HCV treatment and drug users (IDUs)
Hepatitis C treatment has traditionally been withheld from injecting drug users, even though current treatment guidelines recommend that treatment decisions be made on a case-by-case basis. Fortunately, this has begun to change.
Experience in HIV treatment confirms that it is possible for drug users to adhere to ARVs, and response rates from clinical trials of HCV treatment in IDUs are similar to those reported in non-users.
- Try not to miss medical appointments,since some doctors will use this as partof the criteria for not treating your HCV.
- Don’t avoid medical carebecause you are using. This is especially important while you are onHCV treatment, because your doctor won’t be able to monitor and treat your side effects.
- If you are on methadone, wait to taperor stop after treating HCV. Sometimes people find that methadone helps them through treatment, and may choose toincrease the dose to help with side effects.
- It is important to find a doctor whois willing and able to work with drugusers and who will treat your HCV.
- Asking other drug users to recommenda doctor –or to steer you away from one—may be a good place to start.
- Discuss side effects of HCV treatmentwith your doctor, and ask how they will bemanaged. If you need pain medication or other medications with abusepotential, discuss this with yourdoctor. Make an agreement on howthe two of you will handle this.
Depression and other mental health diagnoses are much more common among people with HCV, people with HIV, and drug users than the general population. Many of these conditions are treatable.
People with a history of depression are more likely to develop depression during HCV treatment. Depression can also happen to people who have not been depressed in the past. If you are concerned about the psychiatric side effects of HCV treatment, but want to treat your hepatitis C, consider support from mental health care services.
Some people can manage HCV treatment while they are using drugs. Others have found that stopping or cutting down on drug use has helped them to prepare for, and stay on HCV treatment.
This could be from a self-help programme, counselling, drug treatment, or heroin substitution, methadone maintenance, naltrexone implants, or using buprenorphine.
Increasing the dose of methadone has helped people manage side effects of HCV treatment.
If you are still injecting drugs, ask your doctor or local syringe exchange programme for information on safer injection to lower your risk of HCV reinfection (and other infections).
Concerns for people in recovery
Many people fear that they will relapse to active drug use, because the symptoms of interferon are very similar to opiod withdrawal.
The risk of relapse is lower when side effects are promptly and effectively treated and when counselling and support from peers and medical and mental health providers is available.
Some people are concerned about self-injecting PEG interferon. If possible, injections can be given once weekly by a nurse to avoid triggering a relapse to injection drug use.