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Safer substance use and hepatitis C prevention

Key points

  • Hepatitis C can be passed between people if drug use equipment is shared or reused by another person. This includes equipment used for injecting, smoking or snorting drugs and other substances.

  • Safer substance use refers to a range of practices that can prevent hepatitis C transmission and other drug-related harms.

  • Safer substance use involves not sharing drug use equipment and using new equipment every time.

Substance use and hepatitis C

People use drugs in a range of ways, including injecting, smoking and snorting. Equipment that has been used to prepare and use drugs can have microscopic amounts of blood on it. This includes needles/syringes, cookers, filters, water, tourniquets, mouthpieces, straight stems, bowl pipes and snorting devices. If used equipment is shared, or some equipment is used communally, hepatitis C can be transmitted.

The hepatitis C virus is small and resilient — it can survive for weeks outside the body and on surfaces. It only takes a tiny amount of virus to pass on hepatitis C. Transmission happens when virus in the blood of a person with hepatitis C enters the bloodstream of another person. Safer substance use practices are designed to prevent blood-to-blood contact, thereby reducing the risk of hepatitis C transmission, as well as other infections.

Safer injecting

Injection drug use can increase the risk of experiencing a range of health issues, including abscesses, cellulitis, endocarditis and blood-borne infections such as hepatitis C and HIV. Safer injecting practices can help reduce these harms.

How can hepatitis C be transmitted by injecting?

Hepatitis C virus can be in the blood that remains in used needles, syringes, cookers, filters and other equipment, even if the amount of blood is so small it can’t be seen. When equipment containing residual blood from a person with hepatitis C is reused by another person, the hepatitis C virus can get into their bloodstream. Once inside the bloodstream, the virus can cause an infection.

What is safer injecting?

Safer injecting practices can reduce the chance of hepatitis C transmission and other health issues related to injecting drugs. Equipment used to inject drugs includes needles/syringes, cookers, filters, sterile water, alcohol swabs, tourniquets and ascorbic acid. Safer injecting guidelines advise using all new equipment for every injection, not sharing equipment and not reusing equipment, including cookers with drug residue. Safer injecting also includes other practices, such as prepping the area for injection, rotating sites, taking care of your veins post injection and abscess care.

Safer smoking

Smoking or inhaling drugs can increase the risk of certain health issues. Smoking and inhaling drugs is often viewed as a lower risk activity than injecting drugs, although there is a potential risk of contracting hepatitis C through sharing smoking or inhaling supplies.

How can hepatitis C be transmitted by smoking?

Smoking drugs can lead to sores, burns or cuts on the lips and mouth. These cuts and sores can leave tiny amounts of blood on smoking equipment, such as pipes and mouthpieces. Cuts and sores also provide an entry point for bacteria and viruses. Blood containing the hepatitis C virus can be found on pipes and mouthpieces, and there is a theoretical risk that it could pass into another person’s bloodstream through broken skin on their lips or mouth. Once inside the bloodstream, the virus can cause an infection.

What is safer smoking?

Safer smoking involves using mouthpieces to decrease the risk of sores or blisters from hot pipes and not sharing stems, pipes, mouthpieces or bowls. Many harm reduction programs distribute smoking equipment, including straight stems, brass screens, wooden push sticks, bowl pipes, foil and mouthpieces.

Sharing smoking equipment has the potential to lead to hepatitis C transmission. Providing people with their own straight stems, bowl pipes and mouthpieces can prevent hepatitis C from being passed on.

Safer snorting

Snorting drugs can damage the mucous membranes in the nose and increase the risk of hepatitis C transmission. Safer snorting practices aim to reduce the risks associated with snorting drugs.

How can hepatitis C be transmitted by snorting?

Snorting drugs can cause blood vessels in the nose to expand and rupture. Sometimes drugs or the cutting agents added to them can cause tearing and bleeding of the nasal passageways. Tiny amounts of blood can be transferred onto equipment used to snort, such as straws or bills. If snorting equipment that contains blood from a person with hepatitis C is shared, hepatitis C could get into the bloodstream of another person. Once inside the bloodstream, it can cause an infection.

What is safer snorting?

Safer snorting involves using personal, single-use snorting equipment, not sharing equipment, and taking care of the nasal tissue. Equipment used for safer snorting can include straight stems, straws or other devices rolled into a tube.

Sharing snorting equipment can lead to hepatitis C transmission. Providing people with their own snorting equipment can prevent hepatitis C from being passed on.  

Preventing and responding to overdoses

Canada’s illicit drug supply is toxic and unpredictable. This means that drugs may be contaminated with drugs that are more powerful than expected as well as unknown substances, increasing the risk of overdoses. It is important that people who use drugs have the information and tools they need to prevent and respond to overdoses. Overdose prevention includes:

  • using at an overdose prevention site or supervised consumption site, where possible
  • using with at least one other person and taking turns to use
  • starting with a small amount of drugs and using slowly
  • avoiding mixing different substances
  • knowing the signs and symptoms of an overdose
  • carrying naloxone and knowing how to use it
  • calling 911 if someone overdoses (the Good Samaritan Act may provide protection from arrest)
  • maintaining as consistent a supply as possible
  • decreasing the amount of drug used after even a brief period of reduced use
  • knowing how health issues can affect drug tolerance

Resources for service providers

Resources for clients

Revised 2021