Treating both hepatitis C and substance use disorders: what you need to know

Hepatitis C is a liver infection that you can pass on through contact with blood that carries the hepatitis C virus (HCV). Although young people who inject drugs are often the most likely to be infected, fewer 5 percent of this population is receiving treatment for hepatitis C.

Prompt treatment is important to prevent cirrhosis, liver cancer, and liver failure. Treatment also significantly lowers the chances that people with hepatitis C will pass the infection on to others.

Taking direct-acting antivirals (DAAs) for 12 weeks can usually cure most people with hepatitis C. Yet many people who need this treatment do not get it due to stigma, lack of insurance and other obstacles.

Finding the right treatment program — one that addresses both substance use and hepatitis C — is usually the best way to cure hepatitis C, prevent complications, and avoid spreading the infection.

Almost three quarters new hepatitis C infections are occurring among people who inject drugs. But this group often does not receive diagnoses or treatment, even though they may have as good treatment outcomes as people who do not inject drugs.

A small study 2021found that several barriers prevent people with substance use disorders from obtaining treatment for hepatitis C, including:

  • a lack of knowledge about hepatitis C and its treatments
  • stigma surrounding disease and drug use
  • a lack of referrals to specialists for treatment
  • fear that the treatment will not work

Mental health issues can also be barriers to treatment, and they tend to be more common among people who inject drugs. Having a mental health issue can often make it more difficult to maintain a treatment program. And some of the drugs that treat mental health issues interact with hepatitis C drugs.

Bias among physicians is another problem. Some doctors will not offer DAAs to people who actively use drugs because they believe that this population will not follow their treatment plan or will be re-infected after treatment. Yet studies show that people who inject drugs adhere to their hepatitis C treatment and have low rates of reinfection.

Cost is also a barrier to treatment. The full 12-week DAA course costs between $27,000 and $47,000. This price may be unaffordable for anyone without health insurance coverage.

State laws can also impede access to treatment. Research shows that in 2020, there are still 13 states with Medicaid programs that require a certain period of abstinence from injection drugs — ranging from 1 to 6 months — before qualifying for hepatitis C treatment.

Additionally, Medicaid may require you to take a drug test before covering your hepatitis medications. The embarrassment of having to undergo a drug test prevents some people from seeking treatment.

Treatment is usually very effective in preventing cirrhosis and other complications of hepatitis C, whether or not you use injection drugs. Taking a DAA can also prevent you from passing the infection on to someone else.

Sustained virological response (SVR) is the measure doctors use to see if treatment is working. You have SVR when blood tests show no virus 12 weeks or more after you finish treatment.

The average SVR rate for people taking DAAs is 95%. SVR rates among people who inject drugs are also close to 95%.

Because hepatitis C often does not cause symptoms, you may not know if you have it unless you get tested. If you use or have used injection drugs, a blood test called an HCV antibody test can tell if you have hepatitis C.

It may be helpful to get your test at a center that also offers treatment for Hepatitis C. Then, if you test positive, you can get advice and treatment advice from the same place.

There are inpatient and outpatient addiction treatment centers across the country. Some of them offer free or low cost services. The Substance Abuse and Mental Health Services Administration has a directory of agencies in each state to help you with your research.

An effective program can treat both hepatitis C and substance use disorders. Finding a drug treatment center that treats both conditions can increase your chances of reaching your treatment goals.

In a 2022 study, 110 people receiving drug treatment also received treatment for hepatitis C and their hepatitis C was cured. Participants said they found it helpful to go to treatment while pursuing substance abuse treatment and in various stages of recovery.

You do not need to stop taking medication to be treated for hepatitis C, but if you continue to use it, it will be harder for you to remember to take your medication. And you may not be able to achieve SVR if you skip doses.

Although it usually takes 12 weeks to fully cure hepatitis C, the process may take longer for people who use injection drugs. You will need time to build a relationship with your treatment team and find a treatment plan that works for you and your particular situation.

It is rare to get re-infected with hepatitis C after treatment has finished, but it can happen if you continue to use drugs and share needles. If you have a reinfection, you can get treated again.

One way to reduce the risk of reinfection after treatment is to use a clean needle for each injection. If the substance you are injecting is an opioid, drugs such as methadone or buprenorphine can help reduce cravings and prevent further opioid use.

Injection drug use increases the risk of hepatitis C. Many people with substance use disorders do not receive treatment for hepatitis C due to stigma and other barriers. Participating in a program that treats both substance use disorders and hepatitis C can help treat both conditions at the same time and prevent you from having liver complications.

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