Hepatitis C and Injection Drug Use: Harm Reduction Strategies

Hepatitis C is a viral infection that primarily affects the liver and can lead to serious health complications if left untreated. One of the most common ways that hepatitis C is transmitted is through the sharing of needles or other equipment used to inject drugs. In fact, injection drug use is the leading cause of new hepatitis C infections in the United States. In this blog post, we'll explore the link between hepatitis C and injection drug use, and discuss harm reduction strategies that can help reduce the risk of transmission and protect the health of people who inject drugs.

The Risks of Hepatitis C Transmission Through Injection Drug Use

When a person injects drugs, there is a risk of exposure to blood-borne infections like hepatitis C if the equipment used to inject is shared with others. This can occur through several different mechanisms:

1. Sharing needles or syringes: If a needle or syringe that has been used by someone with hepatitis C is shared with another person, even a tiny amount of blood remaining in the equipment can transmit the virus.

2. Sharing other injection equipment: Other equipment used in the injection process, such as cookers, cotton, or water, can also become contaminated with hepatitis C and transmit the virus if shared.

3. Inadequate cleaning of equipment: Even if needles or syringes are not directly shared, inadequate cleaning of injection equipment between uses can allow the hepatitis C virus to survive and be transmitted to the next person who uses the equipment.

4. Backloading: This is a practice where one syringe is used to prepare the drug solution, which is then divided into one or more other syringes. If any of the equipment is contaminated with hepatitis C, the virus can be transmitted to all of the people who inject the shared solution.

Given these risks, it's essential for people who inject drugs to take steps to protect themselves and others from hepatitis C transmission.

Harm Reduction Strategies for People Who Inject Drugs

Harm reduction is a public health approach that seeks to minimize the negative consequences associated with drug use, while respecting the rights and dignity of people who use drugs. In the context of hepatitis C prevention, harm reduction strategies aim to reduce the risk of transmission and connect people who inject drugs with testing, treatment, and support services.

Some key harm reduction strategies for preventing hepatitis C transmission through injection drug use include:

1. Access to sterile injection equipment: Providing people who inject drugs with access to sterile needles, syringes, and other injection equipment through syringe services programs (SSPs) or pharmacies can greatly reduce the risk of hepatitis C transmission.

2. Education on safer injection practices: Teaching people who inject drugs about the risks of sharing equipment, the importance of using sterile equipment for each injection, and proper techniques for cleaning equipment can help reduce the risk of transmission.

3. Testing and linkage to care: Offering regular hepatitis C testing for people who inject drugs, and connecting those who test positive with medical care and treatment, can help identify infections early and prevent the spread of the virus.

4. Medication-assisted treatment (MAT): Providing access to MAT, such as methadone or buprenorphine, can help reduce injection drug use and the associated risks of hepatitis C transmission, while also supporting recovery from addiction.

5. Overdose prevention: Providing education on overdose prevention and access to naloxone, a medication that can reverse opioid overdoses, can help reduce the risk of overdose death and create opportunities for engagement in hepatitis C prevention and treatment services.

Addressing Stigma and Barriers to Care

Despite the clear public health benefits of harm reduction strategies for preventing hepatitis C transmission among people who inject drugs, there are often significant barriers to accessing these services. Stigma, discrimination, and criminalization of drug use can make it difficult for people who inject drugs to seek out testing, treatment, and support services for fear of judgment or legal consequences.

Addressing these barriers requires a multi-faceted approach that includes:

1. Educating healthcare providers and the public about the principles of harm reduction and the importance of treating people who use drugs with respect and compassion

2. Advocating for policies that prioritize public health over criminalization, such as decriminalization of drug possession and expanded funding for harm reduction services

3. Collaborating with community organizations and people who use drugs to design and implement harm reduction programs that are responsive to the needs and preferences of the community

4. Providing low-barrier, non-judgmental services that meet people who inject drugs where they are and address their comprehensive health and social needs

PROTECTING THE HEALTH OF PEOPLE WHO INJECT DRUGS

Preventing hepatitis C transmission among people who inject drugs is a critical public health priority that requires a harm reduction approach grounded in respect, compassion, and evidence-based practices. By providing access to sterile injection equipment, education on safer injection practices, testing and linkage to care, medication-assisted treatment, and overdose prevention services, we can reduce the harms associated with injection drug use and support the health and well-being of this vulnerable population.

