How The Opioid Crisis Could Lead To More Cases Of Liver Cancer In Oregon
Growing up, M.J. Dunne spent weekends with her dad Tom.
Tom didn’t always have a stable address. For a while, he lived in the closet in the back of a Portland barber shop.
But he loved her, and they were close.
“We were just silly buddies," Dunne said. "He taught me how to play poker with marshmallows and raisins. You know, 'I’m going to bid two marshmallows. Ante up one raisin.'"
Today, Dunne is a health researcher in Portland where she studies the factors that can contribute to poor health, such as poverty.
It’s an issue she connects with personally. She lost both her parents to addiction. Her mother died of an overdose. Her father’s death was more complicated. It started with a virus he picked up from sharing a needle.
“He had always just kind of had issues with drugs and alcohol, and he developed hepatitis C at some point,” Dunne said.
Hepatitis C is an infectious disease discovered in 1989 that spreads through blood-to-blood contact and can be transmitted when people share needles or other injection drug supplies.
In the past, it was also transmitted through blood transfusions and other medical procedures, but today blood banks and hospitals screen for it.
Doctors call hepatitis C a silent killer. Many people feel no symptoms at all when they are first infected, and thus aren't aware they carry the virus.
But about 80 percent of people who get it develop a chronic infection. The disease can progress slowly, over decades. It can scar a person's liver, eventually leading to liver disease and cirrhosis.
That's what happened to M.J. Dunne's father.
By the time he reached his 50s, a doctor told Dunne’s dad that he needed a liver transplant. He quit drinking, but continued to inject, and so he was taken off the transplant list.
Then he developed liver cancer.
“My dad never took care of it. He lived on the streets. He lived on people’s couches," Dunne said. "So he never really got consistent treatment for this cancer that had started.”
Hepatitis C is one of the leading causes of liver cancer in the United States, and it’s the most common reason people need liver transplants in Oregon.
In 2017, researchers with the Centers For Disease Control analyzed death records and health surveys and mapped the prevalence of the virus nationwide.
They found it was particularly common in the Pacific Northwest. Oregon had the third highest per capita infection rate nationwide, and the highest per capita death rate from hepatitis C.
“Typically we’ve been seeing 400 to 500 deaths each year,” said Ann Thomas, an expert on the virus for the Oregon Health Authority. “It’s one of the leading causes of death. It’s right up there with influenza.”
Most of the people who who are dying from complications of hepatitis C are Baby Boomers.
The number of new infections fell nationwide after researchers identified the virus and hospitals and blood banks began screening for it.
But after remaining flat for years, the rate of new hepatitis C infections began to rise again nationally in 2010, particularly among younger Americans, women and white people.
Last year, the Centers for Disease Control reported that new cases of hepatitis C had tripled over the past five years.
The CDC has linked the rise in cases to the opioid epidemic, calling hepatitis a deadly and often invisible result of the rise in the number of people injecting opioids, and potentially sharing needles and other equipment.
In Oregon, people under 30-years-old account for about half of new hepatitis C infections.
"We have an increase in new cases among people who inject,” Thomas said.
New infections of Hepatitis C are notoriously difficult to track because most people don't experience symptoms and don't visit a doctor. But a small percentage of newly infected people do get sick, with symptoms like jaundice, nausea and abdominal pain.
Thomas says the number of acute cases reported to the state by doctors has been relatively stable in Oregon — around 20 cases a year — until last year, when it rose to 40.
For every acute case the state is aware of, Thomas estimates another 13 people have been newly infected without developing any symptoms.
Thomas says there’s a pretty straightforward way to stop the spread of hepatitis C : educate people who are using injection drugs about the risk, and make sure they have access to clean needles.
“We need more funding and more syringe exchange programs, really reaching out to people who inject,” Thomas said.
There are also new, game-changing oral medications that can cure most cases of hepatitis C before the virus causes liver damage.
But Thomas says in spite of significant advances in treatment, the stigma around addiction has made hepatitis C a neglected disease.
“At the federal levels, we don’t have enough money to do surveillance for it or to do outreach, like the way we have for other diseases. But I think that’s starting to change,” she said.
Experts say the cost of the rising rate of hepatitis C transmission among young injection drug users could be high: more cases of liver disease and liver cancer in the future.
On New Years Eve 2008, Dunne got a call. Her dad, Tom, had fallen and broken a bone. He was in and out of consciousness. She rushed to intensive care.
“I stayed there all night with him in a chair, listening to him yell and cry and scream. That’s all he could do," she said. "He couldn’t ask for pain meds, he couldn’t say anything other than 'ow.'"
At first, Dunne thought her father had overdosed on heroin. Doctors gave him multiple doses of Naloxone in the emergency room.
Then they got the results of an MRI and discovered that Tom’s liver cancer had spread. He had tumors all throughout his body.
“I had 11 days with him, before he died,” she said.
Dunne has two regrets: That she wasn’t able to sneak Tom a cigarette in the hospital before he died, and that her dad was never able to get his life together enough to take care of his health.
She says she hopes Oregonians recognize that drug addiction and poverty are part of our shared history.
“My dad was your neighbor. My dad was the guy you saw passing on the street," Dunne said. "I’m your neighbor. Everyone has someone like him in their family."