Supporting people with hepatitis C treatment who are using drugs

Key points

  • Hepatitis C treatment is as effective for people who are actively using street drugs as it is for people who are not.
  • Canadian and international hepatitis C treatment guidelines recommend hepatitis C treatment for people who inject 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.
  • Education on overdose prevention and naloxone use also important.

Hepatitis C treatment is as effective for people who are actively using street drugs as it is for people who are not. In both cases, successful treatment often depends on having the right support systems in place.

Drug use in and of itself is not a barrier to successful hepatitis C treatment outcomes. Canadian and international hepatitis C treatment guidelines C recommend hepatitis C treatment for people who inject drugs. Active drug use alone is not a justifiable reason to deny a person hepatitis C treatment. The decision not to provide hepatitis C treatment to anyone who uses drugs is often made because of misinformation or from a place of judgment.

Studies from Canada and around the world have found similar cure rates between people who are injecting drugs and people who are not injecting drugs. In many of these studies, people with active drug use had access to support from a multidisciplinary team that included healthcare and social support workers.

Concerns about hepatitis C re-infection

It is possible for a person who is cured of hepatitis C, either because their body spontaneously cleared the virus or because they received treatment, to get hepatitis C again (re-infection) if they are exposed to the hepatitis C virus.

The risk of hepatitis C re-infection can be low when people have harm reduction knowledge and support. This includes access to harm reduction resources to prevent re-infection, such as new drug use equipment.

Considerations in supporting clients who are actively using drugs through hepatitis C treatment

For any person, whether or not they are using drugs, hepatitis C treatment can be straightforward and simple or it can be a challenge. Certain considerations may be important for someone who uses drugs, such as the ability to manage side effects and adhere to the treatment regimen. Other considerations may include negative perceptions about treatment side effects, blood draws and healthcare providers. Lack of personal support systems can also be a challenge.

With effective care and the right supports in place, people can make more educated decisions about hepatitis C treatment and people who use drugs can receive the support they need to successfully complete treatment and be cured of hepatitis C.

Here are some ways to support clients who are using drugs through hepatitis C treatment:

  • Talk to clients about hepatitis C treatment. The more information people have, the better they are able to make decisions about treatment and to 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 workers and advocates.
  • Help clients identify potential allies such as family, friends, harm reduction workers and employers.
  • Address mental health issues. Mental health conditions are often manageable with monitoring and referrals to counselling or psychiatric care when appropriate.
  • Identify and link clients to resources such as stable housing and healthy food sources. Adherence to treatment is easier when a person’s basic needs are met.
  • Develop a plan to manage side effects. Side effects are generally mild or moderate and diminish or stop after a few weeks.
  • 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 and resources without being judged or punished. For more information on safer drug use, see Prevention and harm reduction.

Avoiding a drug overdose

Talk to clients about the risk of overdose from street drugs and give them tips to prevent an overdose. Tips include:

  • using with at least one other person or using an overdose prevention site
  • trying a small amount first – the drug supply is unpredictable and always changing
  • avoiding mixing substances, such as alcohol or prescription drugs
  • having an overdose plan – carrying naloxone and knowing how to use it

Encourage clients to get training on how to use naloxone, which is an antidote to an opioid overdose, and connect them with training opportunities. There is no antidote to a stimulant overdose.

Resources for service providers

Resources for clients

Revised 2020.