If you or someone you know is injecting drugs and needs access to harm reduction services or hepatitis C testing and treatment, contact me to schedule a confidential consultation. As a healthcare provider committed to providing non-judgmental, evidence-based care for people who use drugs, I am here to help you access the services and support you need to stay safe and healthy.

Remember, seeking help for drug use or hepatitis C is a sign of strength, not weakness. By taking steps to protect your health and the health of others, you are making a positive difference in your life and in your community.

Most With Hepatitis C May Soon Find Hope in New Treatments

This is fascinating.  I love the world of medicine!  -- Dr. Dale. -----

Most With Hepatitis C May Soon Find Hope in New Treatments

Two studies suggest pill cocktails may one day replace injections altogether

WebMD News from HealthDay

By Mary Brophy Marcus

HealthDay Reporter

WEDNESDAY, Jan. 15, 2014 (HealthDay News) -- Hepatitis C treatment isn't pretty, but the dark days of weekly injections, rough side effects and no guarantee of full recovery from the liver-damaging disease may soon be over, researchers report.

Two studies, both published in the Jan. 16 issue of the New England Journal of Medicine, involved giving various combinations of antiviral pill cocktails to patients with hepatitis C. Some had failed to respond to standard treatments, and some had not received treatment yet. Yet, the cocktails cleared the virus in both studies for between 93 percent and 98 percent of the patients.

These cocktails are game-changers for the illness, said Andrew Muir, director of gastroenterology and hepatology research at the Duke Clinical Research Institute.

"This has made me change the way I'm talking with patients. These regimens are essentially going to cure everybody," said Muir, who has conducted related research but did not participate in these studies. "I had a patient in my office this morning who said, 'If I get cured,' and I said to him, 'When you get cured,'" Muir added.

Continue reading below...

"I think the great thing about these new direct-acting antivirals is that with the right combinations of drugs, all patients appear to be cured," said Muir.

The first study, conducted by Johns Hopkins researchers, included 211 men and women with hepatitis C who took two pill-form antiviral medications, daclatasvir and sofosbuvir. The patients were treated at 18 medical centers in the United States and Puerto Rico. They took 60 milligrams of daclatasvir and 400 milligrams of sofosbuvir for either 12 or 24 weeks, with or without a third drug, ribavirin.

The scientists reported that the experimental drugs were safe and effective in the patients, even those who'd had earlier standard therapy for hepatitis C virus -- interferon shots and two other medications.

"We saw a very high response rate in those who got the two [new] medications. This study paves a path forward for interferon-free regimens. These drugs are potentially highly effective and tolerable," said study author Dr. Mark Sulkowski, medical director of the Johns Hopkins Center for Viral Hepatitis.

Sulkowski said 98 percent of the 126 previously untreated patients and 98 percent of 41 patients whose infections had not cleared despite treatment with standard hepatitis C therapy, were considered cured. "There was no detectable virus in their blood three months after the treatment stopped," he noted.

The U.S. Food and Drug Administration approved sofosbuvir in combination with peginterferon and ribavirin this past December for one form of hepatitis C, and daclatasvir is still in the approval process, Sulkowski said.

According to the U.S. Centers for Disease Control and Prevention, 3.2 million people in the United States have chronic hepatitis C infection. The virus is silent early on, but over two or three decades it can lead to severe liver damage, sometimes requiring a liver transplant. It's the leading cause of liver transplants in the United States.

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Up until now, injectable interferon has been the key form of treatment, usually combined with antiviral medications, said Sulkowski, but many patients can't tolerate the side effects of the interferon, which can include flu-like symptoms, nausea, fatigue, anxiety and depression.

The second study, headed up by researchers at Virginia Mason Medical Center in Seattle, involved more than eight medical centers in the United States and internationally. It included 571 patients with hepatitis C, some of whom had not received treatment previously and others who had previously received standard treatments with interferon injections and ribavirin -- an antiviral drug that when given reduces relapses -- but had not responded to them.

The participants were randomly assigned to take any of three combinations of antiviral pills -- medications called ABT-450, ABT-267, and ABT-333 -- for eight, 12 or 24 weeks.

