Substance Use Disorder and the Hep-C Connection

This episode explores the critical intersection of substance use disorder and hepatitis C, featuring personal stories and expert insights.

Dean Babcock and his guest, Dr. Janet Arno, discuss the critical intersection of substance use disorder and hepatitis C. They explore the stigma surrounding these issues, the importance of testing and treatment, and the public health implications of addressing these conditions. Dr. Arno shares her extensive background in infectious diseases and emphasizes the need for healthcare providers to be proactive in testing and treating hepatitis C, particularly among populations at risk due to substance use. The conversation highlights the advancements in treatment options and the importance of accessibility to care for all individuals.

In our personal story, Jodi Miller got to know Jason Rush. Jason shares his personal journey through substance use disorder, detailing his experiences with addiction, the impact of hepatitis C, and his path to recovery. He discusses the challenges of stigma, the importance of seeking help, and the resources available for those struggling with addiction. Jason emphasizes gratitude for his life and sobriety, encouraging others to not be ashamed of their struggles and to reach out for support.

Episode Links:
https://www.connecttocure.org/

Want more from Beyond Substance? Visit us online:
https://beyondsubstancepodcast.org

Chapters
00:00 Connecting Through Stories
01:49 Understanding Hepatitis C and Substance Use Disorder
04:12 The Intersection of Public Health and Personal Stories
09:58 The Risks of Hepatitis C in Substance Use
16:12 Treatment and Recovery: A Personal Journey
22:03 Overcoming Stigma and Finding Hope
27:45 Messages for the Medical Community and Public
34:01 Jason's Journey: From Addiction to Recovery
46:10 Lessons Learned and Future Directions

#addiction #substanceusedisorder #hepc #hepatitisc #RecoveryIsPossible #Stigma #Treatment #PublicHealth #Indiana #Indianapolis #buprenorphine #opioidusedisorder #addictiontreatment #primarycare #recovery #personalstories #healthcaresystem #communitysupport #trauma #healing #resilience #mentalhealth #mentalhealthmatters #peersupport #heroin

Episode Transcript

(00:00):
[Music]

(00:04):
Stories connect human beings to human beings.
[Music]
As we realize that our experiences are uniquely our own.
And yet somehow, apart of the bigger picture.
[Music]
These are the stories from a community that is building hope through recovery by going beyond substance.

(00:28):
[Music]
Hello, I'm Dean Babcock.
And I'm Jody Miller.
Welcome back to the podcast where we explore the stories and solutions that drive progress in recovery and public health.
Today we're taking a closer look at the critical intersection of substance use disorder and hepatitis C.

(00:49):
Both these conditions have far reaching public health implications.
That's right, Dean. And in this episode we'll be sharing two unique perspectives on this topic.
I'll be introducing you to Jason Rush, whose journey through addiction and hepatitis C is as heartbreaking as it is inspiring.
And his resilience shines through every step of the way.

(01:14):
Jason's story is powerful, Jody. And alongside that personal journey, I'll be speaking with Dr. Janet Arno,
a physician with decades of experience treating infectious disease.
She offers a wealth of insight into the importance of proactive testing and treatment.
And she doesn't shy away from addressing the barriers that stigma creates, both for patients and for the health care system.

(01:38):
It's such an important conversation. Dr. Arno's work highlights the advancements in care and why it's essential that everyone have access to this life-saving treatment.
So whether you're here to learn more about public health, recovery, or the real stories behind those headlines,
we think this episode will offer both perspective and hope.

(01:59):
So let's start as usual with Angela Shambling by taking a look at the numbers.
[Music]
hepatitis C is a liver disease caused by a virus, and it can be pretty serious. The symptoms usually start showing up anywhere from two weeks to six months after you're exposed.

(02:21):
But here's the tricky part. About 80% of people don't show any symptoms at all.
This makes it easy for the disease to go unnoticed, which is why the CDC says that everyone should get tested at least once in their life,
and women should be tested during pregnancy.
Hepatitis C can be short term, acute, or long term chronic.

(02:42):
Chronic cases are the ones that can lead to major problems like liver scarring, also called cirrhosis, liver cancer, or even liver failure.
In fact, hepatitis C is the most common blood-borne disease in the United States, and the main reason people need liver transplants, around four million Americans have it.
Here's something to keep in mind. In 2022, there were about 1.5 new cases of acute hepatitis C for every 100,000 people in the US, and in Indiana, the rate was a bit higher at 2.2.

