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Hepatitis C Outbreak Adds a New Woe to Drug Rehab Centers
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NY Times
July 17, 2004
By ALAN FEUER
As one of the largest residential drug treatment centers in the city, Palladia Starhill cares for people already suffering from a raft of problems: drug addiction, mental illness, lack of education, H.I.V. infection, sometimes full-blown AIDS.
Now, officials at the Bronx center say, a new crisis is beginning to complicate, even endanger, their work: treating hepatitis C.
In the last year, hepatitis C, an insidious illness that destroys the liver, has been diagnosed in 114 of Palladia Starhill's 400 patients.
The outbreak, officials say, has left drug abusers unable to concentrate on the hard work of breaking their addiction. It has also cost the short-of-cash center nearly $500,000. One staff member has died of the disease.
"It's one more thing for us to deal with and focus on," said James Hollywood, senior director of the center, on Macombs Road in the Mount Eden section of the Bronx. "People come here to deal with their addictions, but they end up dealing with this serious medical issue as well."
To confront the hepatitis C cases, Palladia Starhill has begun working with a medical clinic at the center, Project Samaritan Health Services, to establish an unusual program. Palladia Starhill has gone beyond its role as a drug treatment center and now screens each patient for hepatitis C and helps those afflicted pursue a long-term cure - a process that can take up to 48 weeks.
"We are one of the very few drug treatment providers around that has such a comprehensive program," said Marguerite Gebhardt, Project Samaritan's executive director.
The program was established last year, said Ms. Gebhardt, soon after the State Office of Alcoholism and Substance Abuse Services published a report on hepatitis C, recommending that drug treatment centers begin testing patients.
Jennifer Farrell, a spokeswoman for the office, said it has confronted the prevalence of viral hepatitis at drug treatment centers by establishing a task force called the Addiction Medicine Unit. She said the office also holds symposiums, teleconferences and other events to educate the public about hepatitis C.
Ms. Gebhardt said that Project Samaritan had independently concluded that hepatitis C was a growing problem because so many addicts at Palladia Starhill had complained of symptoms of the disease.
She added that hepatitis C, which is often spread through intravenous drug use, has long been a problem among addicts but that treatment centers are just beginning to understand how extensive it has become.
"It's been there all along, but it's been a silent problem," Ms. Gebhardt said. "We realized that we were on the cusp of a brand-new epidemic that was potentially larger than H.I.V."
Currently, between 20 and 25 percent of patients at Palladia Starhill are infected with hepatitis C, compared with 30 percent infected with H.I.V., Mr. Hollywood said. But hepatitis C infections could easily overtake H.I.V. infections among drug users, he added, because drug use can expedite its spread.
Complicating matters is the fact that 70 percent of Palladia Starhill's patients have spent time in the state prison system, which is rife with hepatitis C. According to prison officials, about 9,250 state inmates have hepatitis C. About 5,500 inmates are H.I.V.-positive.
Juan Vega, 52, discovered that he had hepatitis C two years ago while living at Palladia Starhill. He had gone there to fight off heroin addiction. Suddenly, he found himself fighting off disease.
His drug treatment, which included hours of group therapy and performing odd jobs, was hampered by the side effects of his hepatitis medication. There were headaches, nausea, depression and fatigue. "It was difficult," Mr. Vega said. "The drugs didn't even come into play in my mind. I had to focus on my liver."
Palladia Starhill treats hepatitis C with a regime of 50 pills and an injection of a drug called interferon every week. But some addicts are loath to take the injections, officials said, because the needles are frighteningly reminiscent of their days of taking drugs.
"We've had clients who used to shoot up, and the injections give them flashbacks," said Otilia Phillips-Drakes, the center's medical director.
Drug treatment centers have long been places where societal problems collect. In the 1970's and 80's, Mr. Hollywood said, Palladia Starhill established a mental-illness counseling program to replace the city's program, which was slowly dismantled. When the AIDS epidemic occurred, he said, the treatment center set up medical and support programs to deal with that disease.
Now, Mr. Hollywood said, hepatitis C has emerged, and it is distracting the staff of the treatment center from its primary job: helping people get off drugs.
"By design, we're not set up as a medical facility," Mr. Hollywood said, "but we're dealing with an ever-increasing medical problem."
Ms. Gebhardt, for one, says that drug treatment centers should seize the chance to treat people infected with hepatitis C. Where else, she said, could doctors and nurses find people, in a controlled environment, sick with a fatal but curable disease?
"In some ways," she added, "this is such a golden opportunity."
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