Almost all of the patients (more than 93 percent in both groups) saw the virus cleared from their systems within 24 weeks, said lead author Dr. Kris Kowdley, director of the liver center of excellence in the Digestive Disease Institute at Virginia Mason.

"Even in patients with prior no-response, a difficult-to-treat population with interferon, this all-oral regimen for 12 weeks can achieve a cure in the vast majority of patients. It is safe and well-tolerated," said Kowdley. "It really changes the paradigm for treatments."

Dr. Anna Lok, director of clinical hepatology at the University of Michigan Medical School, and a co-author on the Hopkins study, said, "These two regimens have excellent safety profiles." But she noted, the drugs are expensive, up to thousands of dollars per treatment course.

"Cost is an issue, and will make these treatments not accessible to many patients," said Lok.

Drug makers funded both studies, but Lok noted, "They scrutinize the data carefully and these data will be scrutinized by the FDA also, so I would trust the data presented."

Muir said the next step is to keep pushing for better hepatitis C screening, so that patients can receive treatments before their livers fail. "Anybody we can catch when they have stable liver disease, we can help," he said.

http://www.webmd.com/hepatitis/news/20140115/most-with-hepatitis-c-may-soon-find-hope-in-new-treatments

Living With Hepatitis C: Truths Unveiled

7/11/13 Hello Friends,

I want to spend a little time breaking down Hepatitis C and explain different preventative measures.

Our body is made of complex systems with the ability to heal itself. However, certain factors reduce its capacity to protect, making it vulnerable to certain illnesses. One example of this is the liver. This organ is known to filter all toxins that get inside our body. It’s one of the body’s most tolerant organs since it doesn’t show symptoms of health problems until the illness has progressed to its latter stage. And one health threat that commonly hits the liver is Hepatitis C.

What is Hepatitis C?

This illness is caused by a virus which greatly affects the liver. And if the filtering organ of our body is defective; other vital body systems will also suffer. Hence, if you have this illness, you will also experience jaundice, itching, loss of appetite, dark colored urine, abdominal swelling, right upper abdominal pain, clay colored stool, nausea and vomiting. Your kidney, autoimmune system, skin and circulatory systems will also suffer. Hence remote cases of Hepatitis C suffer complications which include:

• Lymphoma
• Essential mixed cryoglobulinemia
• Monoclonal gammopathy
• Autoimmune thrombocytopenic purpura
• Sialadenitis
• Thyroid illnesses
• Necrolytic acral erythema
• Porphyria cutanea tarda
• Lichen planus
• Leukocytoclastic vasculitis
• Porphyria cutanea tarda
• Membranoproliferative glomerulonephritis
• Diabetes Mellitus
• Osteoclorosis
• Eye disorders

Preventive Measures

The good news is; Hepatitis C can be prevented. Hence, if you have it, do all measures to prevent it from spreading. And for those who are still devoid of this illness, be cautious enough so as not to contact the disease. Since this can be spread through blood contact, be careful when handling blood and needles. Use your own razor and toothbrush and have a monogamous relationship. You need to know that Hepatitis C cannot be passed on through breastfeeding, sharing of utensils, coughing, holding hands and even kissing. Hence, you don’t have to outcast Hepatitis stricken individuals from the society. They too deserve to live a good quality life like you do.

Is Hepatitis C Curable?

People who are diagnosed with this illness have one common question in mind. They want to know if their illness is curable. This is considering the fact that medicines are already available such as antiviral drugs and peginterferon. These are touted to help to get rid of Hepatitis C virus from the body’s system. These are also taken to lower the chances of developing liver cirrhosis and liver cancer at the latter part of the illness. Unfortunately, these medicines do not totally cure the illness but are there just to manage the symptoms and further progression of the disease. Records show that some individuals reacted positively to these drugs when Hepatitis C virus is undetectable on the person’s blood. Since Hepatitis C is incurable, management is centered to the prevention of further complications thereby preserving the person’s health as much as possible.

If you have been diagnosed with Hepatitis C, you need to know that life doesn’t stop at the time you know that you have the illness. By living a healthy lifestyle and doing all you can to preserve your liver’s health, you can prevent possible complications of the disease.

-- Dr. Dale