(03:15):
The US also saw nearly 94,000 new chronic cases last year. So, if you haven't been tested, it's definitely a good idea.
Hepatitis C might be hidden, but knowing your status can make a big difference.
Back to you, Dean.
[MUSIC]

(03:42):
We would like to welcome Dr. Janet Arno to our podcast today.
We'll be kind of talking about substance use disorder and hepatitis C.
And why kind of hepatitis C in substance use disorder tend to kind of many times go hand in hand, and why they are both serious conditions and how we need to kind of approach those.

(04:05):
So, our guest today is Dr. Janet Arno, and Dr. Arno, so welcome to be on substance.
Thank you. I'm really happy to be here, and thank you for the opportunity to share in the conversation.
So, why don't we get started by if you could share a little bit about yourself and your background, and then we'll move into how you got interested in treating people in the public health space, and in particular people who might have a substance use disorder.

(04:36):
I'm a specialist in infectious diseases, and recently retired from IU School of Medicine and IU Health.
But started my career first in HIV/AIDS when patients were first discovered in Ohio, leave it or not.
Shortly after they appeared in San Francisco, so I probably had one of the very first AIDS patients in Ohio.

(05:01):
When I chose infectious diseases as a subspecialty, actually it attracted me because you, if you were smart, you took people who were very, very sick,
figured out what they had, treated them, and they got 100% better.
And that was really, really gratifying. But when the acquired immune deficiency syndrome appeared, that wasn't possible, and the infected individuals were subject to unbelievable prejudices and stigma.

(05:36):
And actually that moved a part of me that had not yet been born. It kind of cemented my relationship with individuals affected by threatening complications of infections, but also society, including HIV, hepatitis C, tuberculosis, malaria, homelessness, and poverty.
Wow. We first met when you were at the, at the Belfar Clinic, doing some projects there. And so can we start by talking about how hepatitis C and substance use disorders kind of get connected?

(06:11):
Yes. Unfortunately, putting needles under the skin and into a vein, put people at risk for getting all sorts of infections.
One of those is hepatitis C, and one of them is HIV.
So while we were very attuned to HIV early on in the 80s, there was another entity called non-A, non-B hepatitis, which later was discovered to be hepatitis C.

(06:44):
And those same individuals who had HIV also often had hepatitis C. But then we actually began to learn a lot more about hepatitis C and realized that anyone who used needles to get drugs high, or even sometimes, if they were dirty, medications in certain countries, they could be infected by this disease, which for many, many years,

(07:13):
led to chronic liver disease and death, but now is curable. So it's been one of those round circles where we can take people who are very, very sick, make them 100% better, if we're smart.
So one of the things I have learned in doing the work I have done over the years in treating people who had substance use disorder.

(07:36):
I don't think that we were very conscious of this whole dynamic with hepatitis C. I think we were kind of very well versed in how HIV aids may impact this population.
But it almost felt for many years that the hepatitis and hepatitis C in particular was kind of this silent thing that wasn't on the radar of people in the substance use treatment community. Do you have any thoughts on that?

(08:06):
I think really what happened was in the dark days of HIV before effective treatments were available. The clouds were dark and we couldn't see very far. I think it's only after the clouds began to clear that we saw that there was another threat.
Also, hepatitis C was not as well studied. We didn't know it affected as many people worldwide. It may have, but we didn't know. And so it wasn't really until we were able to control people's HIV.

(08:42):
The individuals were infected with hepatitis C and HIV, co-infected that we really could see there were things still threatening their lives that we had to take care of. And then we found that there was a lot of people who didn't have HIV who also needed to be taken care of.
I don't know the current data and maybe you, you know, you are more familiar with recent data about how prevalent in the substance use population, how prevalent this can be.

(09:10):
You know, it's a disease of clusters. And so you need denominators for some of those things to be able to know. I do know that in 2021, there were 5,000 cases in Indiana. And that it has gone up substantially since then because we have better outreach and testing.
So I know how many HIV cases are infected with hepatitis C. And I think that's about 20% or so. But I don't know the opposite, which is how many people who use intravenous drugs have hepatitis C.

(09:46):
I think it's a matter of who gets tested and how many we know about. Right. People who often, the data often is derived from treatment facilities. And in treatment facilities, it's really a different population. Right.
It's people who have been motivated to come and they may not be the same as the general intravenous drug using population.

