Patty Wight reports on hepatitis C.

There's an outbreak of hepatitis C in the state, according to the Maine Center for Disease Control.

Both acute and chronic cases of the liver infection have surged to an all-time high due in large part to the increase in heroin use.

Health advocates say reducing hepatitis C will take more treatment and prevention programs, as well as more empathy for those affected by the disease.

Hepatitis C is the most common chronic blood-borne infection in the U.S., but it can take years for symptoms — such as nausea, fatigue, and dark colored urine — to surface.

Some infections trace back to blood transfusions received before 1992. But beyond the undercurrent of old cases, "There's this new epidemic of hep C that's kind of resurging among youth as more and more people are taking up injection drug use," says Kenney Miller, executive director of the Down East AIDS Network and Health Equity Alliance.

Between 2013 and 2014, the number of acute hepatitis C cases has more than doubled in Maine, from 9 up to 31. In the same time frame, chronic cases increased 11 percent, from about 1,200 to 1,400.

Miller says the actual number in Maine is likely much higher.

His organization recently opened two new testing clinics for hepatitis C, in Waterville and Augusta. He says there's an urgent need to lower barriers to testing and treatment, because the chance of developing hepatitis C increases dramatically after injecting drugs for about five months.

"So if we can get people into treatment services as quickly as humanly possible, we can very well curb the number of new cases," he says.

Miller says one of the most cost-effective ways to prevent hepatitis C is through needle exchange programs.

A clean needle costs a little more than a dime, while treatments can run upwards of $50,000 dollars.

There are five needle exchange programs in the state, including at the India Street Public Health Center in Portland. Program manager Caroline Teschke says that while the rest of the state is seeing increases in hepatitis C at an alarming rate, incidences at the clinic have remained stable for the past three years, at 18 percent.

"Which we take to mean that when people exchange their needles — their dirty needles for clean ones — it is a highly effective public health prevention method, and it stops this alarming increase," she says.

The key to Portland's success, Teschke says, is that it provides a trusting, nonjudgmental environment for intravenous drug users, who cross all income levels, from men and women to teenagers.

She says some of the Needle Exchange's clientele travel all the way from Aroostook County, and that education, along with access to drug treatment, are critical to reducing the incidence of hepatitis C.

"Increasing the number of treatment facilities is vital," Teschke says. "It's said over and over again that the current rise in intravenous drug use and heroin use is not something you can arrest your way out of. It's not. It's something that requires a solution from the health care system, and in society and their attitudes."

A spokesperson for the Maine CDC confirmed in an email statement that the state plans to step up efforts to combat hepatitis C through prevention, education and testing of the disease, as well as by connecting patients to health care services.