Iowa prisons brace for possible uptick in HIV, hepatitis C cases as opioid epidemic swells

Correction: This story has been updated to show that hepatitis C cases have been linked to the opioid epidemic in Iowa.

Iowa’s Department of Corrections is bracing for a possible uptick in the number of inmates infected with HIV and hepatitis C as a result of the opioid epidemic — an outcome that could put pressure on an already cash-strapped system.

State public health officials say they have yet to link any new HIV infections to opioid use, but they remain "vigilant" after nearly 200 people in rural Indiana contracted the viruses by sharing needles to inject prescription pain medications in 2015. But they do attribute an "alarming" rise in hepatitis C infections to the epidemic.

Jerome Greenfield, the Department of Corrections’ health services administrator, said the department will need a $1 million budget increase going into the 2019 budget year to accommodate rising pharmaceutical costs for things like HIV and hepatitis C, as well as a generally aging prison population.

"When we look forward to health care changes that are literally cataclysmic in the United States, we have to respond to that," Greenfield said.

But the prospect of continued state budget cuts looms large as legislators eye a potential special session later this year.

Lawmakers already have shifted money out of the state's reserve accounts and cut millions of dollars in spending to combat lower-than-expected revenue returns during the last year. But fiscal analysts predict revenue could still fall about $75 million short for the budget year that ended June 30, possibly forcing additional spending cuts.

The Department of Corrections shouldered a $5.5 million budget cut in the 2017 budget year and a $1.6 million cut in the current 2018 budget year.

According to a department report, corrections officials believe any further cuts to the current year's budget would directly result in staffing reductions.

HIV and hepatitis in Iowa

Last year, Iowa saw its highest number of HIV infections since the state began tracking the number in 1998, and the number of hepatitis C patients here nearly tripled between 2000 and 2015.

Those blood-borne infections are easily spread through the sharing of needles and tend to spike as injection drug use rises.

Right now, Iowa's public health officials are attributing the HIV increases to greater outreach and testing efforts with reaching more people. But the opioid epidemic is fueling hepatitis C cases, particularly among those under 30.

Randy Mayer, who leads the Department of Public Health's Bureau of HIV, STD and hepatitis, said officials are "certainly vigilant" about the influence of the opioid epidemic "given what happened in Indiana."

A May 2017 report from the Centers for Disease Control and Prevention pegged the growth in hepatitis C infections at 294 percent between 2010 and 2015.

"These new infections are most frequently among young people who transition from taking prescription pills to injecting heroin, which has become cheaper and more easily available," Dr. John Ward, an author of the report and director of the division of viral hepatitis at the agency, told the Register in May.

In Iowa, fatal heroin overdoses remain relatively rare, though hospital admissions related to heroin have climbed from 186 in 2005 to 904 in 2015, state data show — a 386 percent increase.

Admissions related to other opioids nearly quadrupled from 422 cases in 2005 to 1,601 in 2015.

Needle exchanges

Former Gov. Terry Branstad in 2016 signed a bill legalizing Naloxone, a medication that can quickly reverse the effects of an overdose of heroin, pain pills or other opioids.

Surrounded by advocates, many of whom had lost loved ones to heroin and other opioids, Branstad at the time called the legislation a "direct attempt to mitigate the number of opioid overdoses in our state and deaths that result."

The medication is now available without a prescription in some Iowa pharmacies.

Advocates cheered it as one way to combat the effects of the opioid epidemic. But they also have pushed for the legalization of needle exchange programs in which Iowans could access sterile needles and syringes while safely disposing of used ones.

"There certainly are many states that don’t have needle exchange programs, but it is the one thing that time and again has been shown to work," said Margaret Hoffman-Terry, a physician and the chair of the American Academy of HIV Medicine's board of directors.

That organization promotes a "harm reduction" philosophy, which accepts that illicit drug use is inevitable but seeks to minimize negative effects such as disease transmission and overdose fatalities.

"If the availability exists for addicts to get clean needles, many of them will," Hoffman-Terry said. "Certainly not all, but many will. And any time you can decrease the spread of HIV and hepatitis C through needle use, it’s a big win-win for everybody."

Such programs remain controversial among those who believe they facilitate drug use and accommodate addicts, despite studies showing they're effective at curbing the spread of infectious diseases.

A 2016 U.S. Surgeon General's report said studies "clearly have shown" that needle and syringe exchange programs are effective at reducing the transmission of HIV and do not increase rates of community drug use.

But Iowa's drug paraphernalia laws currently make it illegal to carry or possess any equipment used to inject non-prescription drugs, and they do not include exemptions that would allow for any type of needle or syringe exchange program.

A bill introduced last year in the Iowa Legislature would have allowed for such an exchange, but the legislation did not receive consideration.