(10:08):
And I think for many years and the treatment facilities, we didn't ask the question. I think that that's probably true. We were so focused on HIV. We didn't do it.
And you know, testing wasn't as available. You know, now we have better tests. And we have the availability of testing for nucleic acids in the blood, which is really kind of a game changer too. So yeah.

(10:32):
What this really says is we are so much more advanced and we are so lucky to have these kinds of cures that we can get for hepatitis C and tests. But this is the time to do something about it.
So this podcast comes at a perfect time. That's great. So why is the substance use disorder populations so at risk from your point of view?

(11:00):
And so they are not the only individuals who get hepatitis C. Let's be clear on that. It can be passed other ways. But far and away in the United States, blood-borne transmission is the most common.
And without having clean needles available, if you've ever seen a needle, even if it's used once under the microscope, it's jagged and it rips.

(11:26):
And it carries little pieces of the person who used it last time with it. Even if you clean it, it's very hard to get clean. But there are ways to do that. And that's better than nothing, but new needles are the best.
So needle exchange leads to less infection. But the reason individuals who use intravenous drugs and get it is not the drug use.

(11:52):
It's how they get the drugs that they're using. And that usually is needles and shared needles, particularly.
It can be transmitted sexually. That's rare. Mothers can transmit it to babies, blood products overseas. But in this country, those things are screened for and carefully monitored. So in this country, it's individuals who use and share needles.

(12:20):
And I know in our some of our previous podcasts on beyond substance, we we featured the head of the Safe Syringe Access Program at the Merritt County Health Department.
So our listeners may want to go back in and listen to that episode. It was entitled about harm reduction with them.

(12:42):
So talk to me about what happens when someone is infected with hepatitis C. Kind of what happens to them? Does it take time? Do they get have symptoms? What happens?
Most people don't know. If you were infected today, you wouldn't know it for the most part. Some people do get symptoms with it, which could be nausea, vomiting, turning yellow.

(13:11):
Maybe some pain in the right upper part of their abdomen. But almost no one really gets to ill. They might have something minor. Most people never know unless they get tested.
And you know, there's a number of infectious diseases like that. HIV when it was first described, we learned that it took 10 years for people to present with AIDS.

(13:37):
Now we know that people can have symptoms, but we didn't recognize the symptoms before. With hepatitis C, it's not dissimilar. Same with syphilis. The only way to really know if you've been infected, if you've done some risky behavior is to get tested.
In fact, the CDC Centers for Disease Control in Atlanta recommends that every person get at least one hepatitis C test because you don't know if you were exposed by something that you never realize was a risk.

(14:12):
Individuals early on may have had other kinds of like burns or trauma where they became infected. So everyone should get at least one test because most people are not symptomatic.
But most people are at risk for developing chronic liver disease.
And so that's really kind of what this boils down to for hepatitis in general. It's disease of the liver.

(14:39):
Right. And liver disease, you know, we think of hepatitis when we think of hepatitis A, somebody gets really sick, nausea, vomiting, almost all of those individuals or many of those individuals become symptomatic.
Hepatitis B, which also can be transmitted by intravenous drug use, has a vaccine. And so it's much less common than it used to be.

(15:03):
And I was an intern in resident before the vaccine. I'd say about one out of five individuals in my internship group became infected with needle sticks.
But now we have a vaccine. So most young people have received the vaccine. And if you haven't received the vaccine, even if you're not an intravenous drug user, you should get it because it's economical, it's effective, and it's one less disease to worry about.

(15:30):
Another thing that I want to mention is individuals who use substances often use more than one and may use substances to treat other disorders, as you know.
But drinking is another hit to liver. So individuals who both drink and use intravenous drugs have a particularly concerning combination of risk factors to have chronic liver disease, only one of which may be the hepatitis A.

(15:59):
You know, one of the things I'm kind of remembering is it changing in some of our substance use disorder treatment programs, how we asked the questions.
And typically when you are doing an assessment, when a patient comes into treatment, we ask them the question, do you use IV drugs?

(16:24):
And I know becoming aware of hepatitis C made me and in my agency start asking the question differently and saying, have you ever even once used a drug by an IV means, particularly about hepatitis being a risk? Because it only takes one time.

(16:45):
And it doesn't have to be intravenous either. You know, you can introduce the body by putting a needle under the skin that is not necessarily in a vein, although that's the most efficient way to transmit it.
Right. So really kind of our messages for everyone, if you ever use a needle ever, you should take this into consideration.

