The Liver Meeting
The Liver Meeting
October 24, 2017
3 min read

Surgeon General: We Will Conquer HCV, Opioids ‘One Bite at a Time’

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WASHINGTON During a session focused on the connection between the hepatitis and opioid epidemics at The Liver Meeting 2017, Jerome M. Adams, MD, MPH, Surgeon General of the U.S., advised physicians in attendance that hepatitis C elimination will require nontraditional partnerships and innovative strategies for education, prevention and screening.

“I want to ask you all a question that I hope all of you know the answer to,” Adams said to the audience. “How do you eat an elephant? One bite at a time. If you take one bite at a time, if you help all of our partners see which part of that elephant they can take a bite of, we will be able to consume that elephant that is the opioid epidemic.”

“But there’s another way to eat the elephant that is the hepatitis epidemic: because any one of you eating an elephant one bite at a time is still going to take the rest of your lives to eat that elephant,” Adams continued. “If everyone in this room decides we’re going to eat an elephant, we’ll have it eaten before you know it. We need to get through it one bite at a time, but we also have to do it together.”

Adams addressed the common knowledge that baby boomers, those born between 1945 and 1965, have a high risk for HCV. This population, however, does not face the stigmas that exists for the other higher risk population: injection drug users.

“The more we can reframe hepatitis not as a disease of people who have made some unfortunate choices in their life,” he said, “the more we frame it as something that can occur to anybody, the more we’ll be able to lower that stigma.”

According to recent data, opioid-related deaths increased nearly 300% from 2002 to 2013 and HCV has increased at a similar rate within the same timeframe.

Adams presented data on the HIV outbreak that occurred in Scott County, Indiana, as an example of opioid addiction’s connection with infectious disease transmission. In a town of about 4,000 people, 225 new cases of HIV occurred over 2 years. Previously, the town never had more than three cases per year. Additionally, 95% of individuals with HIV were coinfected with HCV.

“It showed very clearly how the opioid epidemic drives large scale changes in HIV diagnosis in an era that has so many scientific breakthroughs,” Adams said. “We thought we had HIV solved. We thought the problem was over. This showed that we are not doing enough.”


The next step

The community in Scott County, Indiana, was concerned with the negative economic effects the HIV outbreak would have, according to Adams. Businesses were worried that people would not want to visit a town that was associated with HIV and injection drug use.

“We know that when businesses invest in the health of their communities, everyone profits,” Adams said. “In order to keep America at the forefront of economic prosperity and quality of life, we need to work together with partners for the benefit of all, especially when we talk about the opioid crises.”

Adams told those in attendance that only attending meetings related to their specialty and only working with traditional partners was not enough. Physicians should strengthen their relationships with traditional partnerships but should also forge new relationships with nontraditional partners, such as businesses, law enforcement and educators. Reaching out to local government and community organizations also represents a potential opportunity in the fight to eliminate HCV.

Additionally, there is a need for evidence-based programs that work not just in large, urban centers like New York City and Los Angeles but in places like Scott County, Indiana, or Akron, Ohio — programs that might need to be designed differently for a different kind of community.

“Everyone has a role to play in our national response to fight viral hepatitis,” Adams concluded. “I challenge you to think about new partners you can reach out to, new ways you can be involved in your community to educate folks, and new ways that you can help make sure we’re adopting evidence-based practices to ensure that those who need care or treatment can get it.” – by Talitha Bennett


Adams JM. Time to Stop the Opioid Crisis and the Related Epidemics of HCV and HIV. Presented at: The Liver Meeting; Oct. 20-24, 2017; Washington, D.C.

Disclosure: Adams reports no disclosures.