5 Things to Know About Hep C if You Inject Drugs

Hepatitis C, a liver-damaging viral infection, is on the rise in the United States, in large part because of the opioid crisis. According to the Centers for Disease Control and Prevention, the number of newly acquired hepatitis C infections more than tripled between 2009 and 2018, with the increase attributed to the opioid epidemic.

People who inject drugs, such as opioids, are at high risk of exposure to the hepatitis C virus (HCV) because the virus can enter the bloodstream via needles, syringes, non–needle injecting equipment — cookers, cottons, and rinse water — or even intranasal equipment, such as straws, says Elana Rosenthal, MD, an associate professor of medicine at the Institute of Human Virology at the University of Maryland School of Medicine in Baltimore.

“As a result, about 50 percent of people who inject drugs in the United States have been exposed to HCV,” says Dr. Rosenthal, “and the risk of acquisition is particularly high in the first few years of injection drug use.”

If you currently inject drugs or did in the past, it’s especially important for you to get tested for HCV. In about 70 percent of people with hepatitis C, the infection will develop from acute (short term) to chronic (long term), according to the World Health Organization, and can eventually lead to liver scarring, followed by cirrhosis, liver cancer, or death, says Rosenthal.

But if you catch and treat the disease early on, you can stay healthy and prevent yourself from spreading the virus. Here’s what else you should know.

1. You can be cured of hepatitis C. If you test positive for HCV, the good news is that current treatments cure more than 90 percent of people and can also reduce the likelihood of complications, says Rosenthal. Even if you continue to use drugs, your odds of being cured are similar to those of people who don’t use drugs. Plus, by being cured, you can avoid transmitting the virus to others.

“In particular, people who inject drugs should be [treated and] cured of HCV, because decreasing the prevalence of HCV in an actively injecting population will decrease ongoing transmission, even in the setting of high-risk behaviors, such as sharing of injecting equipment,” says Rosenthal. Once you’re cured, you can’t infect someone else unless you get reinfected, she says.

2. Reinfection is possible but not a given. Yes, you can get the virus again, but preventive strategies can reduce your risk.

“Contaminated needles are the number one mode of transmission in the United States,” says Lauren Beste, MD, an associate professor of medicine at the University of Washington and the director of data and analytics for the Department of Veterans Affairs’ national HIV, hepatitis, and related conditions program. “For many reasons, the ideal is for people to stop injecting drugs altogether, but if that isn’t possible, then using sterile equipment — available through syringe service programs, safe injection sites, and so on — is an effective way to prevent transmission.”

Rosenthal encourages her patients who inject opioids to enroll in syringe service programs and offers medication, such as buprenorphine, which is used to treat opioid addiction. These strategies, especially in combination, can be effective in reducing the transmission of HCV in people who inject drugs, she says.

3. There are healthcare providers who want to help you. Maybe you’ve had a bad experience with a medical professional who judged you. Or maybe you’re anticipating a negative reaction from your doctor. Either way, you may be hesitant to seek care — a decision that could have a serious impact on your health.

“Unfortunately, many people who inject drugs have had negative experiences with healthcare providers in the past and are reluctant to seek care, because they have been judged or stigmatized as a result of their chronic disease,” says Rosenthal. “This kind of treatment of people who inject drugs is totally unacceptable but distressingly common.”

Not all healthcare providers are this way, and things are changing. The Association of American Medical Colleges is focusing more on educating future doctors about opioid use, for example.

“People who inject drugs should understand that they not only have a right to be treated, but they have a right to expect care that is nonjudgmental and respectful,” says Rosenthal. “My hope is that people who inject drugs can find providers who are compassionate and culturally competent and that they don’t let a negative interaction with the healthcare system dissuade them from receiving the care they need and deserve.”

4. Even if you don’t adhere perfectly to your treatment regimen, it's still likely to work. If you’re receiving treatment for hepatitis C, Dr. Beste says to take your medications as prescribed. But she also provides her patients with detailed instructions on what to do if they miss a dose. “Most importantly, you should not give up on the whole treatment just for missing one dose,” she says.

In fact, Rosenthal’s research, published in October 2020 in the journal Clinical Infectious Diseases, suggests that a large majority of people who inject drugs can be cured of HCV even with imperfect daily pill adherence or interruptions in treatment.

“I think these findings are particularly important for providers to be aware of, as many do not feel comfortable treating people who inject drugs, due to concerns regarding adherence,” says Rosenthal. “I also think it’s important for providers to understand that many people who inject drugs are perfectly adherent, even in the setting of ongoing drug use. Therefore, if a patient feels ready to start HCV treatment, they should not be prevented from receiving this lifesaving therapy.”

5. Treatment could change your life for the better. Beste says she wishes her patients were aware of how easy hepatitis C treatment has become and how much damage can result from a chronic infection, including liver failure or cancer. “Antiviral treatment is very doable, even if someone is actively using drugs,” says Beste. “Treatment involves only eight weeks of oral medication in most cases and can greatly reduce the chances of a liver-related complication later. I have even seen antiviral treatment become a catalyst for making other healthy decisions, too, like quitting drugs, alcohol, or tobacco.”