(17:07):
Right. And you don't necessarily even have to have them admit that to you. I mean, it may be part of your assessment, but I might think of asking, have you ever been tested for hepatitis C?
Because it's very, very common and just test.
That's great.
There are other reasons to ask the question, but it doesn't necessarily need to be about the diagnosis.

(17:32):
Yes. Yeah. Good, very good point. So if someone doesn't get treatment, what happens?
The inflammation associated with hepatitis C as it goes from the blood into the liver leads to a battle where your body is trying to fight off that virus, but it doesn't do so effectively.

(17:53):
And fibrosis, which is a scarring of areas in which the fight occurred occurs.
And so the liver becomes fibrotic. They, a nice, healthy liver is very soft and pliable.
As the fibrosis occurs, it replaces the cells that produce essential enzymes to help you regulate your body.

(18:23):
So a couple of things happen. One is that your liver loses the ability to do that.
There may be a lack of function of the liver that could lead to toxins occurring in the body and in the blood that can affect your brain, your ability to think.
Your ability to clear toxins from your blood. The actual substances from the liver can actually be toxic and eventually you get liver failure in cirrhosis.

(18:54):
When you have cirrhosis, your liver is very stiff and very unproductive.
If you have compensated cirrhosis, you might not even be able to tell from the outside that that's happening.
But on the inside, your body can tell it's not working correctly and you can tip over into a number of complications.

(19:17):
Something else that can occur is a hepatocelular cancer or liver cancer, which is not easily treatable, but if caught in time can be removed.
We're working on treatments, but even after treatment, effective treatment, you still have to watch for the development of liver cancer.

(19:44):
If we do the proper screening and do the proper testing and we come across someone who has been infected with hepatitis C, historically, what have been the treatments and what's the current treatment that we would recommend?

(20:05):
Even in my time, the modern treatment has been available for years, probably almost 10 years by now.
But before that, there were treatments such as interferon or with riboviro, which is an antiviral.

(20:26):
Interferon is a hormone that immune cells make and it makes you feel awful. It makes you feel like you have the flu.
Your body produces it and that's the hormones that lymphocytes and agrofagias and immune cells produce are often what make you feel sick.
We don't use those anymore.

(20:47):
The riboviro in the antiviral, yes, sometimes, but not usually even. The drugs we have now are direct acting antiviral agents.
And the time we have to use them is phenomenally short. Whereas in HIV, we still are in a time where we use lifelong therapy, but with hepatitis C, most people can be cured in eight weeks.

(21:15):
By taking a pill a day, it's a miracle. I mean, it is so gratifying to see people who, when they start off and some people don't feel that well, they don't even know that they don't feel well.
They just don't feel right. And by the time they're done, they can't believe how much better they feel sometimes.

(21:40):
I know over the years, I mean, the talk, certainly in the treatment community was that people being treated for hepatitis C. I mean, historically, so I'm talking more than 10 years ago.
Really talked about how awful it was. And so even people didn't want to do it.
Okay. I also understand there was some being cost prohibitive. And do you have any thoughts about that?

(22:10):
Well, it's not cheap, but generally insurance will pay for it.
I know that our hip in Indiana is a program available to indigenous patients or patients who can't afford to pay for health care.
That covers it. Most places cover it because it's very cost effective. I mean, really, we're talking about saving people's lives.

(22:37):
And no one should be afraid to take treatment because of cost because the places that give treatment will help you find a way.
And cost isn't just the drugs. I mean, the drugs are really expensive.
And when I say really expensive, more than $10,000, kind of expensive, but they are usually paid for it.

(23:01):
But it's all the stuff that goes along with them, the blood work, the transportation, the unique and a particular kind of test that looks at your liver elasticity, cat scans, et cetera, et cetera.
SUDARA, but even now those options, those -- they're not really options. Those costs that go along

(23:26):
with the drug treatment are covered by a number of plans. And there's a wonderful program called
Connect to Cure. You can Google that. It's just C o n n e c t t o c u r e. And they have a way
for you to find a provider and to get help with questions about cost. There are care coordinators now,

(23:54):
which, you know, I am a very direct person. I like to go and get my care and get it fast, but I think
we all have to admit getting linked into health care is not easy, even for people with lots of
education in the field. You know, you can call up and get transferred to 100 people, and that's not

