Integrating Hepatitis Services into Substance Abuse
By Erin Bryant
Individuals seeking help for certain types of substance
abuse are often infected with viral hepatitis, which
is most often spread through needle sharing by injection
Along with HIV/AIDS, viral hepatitis infection is
a major public health issue for clients
and care providers in substance abuse treatment programs.
In response, SAMHSA launched two initiatives seeking
to prevent hepatitis infection among clients seeking
treatment. These programs integrate hepatitis services
into substance abuse treatment programs to reach people
at high risk of infection.
A highlight of these initiatives is included in a
recent issue of the journal Public
Health Reports (Volume
122, Supplement 2, 2007). Authors from
Center for Substance Abuse Treatment
(CSAT) include CSAT Director H. Westley
Clark, M.D., J.D., M.P.H., Robert
Lubran, M.P.A., Director, Division of
Pharmacologic Therapies; Kenneth Hoffman,
M.D., Medical Officer; and Thomas Kresina,
SAMHSA developed two new initiatives to prevent and
control the spread of hepatitis.
- Hepatitis Education
and Training in Opioid Treatment
Programs. This initiative provides onsite
training in prevention, care, and
treatment for providers who work in opioid treatment
programs. Opioid drugs include heroin, OxyContin®,
An expert panel of clinicians
and researchers developed a half-day
curriculum, which describes the latest
data on hepatitis infection, means of transmission,
diagnosis, and treatment. Providers also receive
information on how to promote immunizations and the
importance of care and treatment for patients with
HIV and hepatitis co-infections.
was developed in collaboration with
the American Association for the Treatment of Opioid
- Disease Prevention Hepatitis Vaccinations
for At-Risk Individuals. This 1-year
pilot program provides free combination
hepatitis A and B vaccinations for
substance abuse treatment programs.
Between January and September 2006,
38 programs in 21 states received
a total of 43,950 vaccine doses. Lessons
learned from this pilot will be
Researchers found that more than 90 percent of patients
who were offered the vaccine accepted at least one
dose of it. Results of the pilot program also showed
that clients in opioid treatment programs are more
likely to complete the vaccination series than in other
SAMHSA is using the feedback from these two initiatives
to work more closely with the Centers for Disease Control
and Prevention and state hepatitis C coordinators to
expand the range of preventive services offered by
substance abuse treatment programs.
For more information, visit www.samhsa.gov/Matrix/matrix_HIV.aspx.
Hepatitis Services into Substance
Abuse Treatment Programs: New Initiatives
from SAMHSA. Thomas F. Kresina, Ph.D.,
Kenneth Hoffman, M.D., M.P.H., Robert
Lubran, M.P.A., H. Westley Clark,
M.D., J.D., M.P.H. Public
Health Reports, Volume
122, Supplement 2, 2007.
What Is Hepatitis?
Hepatitis is an inflammation of the liver, usually caused
by viral or toxic agents, but it may have many other causes.
Viral hepatitis is a liver disease caused by several different
forms of the virus, which are currently labeled A, B,
C, delta, and E.
Vaccines to prevent hepatitis A and B infections exist;
however, there is no vaccine to prevent hepatitis C infection.
Injection drug users are at high risk for all forms of
Particularly severe liver disease from hepatitis infection
can be caused by a super-infection of hepatitis
A and hepatitis B viruses in patients with
chronic liver disease caused by underlying
hepatitis C infection. Therefore, hepatitis
A and B vaccinations are recommended for people
who inject drugs and for those who are HIV positive.
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