sessions at Opioid Treatment Programs
60-70 treatment programs in 6-10 communities in several states
AATOD= American Association for the Treatment of Opioid Addiction

8. SAMHSA/CSAT/CDC/HRSA Cross Training Initiative
2 day workshops on HIV, TB, STDs, SA & Hepatitis issues integration
Technical Assistance for public health, substance abuse and other providers
Funded contract to identify best model and funding practices for integrating HIV, hepatitis, mental health and substance abuse services.

9. CSAT HCV Conferences National Conferences: Regional Conferences
“Drug Use, HIV, Hepatitis: Bring it all Together” co-sponsored by CSAT, NIDA and CDC
Regional Conferences
“Keeping it Real” in Atlanta, Georgia, May, 2001 and in Baltimore, Maryland, October, 2002
NIDA= National Institute of Drug Abuse

10. CSAT-CDC Collaborations
CDC’s Hepatitis State Partners Conferences Presentations
Website links
Buprenorphine and Methadone presentation National HIV Prevention Conference, July 27-30, 2003 in Atlanta, Georgia (proposed)
CDC/HRSA/CSAT joint workshop on integrated care models, Washington, DC, April 03, AATOD Conference

11. CSAT-HRSA Collaborations
Presentation on HRSA’s HIV/AIDS Bureau Grantees meeting Aug 02
Buprenorphine physician training
HIV/AIDS Providers Conference
Jun 03, Orlando
Working with HRSA on liver transplantation on methadone patients

12. Best Practice Clinical Guidelines
CSAT Treatment Improvement Protocol (TIP) for Managing Hepatitis C in Addicted Patients being planned to begin in FY 2003
Classifying Skin Lesions of Injecting Drug Users A Method for Corroborating Disease (just published)

13. Major Themes/Issues
Surveillance of incidence and prevalence of HCV among injecting and non-injecting drug users
Reducing the incidence of HCV among new IDUs (especially among adolescents).
Early identification and combination treatment of never treated IDUs with chronic infections and re-treatment of those failing to achieve a Sustained Viral Response (SVR), especially among African American IDUs.

14. Major Themes/Issues
Increase HCV/HIV testing in drug treatment programs
Expand present efforts to vaccinate IDUs with Hepatitis B vaccine.

15. Major Themes/Issues HCV treatment HIV/HCV co-infection issues
Side effects of combination treatment
Neuropsychiatric effects (depression with suicidal ideation)
“Trigger” effects of Peg-Interferon

16. Major Themes/Issues Clinical guidelines on prophylactic SSRIs
Stigma as a barrier to treatment and transplantation
SSRIs= Selective Serotonin Reuptake Inhibitors

17. TIP 24: A Guide to Substance Abuse Services for Primary Care Clinicians

18. TIP 6: Screening for Infectious Diseases among Substance Abusers

19. Buprenorphine Information
Info Center
Toll-free: 866-BUP-CSAT ( )
Mon-Fri 8:30 AM- 5:00 PM ET
Voice message off hours, reply next working day
Se habla español.

20. SAMHSA’s National Helpline
For information on substance abuse treatment and referral:
HELP (4357)
24 hours/7 days a week
Se habla español

21. National Clearinghouse on Alcohol and Drug Abuse (NCADI)
To obtain Treatment Improvement Protocols (TIPS) and other educational materials:
24/7
Se habla español