(24:17):
what you need. You need somebody to do that for you because it's really annoying. But once you connect,
it's wonderful. And you should never not try. So going to that website, you can find where to get
care. You can find out answers to your questions and really be guided. And hopefully on a one-to-one

(24:40):
basis, because everybody's different. Everybody's needs are different. And we will include those links
in our show notes. So if you go to our website or click on it, you'll be able to find that information
for Connect to Bear. That's really important. There's so many good resources online. I mean,
the treatment guidelines are there. The description CDC has a lot of stuff. There's a lot of really

(25:03):
good things. Every episode we do, we include resources to help people know, get help,
and so one of the messages I hear from you, Dr. Arno, is don't be shy about a potential cost or
what have you. People will help you. If you get connected into medical care, people will help

(25:24):
to try to make this as easy as possible and as affordable as possible for you.
And you know, you don't have to stop using drugs necessarily to get treatment. Many programs do
want that. But the important thing is to get treated and not to be afraid. So let's say someone
goes through this treatment. And can they become infected with hepatitis C again?

(25:50):
Unfortunately, yes. Actually, it's a risk because you're always at risk for relapsing,
right, with substance abuse, whether it's alcohol or other substances. And
when you relapse, you may not have your best judgment. So you might have just one brief

(26:20):
lapse that might make you get infected again. And so that's the one of the best reasons to stop is
it's harder to treat the second time. You know, you can be resistant. You can have bad side effects
of the medications themselves. And they're, you know, you're never the same. So avoiding getting it

(26:47):
again should be a high priority. And you should make sure that you keep getting tested if you are
going to do to have risk behaviors. Right. So kind of our message would be if by chance,
you go through the treatment and you become infected again, please seek help again.
Yes, you can be treated again. Right. There are very effective treatments.

(27:09):
And some of it aren't harder. It depends. And I think our, you know, our same messages,
you know, for people who have substance use disorders, you know, we, you know, people don't do
this in a perfect linear kind of way. And many times, you know, people, you know, have, have
lapses and go back to, you return to previous use. And, and that's part of that whole kind of

(27:33):
finding sobriety and finding recovery. You know, people don't do it perfectly. And sometimes it
takes several tries. And so it's that message about always get, you know, get back up on the
horse. And there are people around to help support you in that process. Right. Every minute,
regardless of whether you're using drugs or not, you should value yourself enough to take steps

(27:59):
to take care of yourself. So consider our conversation today. What would be your message to the
medical and other helping communities about how to approach this illness and how it impacts patients?
What would, what would, what do you think those words of wisdom are? To our fellow helpers?
Every primary care physician should test their patients for hepatitis C, at least once.

(28:23):
It's not an expensive test and it might save somebody's life. It also gives us more information
and an opportunity to talk about it for not only them, but maybe people that they know.
I think there are many specialists that can help with treatment, but they have simplified the
guidelines such that almost every provider is capable of treating patients with hepatitis C.

(28:53):
That's really kind of exciting and to be able to cure. The thing that matters most to me is
accessibility of everyone. Because the more we decrease infection in the population,
the more we'll decrease the risk of individuals contracting it, no matter what.

(29:14):
And so if we don't take care of our most vulnerable individuals, then we're not taking care of
everyone. And I don't just mean that for individuals or individuals who might be immigrants and expose
on route and not have opportunities, but it affects, we're one unit. It'll affect me. It'll affect

(29:36):
you. It'll affect your mother. So you really have to be accessible to all populations to be able to
treat just one individual. Thank you for that public health perspective, which is, I look at
subsistence or as a public health problem. So it's all kind of wrapped up in what's the health of

(29:58):
the community. And what would be your message to the public about this, not necessarily the medical
community? What do you think the public needs to know and to digest?
This might surprise you what I'm going to say, I don't know. But you know how we say take care?

(30:18):
That's the kind of thing that we say to people when we say goodbye. I think we should really mean it
and understand that it means take care of yourself, take care of the people around you.
And if you're going to take care of yourself with that connection, then that means get yourself a
test with the things that you're at risk for, whether it be hepatitis C, HIV, colon cancer,

(30:45):
lung disease, whatever it is. Take care because we kind of need you.
[Music]
Addiction often enters quietly, threading itself through the cracks of our lives when we're least prepared.

