Persephanie Lesperance learned she had Hepatitis C while locked in a jail cell in Framingham, Mass. When her blood test came back positive, she was convinced her life was over.
“I was basically devastated,” she said. “I thought I’d never be able to have children without giving it to my child. I never thought I’d be able to have a normal life with this crazy black cloud hanging over me.”
It was the first time after a span of drug use that started with prescription narcotics and led to intravenous heroin use that Lesperance had to get a blood test – she had previously avoided trips to the doctor, ashamed to show her track marks.
She waited a week before she was able to meet with a counselor, who informed her that there was a cure for Hepatitis C.
It took Lesperance another year and a half to get clean and sober, after which she started the lengthy process of getting treated for Hepatitis C, covered by New Hampshire’s Medicaid program.
She had to prove to her primary care and gastrointestinal doctor that she was truly on the road to recovery and abstaining from drugs and alcohol in order to even start the expensive cure – a drug called Harvoni, which cost $90,000.
Today, she is still in recovery, holding down a steady job and working as a recovery coach on the Seacoast. She is also cured of Hepatitis C.
“The state of New Hampshire paid for that for me, and I’m very grateful for that,” Lesperance said. She calls it one of the many “little gifts that recovery has given me.”
Drug overdose deaths are the most obvious signs of New Hampshire’s opioid epidemic, but an additional public health crisis is looming.
Doctors across the state say they are seeing more and more patients with serious infections such as Hepatitis C and bacterial endocarditis, caused by intravenous drug use, most commonly through shared needles.
Sharing needles isn’t the only way to contract the infection; Lesperance said she never shared needles but believes she may have contracted Hepatitis C by using the same water and spoon to mix drugs that were used by others.
The resulting infections are serious and require expensive treatment, surgery, and, in the most severe cases, organ transplants.
It’s difficult to get a handle on the number of Hepatitis C cases in New Hampshire. Individual providers across the state started to report cases to the state’s Department of Health and Human Services late last year, but there’s not enough data to release yet, state officials said.
Furthermore, because individual providers are tasked with reporting, most hospitals don’t keep in-house numbers.
At a recent state Senate hearing on a bill to set up a needle exchange program, one epidemiologist who studies infectious disease from IV drug use compared the Granite State’s Hepatitis C problem with that of Tijuana, Mexico.
At a suboxone program at Franklin Regional Hospital, Dr. Paul Racicot estimates that about 50 percent of his patients are positive for Hepatitis C
“What astonished us was the rate, period,” Racicot said. “I didn’t expect a Hep C rate over 50 percent.” Almost all of his patients contract the disease from sharing needles to inject drugs, he said.
If Hepatitis C is left untreated, it’s a serious disease that eventually causes serious liver damage.
The good news is there is a cure for the disease. The bad news is how expensive it is: treatment can run from about $65,000 to $100,000.
Racicot figures that if 100 of his patients have Hepatitis C and need to be treated at a cost of $100,000 per patient, that’s $10 million “to treat a preventable disease.”
“It is a public policy problem because someone’s going to have to pay,” Racicot said. “That’s just us. We’re just one small little catchment area in New Hampshire.”
Out of 12 New Hampshire hospitals the Monitor contacted, Catholic Medical Center in Manchester is the only one with a complete data set of Hepatitis C cases over the past three years. The hospital tracks cases related to IV drug use, as well as the ones that are not.
From 2014 to 2016, CMC saw the number of Hepatitis C cases in patients who were drug users rise from 157 to 289. At the same time, the numbers of Hepatitis C cases in patients who were not drug users fell from 1,035 to 807.
The hospital’s Chief Medical Officer Dr. William Goodman is quick to say the data aren’t perfect but they show a distinct trend – among drug users, Hepatitis C cases have nearly doubled.
“They’re rising pretty substantially,” he said.
Portsmouth Regional Hospital also provided the Monitor with numbers of Hepatitis C cases it’s seen over the past few years; however, the hospital does not separate out drug-related and non-drug-related cases.
In 2014, the Portsmouth hospital had 53 cases, which went up to 65 in 2015 and 87 in 2016. Fifteen more cases have been identified in the first three months of 2017.
At Dartmouth-Hitchcock Medical Center’s Perinatal Addiction program for pregnant and postpartum women in Lebanon, 29 percent of patients screened from 2014 to 2016 tested positive for the Hepatitis C antibody; of those, 52 percent had active disease.
“That’s just an astounding number,” said Dr. Bryan Marsh, chief of infectious disease at Dartmouth-Hitchcock. “Those who have a history of injection drug use have a very, very high prevalence of Hepatitis C. In some communities in the region, it’s scarily high.”
Whenever a Dartmouth-Hitchcock patient with a history of drug use comes in with endocarditis or other infections, Marsh and hospital staff typically test them for HIV and Hepatitis C as well.
Though Marsh doesn’t have data for this group, he said the “vast majority” who agree to testing are infected with Hepatitis C.
Doctors around the state say they thankfully have not seen a spike in HIV infection among the state’s drug-addicted populations. In part, it’s because Hep C travels much more quickly through the bloodstream and is easier to contract.
But many doctors expressed concern that, if introduced, HIV could spread quickly across the state.
“The big concern is, will HIV spike?” Goodman said. “If you get one infected person in a crowd of users, that will be devastating.”
Many health professionals say the reason numbers are rising is the proliferation of dirty needles in New Hampshire. The state is the only one in New England without a needle exchange; health and addiction experts recently testified at a Senate hearing that users are injecting with dirty needles because there are few clean ones available.
A bill that would establish a needle exchange recently passed the state Senate and now will be voted on by members of the House.
Goodman and many other doctors are seeing another troubling trend – many of the infected patients are young.
At the Franklin Suboxone clinic, many of Racicot’s patients who are seeking treatment are being tested for blood-borne diseases for the first time.
To many, the fact they have Hepatitis C is a surprise.
“It’s one of those things people just walk around with; they don’t know they have it,” Racicot said. “The scope of the problem has come to light all of a sudden.”
The responses when they find out are “widely variable,” according to Dr. David Itkin, an infectious disease specialist at Portsmouth Regional Hospital.
“Some are very nonchalant about it,” Itkin said. Others who “have been under the impression they’re invulnerable, suddenly when they’re confronted with their own mortality … some of it is really just complete depression and breakdown.”
In some patients, the disease will simply clear itself spontaneously in the first year. In those cases, a person’s immune system will get rid of the infection; there’s little known about why this happens in some patients and not others.
Itkin said besides Hepatitis C, the more immediate and serious problems for many patients are bacterial infections caused by drug use, which can necessitate a heart valve replacement.
Some people who continue to struggle with addiction need to have more than one valve replacement, leading to questions about how often doctors should replace the same heart valve in the same patient.
“We have repeat offenders,” Itkin said. “It’s a very difficult, tragic and costly problem.”
In the course her recovery counseling work in the Seacoast, Lesperance said she sees many people confronted with the situation she once faced, struggling with addiction and finding out they have a serious disease on top of that.
“It is a very, very common thing to hear,” she said. “Girls just coming in, and they’re absolutely devastated about this. I can share with them that I’ve been there. This isn’t a death sentence.”
(Ella Nilsen can be reached at 369-3322, enilsen@cmonitor.com or on Twitter @ella_nilsen.)