Hepatitis C is a liver disease that develops in response to the hepatitis C virus (HCV). This virus spreads through blood-to-blood contact. People may contract the virus by sharing unsterilized needles, such as during recreational drug use.

HCV has become a public health concern as the incidence of the infection continues to climb. Evidence suggests it is among the leading causes of deaths from infectious diseases in the United States.

The Centers for Disease Control and Prevention (CDC) reported in 2020 that new cases of hepatitis C were four times higher than in 2010. Among instances of acute hepatitis C reported to the CDC in 2018 with drug use information available, 72% of people reported the use of injection drugs.

The rising cases of opioid addiction in the U.S. have reached endemic rates. The outcome is a public health crisis referred to as the opioid epidemic.

Rising rates of HCV infection may have links to the increase in opioid and injection opioid use.

In this article, we examine the connection between hepatitis C and opioid use. We look at how one may lead to the other, the link between opioid misuse and HCV, and whether people can take prescription opioids if they have hepatitis C.

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HCV is a bloodborne virus that spreads through blood-to-blood contact with someone who has the infection.

People who misuse injectable drugs, such as opioids, may share needles and other equipment, putting themselves at increased risk of coming into contact with the blood of someone with HCV.

There could be a link between the rise in opioid use and HCV infections due to the increase in prescribed opioids. This led to the opioid epidemic and an attempt to reformulate prescription opioids to reduce the chances of addiction.

Prescriptions increases

At the end of the 1990s, pharmaceutical companies gave reassurance that opioid pain relievers were not addictive. This resulted in healthcare professionals prescribing them at a greater rate.

After a steady rise, the total number of opioid prescriptions dispensed peaked in 2012 at more than 255 million and an opioid dispensing rate of 81.3 prescriptions per 100 persons.

Widespread misuse of opioids followed, indicating that opioids were highly addictive. In 2019, around 9.7 million people misused prescription opioids in the past year. In 2020, 3 in 4 drug overdose deaths involved the use of opioids.

Needles and other equipment used to inject opioids facilitate the spread of infections such as HCV. The CDC associates the rise in HCV infections with the increasing number of people injecting opioids and heroin.

The Food and Drug Administration (FDA) has supported strategies to tackle the opioid epidemic, including adopting policies that limit access to prescription opioids and reformulating opioids to reduce misuse.

Opioid reformulation

One opioid, OxyContin, was reformulated and approved by the FDA in 2010. The reformulation aimed to reduce drug misuse by making it more difficult to crush for snorting or dissolve for injecting.

Around the time of the reformulation of OxyContin and other policies to deter opioid misuse, the number of people using injectable opioids increased.

Many people misusing prescription opioids resorted to using injectable opioids, such as heroin, because they were easier to access, cheaper than prescription opioids, and gave them a similar high.

Research suggests that the reformulation of OxyContin may have played a role in the rise of HCV infections in the U.S. HCV infection rates increased three times faster in states with above-average rates of OxyContin misuse.

There is no medical reason a person with hepatitis C cannot take prescription opioids. Prescription opioids do not interfere with other forms of treatment for treating HCV or its co-occurring conditions.

Healthcare professionals can treat people using opioids with medications for clearing HCV infections. A person can take medications for treating HCV while taking buprenorphine or methadone, two drugs that treat opioid use disorder. There are no drug interactions.

However, healthcare professionals avoid prescribing opioids to people with hepatitis C who have previously experienced drug misuse.

Any person receiving treatment for hepatitis C should contact a doctor immediately if their symptoms or condition worsens, even when they are taking prescription or illicit opioids while receiving hepatitis C treatment.

The opioid crisis and increasing rates of HCV infections have become significant public health concerns.

Many HCV infections occur in people who use injectable drugs. In the U.S., reported HCV infections quadrupled between 2010 and 2020. At the same time, increasing cases of opioid misuse in the U.S. reached endemic rates, resulting in the opioid epidemic.

Public health officials associate the rapidly increasing rates of HCV infection with the steep rise in injection opioid use.

Those receiving treatment for HCV infections can take prescription opioids. However, doctors should not prescribe opioids to people who have previously struggled with the misuse or inappropriate use of drugs.