(31:12):
For Jason Rush it began in the richest structure of the military, where an injury and prescription
pain killers became an uninvited companion. It's a story we've heard before, but what comes next
makes his journey uniquely his own. My name is Jason Rush. My journey through substance use started

(31:43):
pretty much like most people's I would imagine. We all have that common I think, you know, mine started
in the military getting injured and you know, back then doctors would over prescribe the pain medicine
and so I got addicted pretty, pretty early while I was still in the military and that carried over

(32:08):
into me getting out of the military and into civilian life. Pain pills weren't something that was
new to me. In high school, I remember, you know, taking them from time to time, but it wasn't an everyday
thing. It was like, you know, we go to a party and on the weekends, you know, just take some pills and
whatnot. So I had some experience with it before, you know, so it definitely wasn't anything new to me,

(32:34):
but what was new was the fact that I had to have them every day no matter what, you know. And if I
didn't have them, I wasn't having a good day. It was just pills at first. It wasn't until I got out
into civilian life and went to the VA and the VA was, they were the first ones to say, wow, you got a

(32:54):
lot of a medication there. That's just too much. And so they, they gave me three refills of my pain
medicine and told me after that, you're on your own. And so that's what happened. I went through the
three refills and I was on my own on the street by impills whenever I could until that got too expensive,

(33:17):
you know. I think the last one I tried to buy was $100 for a hundred milligram morphine, something
like that. As Jason transitioned into civilian life, the safety net he had hoped for unravelled quickly.
The VA could only offer limited support and his resources diminished quickly. He made the decision

(33:41):
so many find themselves forced into heroin became the cheaper, easier alternative. The cost of survival
was steep. My ex-brother-in-law had said, oh, I know a guy that, you know, can get a, you know, he's a
heroin dealer, blah, blah. So that started that, you know, the first time I did heroin, it was,

(34:03):
it was over with for me, you know. I knew it too because it was so much better. It was like taking
a, it's like taking a hundred pills at once, you know, and I knew it was over with. And that kind of
started my journey of, you know, being on the streets and, you know, being a drug addict on the street,

(34:24):
trying to figure out how did you, you're going to get by day to day, you know, where you're going to
get money from. I mean, I exhausted every last resource I had, you know. And, for years, Jason's life
became a series of transactions, securing the next fix, finding a place to sleep, and trying to stay

(34:49):
afloat on the streets, which isn't easy. Your daily existence, you're only thinking about how you're
going to get by, how you're going to make the money to get the drugs that you need. So how, you know,
there was a long period of time there where, you know, I probably couldn't tell you exactly where I was.
I mean, sometimes I was in hotels if I could afford it. I know my mother tried not to let me stay

(35:15):
on the street if possible, you know. She was always a source of support that would put me up in a hotel,
you know. But yeah, it just, it's weird how it happens. It happens so quickly, but you find yourself
out there and you don't care about anything else. You're just along for the ride. As long as you get what

(35:37):
you've got to get at the end, you know, that's all that matters. There were some friends that I had
that lived in a little apartment, kind of around the corner from where I was at at that moment.
Him and his wife, they were both users like me. So I would just go up there and I would use
sometimes, because there were sometimes, if I wasn't there, I would leave stuff like I didn't want

(36:01):
to be traveling around with a bunch of needles on me all the time. So I would leave them at their place.
I knew they were both positive for Hep C, and I had left two brand new needles over there.
And I asked them very explicitly. I said, if you're going to use one, remember which one you used
and leave the other one for me, you know, because I didn't want to be exposed. And came to pick them up

(36:28):
to use them. And it wasn't until after I used it, he said, well, I ended up using both of them, but it's
okay, because I cleaned them out with bleach. So you're safe. You're not going to get infected.
And of course, at the time, I just, I didn't care. I was like, yeah, good enough for me, you know.
But the darkness deepened when he learned he had contracted Hepatitis C,

(36:50):
a diagnosis that at that time felt insurmountable.
It wasn't until after that that I had a blood test, I believe, at the VA for some reason. It was just
a random blood draw for whatever reason. I still went to the VA from time to time.
But somehow my sample got sent off to the Marin County Health Department, and they sent a letter

(37:15):
to my mom's house that is saying that I was infected. I remember when my mother came out and shared
the letter with me, she called me over and said, hey, you got this letter. So I remember standing in
the driveway talking to her. And at the time, I thought, man, my life's over. This is very bad.

