The opioid epidemic that is killing hundreds of intravenous drug users who overdosed this year in the state has resulted in a Hepatitis C epidemic, according to state health officials.

Most of those drug users, they note, are people younger than 30 who probably used contaminated syringes.

The hepatitis C virus, which is the leading cause of liver cancer and was first diagnosed in the 1980s, was mostly contracted by baby boomers from blood transfusions, medical procedures as well as through intravenous drug use.

But with education, blood screenings and needle exchange programs, the number of new cases of hepatitis C declined significantly since then. Now, the numbers are climbing as a result of an intravenous drug crisis.

"Today, the most cases are occurring in people under the age of 30," said Kevin Cranston, director of the state Department of Public Health's Bureau of Infectious Diseases. "The heroin epidemic is resulting in a hepatitis C epidemic in a new generation of injectors."

Mr. Cranston said for the past few years, over 2,000 new cases of hepatitis C have been identified annually in the under-30 age group in Massachusetts. About 200 of those cases are in Worcester County. Heroin and other opioids are thought to be the link in the great majority of cases.

Jesse Pack, director of prevention and screening at AIDS Project Worcester, said the agency has worked with more than 700 injection drug users over the past two years, and half are younger than 30. Ten years ago, APW worked with about 200 IV drug users annually. Most of them were middle-aged. The agency, which provides prevention education, vouchers for new syringes for adults, treatment assistance and testing resources, returns at least one positive hepatitis C test result a week. Most positive results are for people younger than 30.

Dr. Erik J. Garcia, who treats some IV opioid drug users over age 15 through Community Healthlink, said young people typically start by secretly taking some of their parents' prescribed painkillers that go unnoticed. Some young people also become addicted by using pain medications prescribed to them after a sports injury.

Once the prescription drugs are no longer accessible, they turn to heroin which is cheaper and often more readily available than painkillers purchased on the street, he said.

"Now you have a situation where a person has transitioned from a gateway drug into an addiction, and to heroin. A progression that ultimately leads to hepatitis C," Dr. Garcia said.

The hepatitis C virus is tremendously infectious, thought to be 10 times more easily transmissible than HIV, he said. Washing syringes with bleach does not kill the hepatitis C virus, but it is effective against HIV, which causes AIDS.

Dr. Garcia said 90 percent of people who use intravenous drugs have been exposed to hepatitis C. Exposure usually happens within the first 12 months of use.

Unfortunately, the adverse consequences of the opioid crisis do not stop with hepatitis C. Mr. Cranston and other health officials in Massachusetts said they fear illicit IV drug use will eventually lead to a resurgence of an HIV crisis like the state and parts of the country experienced in the 1980s and 1990s.

Last month, health officials in Indiana declared a health emergency after more than 100 people in a small rural city tested positive for HIV. Sharing of contaminated syringes and Opana, a highly addictive painkiller, is thought to be the cause for the outbreak.

"No. Not yet," Mr. Cranston said when asked if the state is seeing an increase in cases of HIV. "We are concerned that the same behaviors that transmit hepatitis C will also transmit HIV, and it is possible to see a re-introduction and spread of HIV among injectors. We are concerned, particularly with another generation who has not had any experience with the HIV-AIDS epidemic. Their older counterparts learned the hard way."

Mr. Pack at APW said his agency educates young drug-using clients about HIV and hepatitis C and how to remain uninfected even if they are still using drugs. Free confidential screenings are also offered so that people who are infected can get into treatment sooner, making it much less likely they will infect others.

"But young adults in general don't see these infections as something that could affect them personally," he said.

Adding comprehensive, age-appropriate substance abuse education in public schools would help young people get a better idea of the risks and consequences, he suggested.

To address the HIV outbreak in Indiana, the governor authorized a temporary needle exchange program. The state had prohibited programs that give out new syringes for used ones.

Massachusetts health officials say needle exchange programs implemented here in the early 1990s are key to not seeing a major HIV outbreak like Indiana's.

In addition to that, they cite statutes enacted in 2006 that decriminalized the possession of syringes and allowed over-the-counter purchase of syringes at pharmacies. The state also began to require communities to have syringe disposal systems, where people can safely dispose of syringes.

In March, the state public health lab also began automatically testing every blood sample sent there for both HIV and hepatitis C.

Only five communities have needle exchange programs which have to be approved by local officials. Those programs are located in Boston, Cambridge, Provincetown, Northampton and Holyoke.

Worcester City Council in the mid-1990s passed an ordinance barring needle exchange programs. Some thought such a program would attract drug users to the city and send the message that drug use was condoned.

"Unfortunately, what they missed is that's not the message that we'd be giving," said Dr. Garcia. "The message would be: Obviously we care about your health. We care about your life. Just because you suffer from an addiction does not mean you should be exposed to HIV or hepatitis C."

In addition to establishing a needle exchange program in Worcester, Dr. Garcia suggested other means to addressing the heroin and opioid crisis. It can be better stopped at the onset by making the medical system more accountable for the opiates they prescribe. Medical providers, he said, are the source of many of the illegally used drugs, unbeknownst to them. Parents should also be educated about safe and responsible storage of medications so their children don't have access to them. Young people also should be educated about drug use. More programs for addicted youths separate from adults are also needed, he said.

Given the current crisis in opioid abuse and task forces set up to try to address the problem, the time may have come for Worcester to consider having a needle exchange program.

Worcester City Manager Edward M. Augustus Jr., who serves on a task force, said all options are on the table.

"These are complicated issues that will require thoughtful public discussion, but I won't close the door to any potential solutions," he said in an email.