One of the downstream health effects of the opioid epidemic is the spread of infectious diseases. Injection drug use, in particular, increases the chance of transmitting HIV and Hepatitis C. Opioid misuse and abuse has also been associated with increased risk of other diseases, including cellulitis, osteomyelitis, and endocarditis.

Impacts on Opioid Related Diseases
The opioid epidemic has impacted the rates of infectious disease and disease complications, including HIV and Hepatitis C. Sharing of contaminated syringes and other injection equipment can transmit these diseases. Establishing syringe services programs (SSP), a critical public health intervention, can reduce the incidence of these diseases without increasing drug use or harm for individuals. SSPs are associated with a 50 percent reduction in the risk of HIV transmission. SSPs provide a spectrum of services, including access and disposal of sterile syringes, connection to substance use disorder treatment, naloxone distribution, vaccination, testing, and connections to treatment for infectious diseases. According to the Centers for Disease Control and Prevention, participants in SSPs were 5 times more likely to enter drug treatment and 3.5 times more likely to stop injecting compared to those who did not participate in SSPs. The first SSP was established in Tacoma, Washington in 1988. There are now more than 300 programs in 39 states, Washington D.C, and Puerto Rico. Learn more about the laws in these jurisdictions through the Law AtlasProject

New HIV Diagnosis
HIV attacks the body’s immune system and can lead to acquired immunodeficiency syndrome (AIDS). HIV is spread primarily through unprotected sex and sharing of syringes or other injection equipment with someone who has HIV. It is recommended by the Centers for Disease Control and Prevention that everyone be tested for HIV in their lifetime, and those with risk factors be tested at least once a year. HIV prevention and testing services are available, use this link to find services near you. Conditional on temperature and other factors, HIV can live on used needle up to 42 days. A clean needle costs about 10 cents, and a lifetime of AIDS care for one person costs more than $450,000.  The graph below illustrates the annual trend in new HIV diagnosis (bar graph) to new HIV diagnosis among individuals using injection drugs (line graph). Trend analysis by quarter and rate are also available, along with counts and rates by gender, and counts and rates by age for this population.

New Hepatitis C Diagnosis
Hepatitis C is a virus that can be spread when bodily fluids from an infected person enters the body of someone who is not infected. This can happen through sex, sharing of contaminated syringes and injection equipment, and sharing of personal items like toothbrushes and razors. For those with chronic Hepatitis C, several medications are available for treatment. These medications can cure over 90% of people. A clean needle costs about 10 cents, and the cost of medication to cure one person can range from $70,000 to $190,000.
Based on data availability, new diagnosis of Hepatitis C are shown for those between the ages of 12-39. Increases in new hepatitis C infections are a primary result of increases in injection drug use connected to the opioid epidemic.
This map shows the annual rate of newly diagnosed cases of Hepatitis C among injection drug users per 1,000 individuals with drug use disorder. More information is available for counts and rates by gender, and counts and rates by age for this population.

Hospitalization Rates for Opioid Related Diseases
In addition to reducing health care costs by reducing the spread of HIV and Hepatitis C, syringe services programs also reduce healthcare costs by providing participants with the means to avoid serious and costly conditions, including endocarditis, cellulitis and abscesses. The graph below shows the annual rates of hospitalization for opioid related diseases per 1,000 individuals with Drug Use Disorder. Individuals with Drug Use Disorder represents the population with a substance use disorder not including alcohol use disorder.  Location is based on patient’s county of residence. Hospitalization for opioid related diseases includes hospitalization for opioid use disorder (OUD), cellulitis, osteomyelitis, endocarditis, viral hepatitis, and intracranial and intraspinal abscess. Hospitalization is categorized by primary reason for admission to the hospital. More information is available for counts and rates by gender,  counts and rates by age and by county of residence for this population. 

Scroll down for descriptions of these conditions.

Hospitalizations for Opioid Related Diseases by Gender
This graph allows you to view trends by gender and condition. For example, by clicking female and then clicking cellulitis, you can view the quarterly counts of women hospitalized with cellulitis by quarter. The counts are based on the total count of hospitalizations for opioid related diseases from 2016 to 2018.

To interpret the data appropriately, please use the following definitions:
Drug Use Disorder is defined as any substance use disorder not including alcohol use disorder. This is an approximation for Opioid Use Disorder prevalence. The estimates are developed by applying mortality weights derived from the CDC’s National Center for Health Statistics to statewide illicit drug use estimates from the National Survey on Drug Use and Health (NSDUH, sponsored by the Substance Abuse and Mental Health Services Administration).

Hospitalization for Opioid Related Diseases includes hospitalization for OUD, cellulitis, osteomyelitis, endocarditis, viral hepatitis, and intracranial and intraspinal abscess. Hospitalization is categorized by primary admission to the hospital
Opioid Use Disorder (OUD) describes a diagnosed pattern of opioid misuse that leads to physical, social, or psychological harm.
Drug Abuse Related infections: 
Cellulitis is a bacterial skin infection, which occurs when a break in the skin allows bacteria in. If not treated, the infection can spread the lymph nodes and through the bloodstream and quickly become life-threatening.  
Osteomyelitis is a bone infection in which an infection spreads through the bloodstream or from surrounding tissue into the bone. This infection can be treated with surgery to remove parts of the bone that have died, along with antibiotics post-surgery.  
Endocarditis is an infection of the endocardium, the inner lining of the heart chambers and heart valves. This infection occurs when bacteria or other germs from another part of the body spread through the bloodstream and attach to damaged areas of the heart. Endocarditis can damage the heart and lead to life-threatening complications. Treatments include antibiotics and surgery.  
Intracranial and intraspinal abscesses are bacterial infections within the brain and spine. While rare, these infections occur when bacteria enter the brain or spine and cause a localized infection/abscess. If not treated, mortality is likely.  
Viral Hepatitis (A, B, and C) are viruses that can be spread when bodily fluids from an infected person enters the body of someone who is not infected. This can happen through sex, sharing of contaminated syringes and injection equipment, and sharing of toothbrushes and razors. Effective vaccines are available for Hepatitis A and B to prevent spread of the virus. For those with chronic Hepatitis C, several medications are available for treatment that cure over 90% of people. 

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