(37:36):
This thing is going to kill me. I've given myself a death sentence here, which ironically,
once I knew I was exposed, I think it actually pushed me further into using, to be honest, because
until several years later, I really thought it was a death sentence. I didn't know anything about it.

(38:01):
And no one offered me any treatments or said like this is what to expect. They just said,
you're exposed. You've got this now, whatever. So, yeah.
It was in the depths of this despair that Jason discovered, the VA's domiciliary program,
a beacon in his storm. This was his first step toward reclaiming his life.

(38:26):
It's for homeless and drug addicts. I believe I was there for six, seven, eight months, you know,
something around there. It was there for several months. They got me hooked up with the infectious
disease clinic at the VA, and they ended up treating me with harvony the first time. I know there's

(38:48):
a bunch of different ones out now, but back then it was harvony. It was pretty painless, one pill a day,
12 weeks, and you got follow-on blood tests. After that, it was like, okay, you're cured, you're good,
that got me through my first exposure.
Recovery, however, is rarely linear. After leaving the safety of the program,

(39:16):
Jason had a recurrence of use. This time, the stakes were higher, and he faced a second diagnosis
of hepatitis C. A sobering reminder of how fragile sobriety can be.
I remember the first time they treated me, they were very explicit in saying that it's important
that you do not reinfect yourself because the chances of being able to treat you a second time

(39:44):
go way down. The medicine's effectiveness won't be, it's 98% the first time, but who knows what is
the second time. I left the domicillary after six months or so, and I thought, "Okay, I've
been sober for six months. I'm good." I went back out. I had nowhere to live. I ended up just

(40:09):
paying for a hotel and staying there. My sobriety lasted probably about a week after
I left there. Since there was no one to monitor, a major drug test, and there were no more consequences,
I just went right back to what was familiar. The relapse went right back to the IV drug use.
That kind of went back and forth. I would get sober for a couple of months, and then I would

(40:38):
start using again. I don't know when I reinfected myself to be honest. It was sometimes
time. Obviously, after I left the domicillary, so that was between 2016 and 2020 that I found out
that I had reinfected myself. There was a four-year period of relapses and sobriety, relapse sobriety,

(41:03):
that who knows how I reinfected myself the second time. I can't pinpoint it like I can the first time.
Jason's turning point came not from a health diagnosis, but from a knock at the door.
Arrested by the DEA, he faced a reckoning with his choices and his future. This time sobriety stuck.

(41:25):
Apparently, I had sold drugs to one of their confidential informants in a parking lot,
which got me in a lot of trouble. So, fast forward, I go through the pretrial, I end up going to
federal prison in November of 22. I was only there seven months. I got out early. I got to spend the

(41:50):
rest of my time on house arrest and probation and whatnot, but it was while I was in prison for that
seven months that I found out that I had it again. They blood test everybody when they come in and
they said, "Oh, you've got this." I said, "Oh, well, great." They offered me treatment in there,

(42:11):
but I wasn't in long enough for them to treat me. They said, "Well, if you're going to be here
for a year or more," and I said, "Well, I'm getting out in a couple months." That's when I found out.
I knew I was getting out in a couple months. They were like, "Well, you won't be here long enough."
I had to wait until I got out of prison and then come back to the VA and say, "Hey,

(42:32):
I got this again, which I expected them to be, I don't know, I expected them to not be happy with me
because I had reinfected myself and I know that medication is not cheap. It's a lot of money
they're spending to try to treat me. I wasn't sure if they were even going to bother treating me

(42:54):
when I came back. I expected them to say no to be honest, but they treated me successfully for a
second time with a new medication. Man, it worked and I've been clear ever since."
Today, Jason is over five years into his recovery. His story isn't just about addiction or illness.

(43:16):
It's about finding the strength to seek help and the courage to persevere,
even when shame and stigma threaten to silence him.
I just went over five years into my 60 year of sobriety. Even though I found out at HEPC again,
luckily the doctors were gracious enough to treat me a second time rather than turning me away,

(43:40):
I'll be forever grateful to them for what they have done for me.
For me, the stigma is actually still there in a way. I can remember back to when I first started
using, and I was out on the street. I had track marks all over my arms even going into a gas station.

