Hepatitis C treatment and drug use
Hepatitis C treatment can be as effective for people who are actively using drugs as it is for people who are not. In both cases, successful treatment often depends on having the right support systems in place. However, few people who are actively using drugs (especially injection drugs) are currently receiving treatment, even though they are eligible.
There are several reasons for this. Often people are not aware of their treatment options or that treatment for hepatitis C even exists. Other times, a person may not be ready for treatment or it might not be a priority for them. And, sometimes, healthcare providers resist providing treatment to anyone who uses drugs.
Separating myths from facts
Drug use in and of itself is not a barrier to successful Hep C treatment outcomes: The Canadian Management of Chronic Hepatitis C: Consensus Guidelines (2007) do not list substance use as an automatic reason to deny treatment. The guidelines recommend it be decided on a case-by-case basis.
The decision not to provide hepatitis C treatment to anyone who uses drugs is often a decision made from misinformation or from a place of judgment. The following are some popular myths about hepatitis C treatment and people who use drugs, along with the facts according to research from Canada and around the world.
Myth: Treatment success rates are lower for people who are actively injecting drugs.
Fact: Studies from Canada and around the world have found similar rates of sustained virological response (SVR) between people who are and are not actively injecting drugs. In many of these studies, people had access to support from a multidisciplinary team that included healthcare and social support workers.
- Zurich, Switzerland: The Association for Risk Reduction in the Use of Drugs in Zurich conducted a study among 500 people living with hepatitis C—199 participants were using drugs and 301 were not. There was no significant difference between the two groups when it came to (a) adherence to the treatment regimen and (b) SVR rates.
- British Columbia, Canada: A study in British Columbia found that 67% of people starting treatment—75% of whom continued to use drugs throughout treatment—successfully cleared the virus.
Myth: There is no point in treating a person who actively injects drugs because he or she will become re-infected.
Fact: The risk for re-infection can be low when people have the harm reduction knowledge and support, such as access to harm reduction materials, necessary to prevent hepatitis C.
There are real challenges to address
Hepatitis C treatment can be a challenge for anyone. However, certain challenges may be more serious for someone who uses drugs, such as the ability to cope with side effects and adherence to the treatment regimen. For some people, the act of injecting interferon is difficult because it triggers memories of injecting drugs. Lack of support systems as well as negative perceptions about treatment side effects, blood draws, needle biopsies, healthcare providers and the chances of clearing the virus on treatment are other common challenges.
Addressing these challenges
With effective care and the right supports in place, people can make more educated decisions about hepatitis C treatment. Treatment can be successful for those who choose to take it.
Talk to people with hepatitis C about treatment. The more information people have, the better they are able to make decisions about and prepare for treatment. A conversation about what treatment involves, the concerns a person has and plans to manage obstacles can boost confidence and ease fears.
Enlist a coordinated team. This team can include specialists, doctors, nurses, counselors, outreach workers, harm reduction programs, peer support and advocates.
Address mental health issues. For people coping with issues such as anxiety or depression, the increased risk of depression with peg-interferon can be a major barrier to treatment. Mental health conditions are often manageable with monitoring and referrals to counseling or psychiatric care when it is appropriate. Some healthcare providers will recommend a person start antidepressant medications before starting hepatitis C treatment.
Develop a comprehensive plan to manage side effects. If pain medications, anti-anxiety medications or other drugs that have the potential for being misused are prescribed, service providers and people with hepatitis C can work together to develop a plan to manage this. The plan can include details such as how often the medications will be prescribed and how long they will be prescribed for, what to do if someone needs a higher dose and a plan to taper off the medications.
Identify and link people to resources such as stable housing and healthy food sources. Adherence to the treatment regimen is easier when a person’s basic needs are met.
Help people identify potential allies such as family, friends, harm reduction workers and employers. A strong support network is important during hepatitis C treatment.
Promote peer support before, during and after treatment. Peers can provide many types of support, such as accompanying people to medical appointments, sharing experiences and coping strategies, and providing emotional support.
Promote and support harm reduction before, during and after treatment. Let people know that they can seek out harm reduction education without being judged or punished. For more information on safer drug use during treatment, see Hep C treatment, street drugs and alcohol.
 Bruggmann P, Falcato L, Dober S, et al. Active intravenous drug use during chronic hepatitis C therapy does not reduce sustained virological response rates in adherent patients. Journal of Viral Hepatitis. 2008 Oct;15(10):747-52.
 Grebely, J, et al. Treatment uptake and outcomes among current and former injection drug users receiving directly observed therapy within a multidisciplinary group model for the treatment of hepatitis C virus infection. International Journal of Drug Policy. 2007 Oct;18(5):437-43.
 Grebely J, Knight E, Ngai T, et al. Reinfection with hepatitis C virus following sustained virological response in injection drug users. Journal of Gastroenterology and Hepatology. 2010 Jul; 25(7):1281-84.