London researchers may have pinpointed why rates of HIV, other diseases rising among drug users
Dr. Sharon Koivu and Dr. Michael Silverman show drug paraphernalia, including a small container for heating crushed drugs in water, then a small white sponge is used to absorb the drug which is then drawn into a syringe and injected. The danger of HIV and endocarditis comes from using the sponge more than once, as it has blood from the first user, and the HIV virus can live in the sponge. (Mike Hensen/The London Free Press)
It’s been a deadly mystery plaguing doctors, nurses, outreach workers and, most of all, Londoners battling drug addiction.
Potentially fatal HIV, endocarditis and Hepatitis C have spread through London’s community of people who inject drugs, in ways few other Canadian cities have experienced.
But why here, why now?
A team of London researchers now has answers to those puzzling questions, and a way to stop the spread — nothing more than a 10-second flame from a cigarette lighter.
Their research, shared exclusively with The London Free Press, links the rising rates of diseases to the way a drug that swept through London, HydromorphContin, is being used.
“It’s exciting because we want to find something we can do to help,” said Dr. Michael Silverman, medical director of infectious diseases care at St. Joseph's Heath Care in London.
The research especially targeted the HIV epidemic in the city.
“It’s exciting that we might actually be able to make an impact to slow or, hopefully, stop the (HIV) epidemic,” Silverman said.
“I don’t think it will stop it completely, but it could slow it and maybe turn it going in the other direction, where the numbers start coming down and that could save lives.”
The research hasn’t been published yet, but Silverman and other health care professionals want to share the basics now to try to save lives.
The rates of human immunodeficiency virus (HIV) in the region prompted the Middlesex-London Health Unit to declare an epidemic in 2016.
But rates of endocarditis — caused by bacteria infecting the heart — and Hepatitis C also have been rising.
Injection drug use can raise the risks of all three diseases, and all three can be fatal.
London does all the right things to reduce harm for people who inject drugs, such as handing out clean needles and other gear for free, providing substitute medications like methadone and suboxone for opioid addiction, and running HIV clinics that provide treatment and counselling.
A supervised injection site is in the works now, with a round of public meetings next month announced this week.
Given the harm-reduction efforts, the increase in the three diseases has mystified and worried health care and social service workers in the city, not to mention those struggling with addiction.
Particular to London, however, is the popularity of an opioid called HydromorphContin, which is a slow-release painkiller in capsule form containing hydromorphone.
After the popular opioid OxyContin was removed from the market in 2012, doctors across Canada increasingly prescribed the alternative, HydromorphContin.
London’s injection drug users began turning to what they simply call hydro or hydromorph.
That was about the same time rates of HIV, Hepatitis C and endocarditis began to rise.
People crush HydromorphContin capsules in a bit of water in a container called a cooker, then use a small filter to draw up the soupy mixture without getting particles in the needle.
The draw leaves behind a leftover of granular liquid called a wash, which contains a certain amount of the drug in the cooker and the filter.
People will use the wash a second or third time, even days later, and share the wash with others.
That means the mixture and the filter can transfer diseases from user to user, even if people are using clean needles.
London researchers learned that the wash keeps HIV, and two of the main strains of bacteria that cause endocarditis, alive for days.
They also discovered that all it takes to destroy 99 per cent of the virus and bacteria is simply heating the mixture in the cooker for 10 seconds with a cigarette lighter, the research says.
Silverman thinks the same practice of using and sharing HydromorphContin wash could be responsible for similar outbreaks of the same diseases in the Indiana region and Saskatchewan.
“This is just a new way that we think disease is being transmitted,” he said. “There is a potential way to stop it.”