Skyrocketing Rates of HIV & HEP-C Amongst London, Ontario IDU's

A report released by Christopher Mackie, Medical Officer of Health of the Middlesex-London Health Unit, sounds the alarm on the skyrocketing rates of HIV, Hepatitis C, Invasive Group A Streptococcal Disease, and infective endocarditis amongst intravenous drug users in London, Ontario (my hometown).

The report, entitled "Persons Who Inject Drugs In Middlesex-London: An Update", calls attention to the public health emergency facing the city. Since 2015, "Middlesex-London Health Unit (MLHU) has noticed an increase in newly diagnosed HIV cases in persons who inject drugs (PWID) in Middlesex-London." Provincial figures indicate that between 2013-2014, 12% of new HIV cases were attributable to PWIDs, whereas in London, Ontario, PWID accounted for 68% of new HIV diagnoses.

"Ontario’s HIV rates have decreased, from 7.4 cases per 100,000 in 2005 to 5.5 cases per 100,000 in 2015. Locally, HIV rates increased from 5.9 cases per 100,000 in 2005, to 9.0 cases per 100,000 in 2015."

HIV rates are far from the only concern. While Provincial Hepatitis C rates have declined, cases in Middlesex-London have increased from 32.2 to 53.7 per 100,000 between the years 2005 to 2015. Invasive Streptococcal Disease rates have doubled since 2010, and serious concerns have been raised regarding the increase in infective endocarditis cases, which have more than tripled between 2009 and 2014.

Interestingly, the report also mentions the issue of tamper-resistant opioid medications, and the unintended effects they have had on PWIDs. [Check out my previous blog post on tamper-resistant opioids]

"Contextually, in 2012, the Ontario government de-listed the pain medication OxyContin and replaced it with the alternative OxyNEO. One reason for this decision was to switch to a pain medication that is not as easily crushed for snorting or injecting. While intended to reduce the prevalence of injecting, community partners have reported that this has not had the intended effect as it does not address the underlying mental health and social determinants of health issues that cause injection drug use. Research indicates that the addition of filler agents in various oral prescription drugs when injected is associated with higher rates of endocarditis, soft tissue infections, and increases in communicable diseases such as HCV."

In order to address this growing health emergency, the MLHU states they are "developing a community drug strategy [...] based on a 'Four Pillar' approach of prevention, treatment, harm reduction and enforcement, and solidified through a foundation of collaboration." They also recommend a re-allocation of resources in order to develop an out-reach model with street-level and peer-based components, as well as working to address "underlying social determinants of health and mental-health issues faced by PWID; enhancing HIV and HCV testing, prophylaxis and treatment; and connecting PWID to addiction services and encouraging them to remain in care."

​What isn't mentioned in the report is a call for Safe Injection Sites, which would be deeply beneficial to PWIDs in London, Ontario. Chris Mackie did, however, make the following comments to the London Free Press:

​“Do I hope this HIV outbreak will help to convince people (safe injection sites are needed)? Yes I do,” Dr. Chris Mackie, medical officer of health for London and Middlesex County said Tuesday. “We will probably need one in our community if not more than one.”

I hope so, too.