Hepatitis C: An In-Depth Guide


Supporting people on hep C treatment who are using drugs

Key points

  • Hepatitis C treatment is as effective for people who are actively using drugs as it is for people who are not.
  • Everyone who has hepatitis C is eligible for treatment, including people who use drugs.
  • It may be helpful for a person using drugs to have a support system throughout treatment. This may include peer support and access to harm reduction.

Hepatitis C treatment can be as effective for people who are actively using drugs as it is for people who are not. In both cases, successful treatment often depends on having the right support systems in place. However, few people who are actively using drugs (especially injection drugs) are currently receiving treatment, even though they are eligible.

There are several reasons for this. Often people are not aware of their treatment options or that treatment for hepatitis C even exists. Other times, a person may not be ready for treatment or it might not be a priority for them. And, sometimes, healthcare providers resist providing treatment to anyone who uses drugs. 

Separating myths from facts

Drug use in and of itself is not a barrier to successful Hep C treatment outcomes. International treatment guidelines for hepatitis C recommend hepatitis C treatment people who inject drugs.1

The decision not to provide hepatitis C treatment to anyone who uses drugs is often a decision made from misinformation or from a place of judgment. The following are some popular myths about hepatitis C treatment and people who use drugs, along with the facts according to research from Canada and around the world.

Myth: Treatment success rates are lower for people who are actively injecting drugs.

Fact: Studies from Canada and around the world have found similar rates of sustained virological response (SVR) between people who are and are not actively injecting drugs. In many of these studies, people had access to support from a multidisciplinary team that included healthcare and social support workers.

Myth: There is no point in treating a person who actively injects drugs because they will become re-infected.

Fact: The risk for re-infection can be low when people have the harm reduction knowledge and support, such as access to harm reduction materials necessary to prevent hepatitis C. See the Prevention in Focus article on Risks, realities and responses: Hepatitis C re-infection among people who inject drugs and HIV-positive MSM for more information.

There are real challenges to address

Hepatitis C treatment can be a challenge for anyone. However, certain challenges may be more serious for someone who uses drugs, such as the ability to manage side effects and adherence to the treatment regimen. Other challenges may include negative perceptions about treatment side effects, blood draws, needle biopsies, and healthcare providers. Lack of personal support systems can also be a challenge.

Addressing these challenges 

With effective care and the right supports in place, people can make more educated decisions about hepatitis C treatment. Treatment can be successful for those who choose to take it.

  • Talk to people with hepatitis C about treatment. The more information people have, the better they are able to make decisions about and prepare for treatment. A conversation about what treatment involves, the concerns a person has and plans to manage obstacles can boost confidence and ease fears.
  • Enlist a coordinated team. This team can include specialists, doctors, nurses, counselors, outreach workers, harm reduction programs, peer support and advocates.
  • Address mental health issues. Mental health conditions are often manageable with monitoring and referrals to counseling or psychiatric care when it is appropriate.
  • Develop a plan to manage side effects.
  • Identify and link people to resources such as stable housing and healthy food sources. Adherence to the treatment regimen is easier when a person’s basic needs are met.
  • Help people identify potential allies such as family, friends, harm reduction workers and employers.
  • Promote peer support before, during and after treatment. Peers can provide many types of support, such as accompanying people to medical appointments, sharing experiences and coping strategies, and providing emotional support.  
  • Promote and support harm reduction before, during and after treatment. Let people know that they can seek out harm reduction education without being judged or punished. For more information on safer drug use during treatment, see Hep C treatment, street drugs and alcohol.

Resources for service providers

Resources for clients

Revised 2018.



  • 1. Grebly J, et al. Recommendations for the management for hepatitis C virus infection among people who inject drugs. International Journal of Drug Policy. 2015; 26: 1028-1038.