Curing Hepatitis C: What you need to know if you use drugs

Contents

Do you have hepatitis C? Do you use drugs?

If you answered yes, this booklet is for you.

Keep reading!

Lots of people have hepatitis C. Hepatitis C is passed through blood-to-blood contact. A common way to get hepatitis C is through sharing equipment for using drugs.

This includes sharing needles, syringes, filters, washes, water and cookers used for preparing or injecting drugs, pipes or stems and mouthpieces for smoking drugs, and rolled paper or straws for snorting drugs.

If I am still using drugs, can I get treated for hepatitis C?

Yes! You can still get high and be treated and cured for hepatitis C. You can also be treated and cured if you drink alcohol. Treatment for hepatitis C can help your health.

You deserve respectful care by doctors, nurses and other health workers. Ask harm reduction workers or other people who use drugs about which nurses and doctors are good to work with.

What is hepatitis C?

Hepatitis C is a virus that injures the liver. The injury often happens slowly over a long time. You can live for many years with hepatitis C and not know you have it because you don’t feel sick or have any symptoms. Over time, hepatitis C can make you very sick.

There are six different strains (genotypes) of the hepatitis C virus and they can all be cured.

Does everyone need hepatitis C treatment?

About one in four people clear hepatitis C on their own (spontaneous clearance), but most people need treatment to cure hepatitis C. When someone doesn’t clear the virus within the first six months, they have a chronic hepatitis C infection.

If you have been diagnosed with chronic hepatitis C, you need treatment to be cured. Speak with a nurse or doctor about your treatment options.

What is hepatitis C treatment?

Hepatitis C treatments are highly effective and cure over 95% of people with hepatitis C. Treatment works just as well if you are using drugs. You don’t have to stop using drugs to start treatment.

Treatment means taking pills, usually for 8 or 12 weeks.

For most people, treatment means taking one to three pills once a day.

How much will it cost me to get treated?

Most people don’t pay out of pocket. The cost of treatment is covered through public health insurance plans (provincial, territorial or federal).

If you have private insurance from a job, your plan should cover the cost of treatment.

Speak with a nurse or doctor about your options.

How does being cured help me?

  • The hepatitis C virus can no longer injure your liver. Treatment also prevents liver failure and lowers your chances of getting liver cancer.
  • The health of your liver may get better over time.
  • You may have more energy or less body pain. For many people, quality of life gets better.
  • You cannot pass the hepatitis C virus to other people.

How does hepatitis C treatment work?

  • Hepatitis C treatment stops the virus from making copies of itself, and over the weeks of treatment, the virus is cleared from your body.
  • The type of treatment you get is not affected by your use of drugs.
  • Another medicine called ribavirin may be added to your treatment if your liver is severely injured.
  • A nurse or doctor will help you choose the best treatment for you. The goal is to make treatment safe, effective and tolerable.
  • After being cured, you will still test positive for  antibodies to the hepatitis C virus for the rest of your life. This does not mean that you have hepatitis C.

What if I am pregnant or planning a pregnancy?

  • Treatment is generally not recommended during pregnancy. There is not a lot of information on the effects of treatment during pregnancy. Research is being done on hepatitis C treatment during pregnancy so this may change in the future.
  • Treatment that includes ribavirin can cause severe birth defects and must not be taken during pregnancy. Ribavirin should not be used by either partner for at least six months before trying to get pregnant.
  • Use birth control if you are having sex that can lead to pregnancy.
  • Talk to a nurse or doctor about your treatment options and when to start treatment.

How can I prepare to start and stay on treatment?

To give your treatment the best chance of working, you need to take all your pills, every day, as prescribed by your nurse or doctor.

It is very important that you complete the entire course of your treatment.

Part of getting ready for treatment is setting up the supports you’ll need to stick to treatment. Work with a nurse or doctor to add your treatment to your daily routine.

Here are some tips that may help with treatment:

  • Do a “dry run” before starting treatment. Practise your treatment routine using candies or mints.
  • Take your pills at the same time as you do a daily activity, like brushing your teeth or eating breakfast.
  • If you are already taking opioid substitution therapy, it can be helpful to take your hepatitis C treatment pills at the same time.
  • Get a tool that can help keep track of your pills, for example, using a blister pack, daily dosage pill container, an app or a diary.
  • A digital alarm can help remind you to take your pills.
  • Identify a support network of family, friends, service providers and supportive people. Reach out to them about any concerns you have about sticking to treatment and try to come up with a plan together.
  • Be as honest as you can with your nurse or doctor about all the drugs you are taking. This information can be helpful for your treatment and support plan. It doesn’t mean you have to stop your drug use before starting treatment.
  • Find out about the harm reduction services near you. This might be a supervised consumption site, overdose prevention site or needle and syringe program. These places can give you information on how to use drugs more safely and how to prevent an overdose. They can also provide harm reduction supplies and other supports.
  • Speak with someone who has taken or is currently taking hepatitis C treatment while using drugs.

