Drug use in Connecticut’s suburbs and rural towns has risen dramatically over the last 20 years and opioids and heroin overdoses are now at epidemic levels, Professor Robert Heimer told assembled students, faculty and staff at the Yale School of Public Health on Thursday.
In a recently completed study, Heimer and colleagues found that Connecticut’s suburban injection drug users are overwhelmingly white, undereducated and living in poorer areas within their suburban communities. Sixty-two percent are men, most have never married and only 30 percent lived in their own homes. Surprisingly, 60 percent had health insurance and had seen a doctor in the last six months. Most of the people studied reported other serious health conditions, such as depression or chronic pain.
Some 90 percent, meanwhile, had been arrested, many repeatedly, but not most often for sale or possession of drugs, but for offences such as theft or writing bad checks.
“The image that many people have of injection drug users is inaccurate and untrue,” said Heimer, Ph.D., who is also director of the Emerging Infections Program at Yale and a founding member of the Center for Interdisciplinary Research on AIDS. “We need to help these people where they live and make resources available to address a growing epidemic, one that is claiming many lives.”
The number of deaths in from heroin overdose in the state since 2009, has averaged 222 per year, nearly double the rates from the prior decade.
In addition to overdosing, injection drug users are at high risk for acquiring hepatitis C. Forty percent of those in the study tested positive for hepatitis, though well over half did not know they had been infected with the virus. Rates for hepatitis B were also high and vaccination rates low. This is especially disconcerting since there has been a safe and effective vaccine available since the late 1970s universally recommended for the very people participating in Dr. Heimer’s study. Overall, knowledge about the risks of these viruses is low, he said. The lack of access to harm reduction services such as syringe exchange programs contributes to this lack of awareness both of information and about disease status.
This is a failure of the health care system.
Robert Heimer
“This is a failure of the health care system,” said Heimer, noting that opportunities for intervention and education exist through routine health care, as well as in prisons and drug treatment centers.
In addition, even though suburban users frequently buy their drugs in the cities, they are more likely to purchase syringes in suburban pharmacies. By not taking advantage of safe needle exchange programs in cities like New Haven and Bridgeport, they are missing out on important educational and health interventions.
While the majority of people studied indicated that they did not share their syringes, heroin is a social drug, Heimer said. When one person prepares the drug, it is often apportioned using a syringe, increasing the chances of transmitting the hepatitis and HIV viruses if that syringe is not sterile.
Heimer called for increased screening of these viruses, improved vaccination for hepatitis B, and improved health services at all points where health care providers and patients meet: including emergency rooms, drug rehabilitation clinics, prisons and primary care clinics.
“The CDC and SAMHSA (the Substance Abuse and Mental Health Services Administration) recommend these screenings. I don’t know why physicians are not doing them,” he said.