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SAMHSA News - January/February 2008, Volume 16, Number 1

Integrating Hepatitis Services into Substance Abuse Programs

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 drug users.

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 SAMHSA’s 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, Ph.D.

Current Programs

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®, and morphine.

    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.

    This initiative was developed in collaboration with the American Association for the Treatment of Opioid Dependence.

  • 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 published shortly.
    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 public settings.

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

Citation: Integrating 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.

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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 viral hepatitis.

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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