What should I expect with treatment?

  • Before treatment, your nurse or doctor will usually ask you about your health history and do some tests to measure your liver health. These tests may include blood tests, an ultrasound or a FibroScan (which measures liver health using ultrasound waves).
  • Speak with your nurse or doctor about:
    • Any health conditions you have and any medicines, drugs or supplements you take.
    • How often you will speak with your healthcare team during treatment.

This information helps you and your nurse or doctor choose the best treatment for you and the best way to support you during treatment.

Are there any side effects with treatment?

For most people, hepatitis C treatment causes only mild side effects, which usually decrease or stop a few weeks after starting treatment. The most common side effects include headache, feeling more tired than usual, stomach upset and diarrhea.

You may not experience any side effects, or you may get only one or a few side effects.

Speak with your nurse or doctor if you want support to manage your side effects.

  • A blood test is done 12 weeks after you finish your treatment to check if you are cured of hepatitis C.
  • If you are not cured of hepatitis C, you will need to be re-treated. Speak with your nurse or doctor about your options.

What if I have bad veins and need to get a blood test?

You will need to do blood tests when you get hepatitis C treatment and to find out if you are cured. Getting blood tests can be difficult if you have bad veins, but there are things you can do to make the tests easier:

  • Drink two or three glasses of water one to two hours before your test.
  • Bring a friend for support.
  • Show the nurse or doctor your best veins.
  • Warm your body by taking a shower and wearing warm clothes to your blood test.
  • Speak with your nurse or doctor about other ways to make the blood tests easier.

Will treatment make me more likely to overdose?

Some hepatitis C treatment can change the effects of the drugs you use, which can contribute to an overdose. If you use drugs after you start hepatitis C treatment, start slowly and use with someone you trust.

Naloxone helps reverse an opiate overdose and can save someone’s life. If naloxone is available and you want to learn how to use it, talk to a harm reduction worker about how to get training.

How can I stay healthy after being cured?

1. Prevent re-infection

  • After you are cured, you can get hepatitis C again.
  • Use new drug equipment every time you use, including needles, syringes, filters, washes, water and cookers. Use your own pipe or stem, mouthpiece, and rolled paper or straws when smoking or snorting drugs.
  • Use condoms and lube if you are having sex that has a higher chance of hepatitis C transmission.
  • Sexual transmission of hepatitis C is not common. Transmission through condomless anal sex between men is rare and transmission through heterosexual sex is very rare. Your risk of getting re-infected increases if you have HIV and/or a sexually transmitted infection. Your risk also increases with sex where blood is present and with chemsex (using specific drugs to enhance and prolong sex).
  • Speak to your nurse or doctor about regular testing for re-infection.
  • If you get hepatitis C again, you will need to be treated again if you don’t clear the virus on your own (spontaneous clearance). Discuss your treatment options with your nurse or doctor.

2. Monitor liver cirrhosis

  • Cirrhosis is a very severe form of liver injury, which can be caused by the hepatitis C virus over time.
  • If you have cirrhosis, you will need to get checked for liver cancer regularly. This usually means getting a liver ultrasound every six months.
  • Drinking alcohol is hard on the liver. If you have cirrhosis, it is helpful to stop or reduce the amount of alcohol you drink.

3. Protect your liver from hepatitis A and B

  • Get vaccines against hepatitis A and B, if you haven’t been vaccinated already. Discuss this with your nurse or doctor.

Acknowledgements

Writing team: Stephanie Ofoegbu, Melisa Dickie, Zak Knowles, Rivka Kushner

Copyediting: Jennifer Thomas

Design and layout: Pam Sloan Designs

CATIE is grateful to the Toronto Community Hepatitis C Program and Elevate NWO for their help in the development of this booklet. Special thanks to Jennifer Broad, Paula Tookey, and Keith Williams of the Toronto Community Hepatitis C Program who facilitated consultations and provided valuable feedback throughout the development process. We also thank Bernadette Lettner and Lila Desjardine for their review and input.

Production of this publication has been made possible through financial contributions from the Public Health Agency of Canada (PHAC) and the Ontario Ministry of Health and Long-Term Care. The views expressed herein do not necessarily represent the views of our funders.