Most people being treated for opioid use disorder are carrying a second, quieter illness. Hepatitis C spreads through shared needles, which ties its path closely to injection drug use, and the overlap is striking: by one estimate, about 76 percent of people enrolled in opioid treatment programs carry a hepatitis C infection, against roughly 1.8 percent of the general population.
Workit Health, a telehealth provider treating opioid and alcohol use disorder, has built its care around that overlap rather than around a single diagnosis. Its clinicians can treat hepatitis C and prescribe medication to prevent HIV alongside addiction medication, handling in one place the conditions that would otherwise send a patient to three separate offices.
A Virus That Tracks the Opioid Crisis
Hepatitis C infects an estimated 2.4 to 2.7 million people in the United States and ranks among the leading causes of cirrhosis and liver failure. Its prevalence has been climbing, and researchers attribute much of that rise to the opioid epidemic and the increase in injection drug use that came with it. The virus often produces no symptoms for years, so many people carry it without knowing, even as it scars the liver. Left untreated, chronic hepatitis C can progress to liver cancer or require a transplant, outcomes that a short course of medication taken early can prevent.
For someone entering treatment for opioid use disorder, that makes the appointment an opening. A patient who arrives for buprenorphine is, statistically, far more likely than the average person to also carry hepatitis C and to have gone undiagnosed. That first visit is a chance to catch infections that the fragmented health system routinely misses.
A Cure Most Patients Never Get
The clinical picture changed dramatically over the past decade. Direct-acting antiviral medications now cure hepatitis C in 96 to 99 percent of patients over a course of roughly 8 to 12 weeks, and they are well tolerated. Medical bodies, including the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, recommend treating nearly everyone with the virus, including people with substance use disorders. Because a cure also stops the virus from spreading, reaching people who use drugs is central to any plan to eliminate it.
The barrier has not been the medicine. It has been accessed. When direct-acting antivirals first arrived, they cost upward of $90,000 per patient, and many state Medicaid programs answered with restrictions, requiring patients to prove sobriety, reach a threshold of liver damage, or see a specialist before qualifying. Those rules fell hardest on people who use drugs, the group most likely to be infected. One analysis found that only about 23 percent of Medicaid patients with hepatitis C were treated between 2017 and 2020. The cure existed; most of the people who needed it did not get it.
Sobriety requirements are a particular trap for addiction patients, because they create a curable infection behind a milestone that treatment itself is meant to work toward. Treating the two conditions in sequence, rather than together, loses people at every handoff.
Treating Both in One Place
Workit Health’s answer is to keep the care under one roof, or rather one app. The company keeps primary care physicians on staff, so a patient can receive not only medication for opioid or alcohol use disorder but also treatment for hepatitis C and PrEP, the medication that prevents HIV. Because visits are by video, someone in a county without a liver specialist can still be screened and treated. No one has to assemble a team across town or repeat their history at each new office.
That design follows from how the company reads its patients. “We don’t know anybody that really only has one diagnosis,” said Robin McIntosh, Workit Health’s co-founder and co-CEO, describing why the model treats the whole person rather than a single condition. Substance use rarely arrives alone. It travels with infections, chronic pain, and mental health conditions, and a platform that can address them together keeps patients from slipping through the gaps between separate providers.
Handling those conditions in one place is more than a convenience. For an infection like hepatitis C, where every dropped handoff is a chance to lose a patient, folding treatment into a visit the person is already keeping can be the difference between a cure and a missed one.
The approach reframes what an addiction appointment can accomplish. Someone who comes to Workit for help with opioids may leave on a path to clearing a virus that would otherwise have gone untreated for years. Treating the addiction, in that light, is not the end of the visit. It is the door through which a curable and sometimes fatal infection finally gets caught.
