Hepatitis C: An In-Depth Guide

Safer drug and alcohol use during Hep C treatment

People often ask, “Can I use drugs or alcohol while I’m on Hep C treatment?” The answer to the question isn’t simple and can depend on how people are using these substances.

Some people can manage Hep C treatment while they are using drugs or alcohol. For some other people, stopping or cutting down has helped them prepare for and complete treatment.

Everyone’s situation is different and treatment can still be possible while people are using drugs or alcohol.

Working with a doctor

Some doctors do not want to treat people with Hep C who are using drugs. In the Canadian hepatitis C treatment guidelines, active drug use is not considered a valid reason to deny treatment to someone.

Some of the reasons that doctors may not want to treat a person who uses drugs is a fear that the person will get re-infected or will find it hard to stick to the treatment routine. They also may be concerned that the drugs will interact with Hep C medications.

Street drugs and Hep C treatment

There’s not a lot of information about how street drugs (such as heroin, crack, crystal meth or speed) affect the liver or how Hep C medications and street drugs interact with each other.

Avoiding an overdose

Some Hep C medications can boost the effect of street drugs. To reduce the chance of an overdose, it is a good idea to use a smaller amount of street drugs during the first few weeks or months of Hep C treatment and see how that feels. A smaller hit may have the same effect during treatment that a full hit used to have.

Getting naloxone (Narcan) training, if it is available, and using with a trusted person can also help prevent an overdose.

Recovery and Hep C treatment

Since one of the medications for Hep C—peg-interferon—is taken by injection, some people who quit using injection drugs or are trying to quit or cut back their use feel uncomfortable or triggered by the needles.

One strategy to manage this situation is to ask a doctor or nurse to give the peg-interferon injection.

Also, some of the side effects from Hep C medications can feel a lot like withdrawal. Talking with a healthcare provider about tips for coping with the side effects can help.

Opioid substitution therapy (methadone, buprenorphine) and Hep C treatment

Generally, methadone and buprenorphine are safe for the liver. People on these opioid substitution therapies are often able to complete Hep C treatment.

For some people, the medications for Hep C make them feel like they’re going through withdrawal and their methadone dose needs to be adjusted so they’re comfortable.

For others, the Hep C medications make their body more sensitive to methadone and they need a smaller amount of methadone.

Hep C medications may also increase or decrease the amount of buprenorphine in the body, so a person may need to have their buprenorphine dose adjusted after starting treatment.

Marijuana (pot)

Smoking pot may come with some risks but also some benefits for people living with hepatitis C.

Some people want to avoid pot because it may cause liver damage. For others, using pot has helped them to manage their side effects and stay on Hep C treatment. For more information, see What effect does marijuana (pot) have on hepatitis C?


Hep C treatment has a better chance of working if a person can cut back on or stop drinking alcohol. Alcohol makes it harder for Hep C medications to clear the virus. Alcohol can also make it more difficult to follow the treatment routine. Harm reduction strategies that may be helpful are:

  • Setting a drinking goal and trying to stick to it.
  • Spacing out alcoholic drinks with non-alcoholic drinks such as water, juice or pop.
  • Switching to smaller drinks or drinks with lower alcohol content (a 3% beer instead of 5%, for example).
  • Watering down hard alcohol by mixing it with juice, soda pop or water.
  • Seeking support through a support group, addiction treatment or counselling.

Revised 2014.