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

You can still use drugs and be treated for and cured of hepatitis C.

You deserve respectful care.

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, even if the amount of blood is so small that you can’t see it. A common way to get hepatitis C is through sharing equipment for using drugs.

This could include sharing needles, syringes, filters, water, cookers and tourniquets used to prepare or inject drugs, pipes or stems and mouthpieces used to smoke drugs, and rolled paper, straws or other supplies used to snort drugs.

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

Yes! You can still use drugs and be treated for and cured of 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 an infection in the liver caused by the hepatitis C virus. Over time, the virus injures the liver and can make you very sick. 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, even though the virus is injuring your liver.

The only way to know if you have hepatitis C is to get tested.

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. If someone doesn’t clear the virus after 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 treatment is highly effective and cures 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 eight 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 may 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.
• Using drugs does not change the type of treatment you get.
• 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, planning a pregnancy or breastfeeding (chestfeeding)?

• Treatment is generally not recommended during pregnancy, when trying to get pregnant or while breastfeeding (chestfeeding). There is not a lot of information on the effects of treatment during pregnancy or while breastfeeding (chestfeeding). 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:

• Take your pills at the same time as you do a daily activity, like brushing your teeth or eating breakfast.
• 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.
• Ask your doctor, nurse or pharmacist about daily or weekly dispensing of treatment to help keep track of pills.
• If you are already taking opioid agonist therapy (like methadone or Suboxone) or safe supply, it can be helpful to take your hepatitis C treatment pills at the same time.
• 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 or reduce 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 (legal or illegal) 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 retreated. Speak with your nurse or doctor about your options.

How can I stay healthy after being cured?

1. Prevent reinfection

• After you are cured, you can get hepatitis C again.
• Use new equipment every time you use drugs, including new needles, syringes, filters, sterile water and cookers for injecting drugs. Use your own pipe or stem and mouthpiece for smoking drugs, and your own rolled paper, straws or other supplies when snorting drugs.
• Hepatitis C transmission during sex is not common. The risk increases if you use drugs before or during sex, if you have condomless anal sex or group sex, if you have sex where blood might be present, or if you or your partner(s) have HIV or another sexually transmitted infection.
• Use condoms and lube if you are having sex that has a higher chance of hepatitis C transmission.
• Speak to your nurse or doctor about regular testing for reinfection.
• 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 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.

4. Staying healthy after being cured is about more than preventing hepatitis C and protecting your liver.

• Connect with harm reduction services near you, such as a supervised consumption site, overdose prevention site or needle and syringe program. These places can give you information on safer drug use and responding to an overdose, and they can help to connect you to other supports and services.
• Have an overdose plan. Try to not use alone. Ask someone to check in on you when you’re using or use at a supervised consumption or overdose prevention site to prevent a fatal overdose. Carry naloxone, know how to use it and let others know you have it.
• Reach out to your healthcare provider about other health concerns you may have or other supports you may need.

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:

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