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Two American public health epidemics are colliding – creating new headaches for policymakers and more heartache for communities across the country.As the opioid abuse epidemic grows, heroin use continues to worsen. Heroin overdose-related deaths spiked 286 percent between 2002 and 2013. Making matters worse, the needles used to inject heroin can transmit deadly viral diseases – in particular, hepatitis C.

Treatments exist to cure hepatitis C, which causes the liver to deteriorate and can lead to cancer or cirrhosis. But in a twist of painful irony, some health plans require hepatitis C patients to abstain from drug and alcohol use to qualify for access to the cure. In other words, people who cannot stop themselves from abusing heroin cannot be stopped from spreading a disease that might otherwise be eradicated.

Challenges in the States

Multiple states have acknowledged the complex challenge. In Virginia the state health commissioner recently predicted an oncoming “tidal wave” of hepatitis C. Spurred by the opioid epidemic, the state reported 8,000 new cases of hepatitis C last year, up 1,400 since 2014. Meanwhile, Kentucky faces a hepatitis C rate that’s seven times the national average, yet only three percent of the state’s Medicaid patients received curative treatment last year. As the opioid crisis worsens, infected patients’ likelihood of spreading the disease could grow.

The Centers for Disease Control and Prevention has also acknowledged the phenomenon. The agency reported spikes in hepatitis C last year, citing data from 2006-2012 state surveillance reports. A closer look at IV drug users in Appalachia under the age of 30 led the CDC to describe “a geographic intersection among opioid abuse, drug injecting, and [hepatitis C] infection.” The agency explained that the situation “underscore[s] the need for integrated health services in substance abuse treatment settings to prevent [hepatitis C] infection.”

The phenomenon is apparent in other areas of the country too. In Massachusetts, for example, skyrocketing opioid abuse has coincided with a 74 percent increase in hepatitis C among adults ages 15-24. Notably, the state’s Medicaid system, MassHealth, decided earlier this year to lift restrictions that previously blocked patients with hepatitis C from receiving curative treatment.

The Cost & Value of Curing Hepatitis C

Direct-acting antiviral treatments became available in 2014, offering the first cures for hepatitis C. High upfront costs, however, have led Medicaid systems and private insurers to impose stringent requirements for access to the drugs. By minimizing the number of patients treated, prior authorization processes keep costs down. But they also allow for continued disease transmission, in addition to forcing patients to wait as their livers deteriorate.

[READ: The Wait Continues for Hepatitis C Patients]

The emerging generation of hepatitis C patients is younger, bringing a new face to a disease traditionally associated with baby boomers. And the age difference poses challenges of its own. In particular, women of child-bearing age risk passing the infection on to their unborn children – extending the deadly virus to a vulnerable and even younger cohort.

Patient advocates have repeatedly argued that the long-term value of curing hepatitis C outweighs the short-term cost of the medication. Now, as the opioid and heroin abuse epidemic grows, policymakers face a frightening look at exactly what hepatitis C might cost patients, families and communities if it goes untreated.

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