(44:02):
I felt like people were staring at me and judging me. There was a point on the street where I was
stealing cigarettes from ash trays outside of gas stations and I thought, "I was so embarrassed to do it,
but I wanted to cigarette so bad." I always thought how people are looking at me,

(44:23):
that they look down on me and that I'm nothing to them, that I'm just this,
"I'm a drug addict. No one cares whether I live or die."
That always weighs heavily on your mind. At least it did for me.
Even to this day, I've been sober for years now. For an example, when I go to the VA hospital,

(44:48):
and I found this out recently, so I had to go to the emergency room at one point because I had COVID,
didn't know it was back in 2020 or whatever I had COVID,
start feeling sick, so into the ER. When they pull up your file at the VA, there's all kinds of
notes from other providers that maybe they'll put in a note and says, "This person is a drug addict.

(45:12):
This person is combative. This person is this. All the bad things about you."
And mostly mine says, "Drug addict. Isn't that met user, heroin addict?"
All this stuff. One other stuff now is obviously current, but going to the hospital now,
that's what they see. And so going to the hospital just because I was sick, I got treated like a drug

(45:36):
seeker. I was there to get pain pills and whatever else. You know? So you don't want to go anywhere,
where somebody knows what you are, or knows what you used to be. I mean, I avoid that like the plague
now. I didn't like being labeled as a drug addict, you know? Because I always felt like there was always
so much more to me. Yes, that was a part of my life, you know? There's a lot of stigma with it,

(46:00):
unfortunately. And that stigma keeps people from getting treated properly, you know? Because they're
too afraid or too embarrassed or too anything to talk to the people that can actually help them.
When asked what he's most grateful for, Jason's answer is simple. He's alive.

(46:25):
But his gratitude runs deeper than survival. He's thankful for the chance to share his story.
For the hope it might offer someone else who's struggling. And for the opportunity to build a life,
he once thought impossible. I'm thankful to be alive and obviously just to be sober and to have

(46:49):
this strength to wake up every day and just, you know, be able to start stacking years of sobriety.
You know, it used to just be days, hours, days, you know, week, you know. Now I'm talking years,
something I never thought I would actually be able to do. So.
Jason's journey reminds us that no matter how far we fall, there is always a way back.

(47:13):
It may be messy, it may be imperfect, but the support and persistence healing is within reach. His
story is a testament to the power of second chances.
The thing to me is that every time we do this, I always learn something.

(47:39):
And certainly I have known for, you know, many, many years about the dangers of sharing needles,
but really never understood it from the point of view that once you use a needle to inject something,
that it, it kind of ruffs up and kind of damages the damages that that needle to where then

(48:04):
human tissue can get caught up in that damage as you kind of scrape up the needle and whatever.
And if someone else uses it, it is a way to then to share that tissue, whether that's, you know,
blood, skin, you know, body tissues, etc. And that's many times how diseases get
transferred kind of from one person to another. So.

(48:28):
Yeah, I totally agree with that because I was thinking the same thing when I listened to
to your interview with her too, as I did not know that, you know, I just assumed it was
through a blood connection, not necessarily a tissue connection. And then even when Jason's
was sharing in his interview, he talked about how he got that in it, you know, it just made more sense

(48:55):
after hearing your interview. So I really, you know, I'm always learning, you know, these episodes,
the professional side, the personal stories, this one really worked well together.
Yeah. And I think, you know, for our listeners out there, you know, there are programs available,
needle, you know, syringe exchange programs and, you know, contact your local health department,

(49:20):
whether that's here in Merritt County or in other counties where one can get access to new
and clean syringes if that's your route of administration. And help is available. And what we know
now is the treatments for hepatitis C have changed and they're much easier. And
is certainly can be as you say all the time, so he life changing. Life changing, yes.

(49:44):
And so in our next episode that we will be talking with, I represent it from the Indiana State
Department of Health, about non syringe harm reduction. So we'll be kind of exploring that. And
in the past, we've talked about syringe exchange programs, syringe access programs as a form of
harm reduction. And now we're going to look at other forms of harm reduction that everyday people

(50:09):
can do to kind of help reduce the risk of substance use disorder and the problems it creates.
See you next time.
If you feel you need assistance, please reach out to a counselor or other healthcare provider,

(50:31):
support of loved one or contact resources in the community such as 211 where you can be connected
to assistance or talk with a peer or counselor. Beyond substance is hosted by Dean Babcock and
Jody Miller. A look at the numbers segment is hosted by Angela Shamblin. Beyond substance is

(50:53):
produced by Angela Shamblin and the executive producer is Sean P. Neal.
[Music]

(51:38):
[BLANK_AUDIO]