Author: Stacy Mosel, LMSW
Viral hepatitis is a disease that often results in liver inflammation and damage. If you inject drugs, it’s important to know how to protect yourself from becoming infected with the viruses that can cause different types of hepatitis. Most prevention efforts focus on sexual activity and injection practices. If left untreated, hepatitis can cause a number of serious health consequences that can, in some cases, lead to death.1
What Is Hepatitis?
There are 5 main types of viral hepatitis—A,B,C,D, and E—with B and C being the most common among people who inject drugs.1 Drug users are also at risk of contracting hepatitis A.
- Hepatitis A (HAV) is a relatively uncommon form of hepatitis in the U.S. It is generally spread through ingestion of food or water with fecal contamination. Hepatitis A is usually mild, with acute symptoms that resolve on their own within a few weeks. This form of hepatitis does not cause long-term consequences. A vaccine is available that can help protect you from the virus.2
- Hepatitis B (HBV) is transmitted through contact with the blood, semen, or other body fluids of someone who has the virus. HBV may result in both acute and chronic infection. Acute hepatitis B is a short-term infection that can resolve on its own within a few weeks in people with healthy immune systems. Chronic hepatitis B can develop if your immune system does not completely clear the infection. You have a greater chance of chronic hepatitis B if you were infected at birth or during early childhood. Complications associated with hepatitis B include cirrhosis, liver failure, and liver cancer. You can get a vaccine against this type of hepatitis.3
- Hepatitis C (HCV) is the most common bloodborne viral infection in the U.S. It is spread through contact with the blood of a person who has the virus. Hepatitis C can cause both acute and chronic infection. If your body fights off the virus, acute HCV symptoms resolve over a period of 6 months. However, around 75% to 85% of people with acute HCV will progress to chronic HCV, which can lead to chronic liver disease, liver failure, cirrhosis, and liver cancer. There is no vaccination for hepatitis C, but it can be treated.4
Since 2009, the number of new HCV cases has skyrocketed, with just over 10,000 in 2009 compared to more than 40,000 in 2016. The increase is attributed mainly to white adults in their 20s and 30s who live in non-urban areas. In many cases, these people were addicted to prescription drugs but then switched to intravenous opioid abuse, which has a much higher risk of infection.5
Transmission From Drug Use
Hepatitis A can be contracted by drug users in several ways, including:6
- Risky sexual behavior (such as unprotected sex, mainly through oral-anal sex).
- Through injection.
- Contact with another person’s fecal material.
- From a mother to an unborn child (vertical transmission).
Hepatitis B can be contracted through:3,7
- Sex, which is the most common form of transmission. The virus is spread through contact with blood, semen, or other bodily fluids. If you have had sex with someone who has hepatitis B, are a man who has sex with a man, have had more than 1 sexual partner in the past 6 months, or have had an STD before, you have an increased risk of contracting HBV.
- Injection, including shared needles or syringes or drug preparation equipment.
- Sharing personal care items, e.g., razors, toothbrushes, or medical equipment (such as a blood glucose monitor).
- Having direct contact with sores or cuts of an infected person.
- Being tattooed or pierced with tools that were used on an infected person and not sterilized or cleaned properly.
- A mother to her baby during birth.
Hepatitis C can be contacted by:8
- Sharing needles, syringes, and other equipment or surfaces used to inject or prepare drugs such as cotton balls or alcohol swabs. Sharing injection equipment is the most common form of transmission.
- Sharing personal care items like razors or toothbrushes.
- Having your fingers come into contact with the blood of someone with the virus.
- Getting a tattoo or body piercing in an unregulated setting.
- Having sexual contact with a person who has the virus.
Symptoms to Recognize
Symptoms of HAV, HBV, and HCV are similar and include:2,3,4
- Dark yellow urine.
- Gray- or clay-colored stool.
- Pain in joints.
- Decreased appetite.
- Abdominal pain.
- Yellow eyes and skin.
Complications of HAV include:2
- Liver failure (rare).
Complications of HBV include:3
- Cirrhosis, which causes liver scarring and leads to liver failure.
- Liver failure.
- Liver cancer.
Complications of HCV include:4
- Liver failure.
- Liver cancer.
People with chronic hepatitis B or C often display no symptoms until complications develop.3,4
What Treatment Entails
Treatment for HAV includes:2
- Drinking plenty of liquids.
- Eating healthy foods as directed by your doctor.
- Medications for symptomatic treatment.
Although doctors don’t usually treat HBV unless it becomes chronic, treatment for HBV includes:3
- Antiviral medicines taken orally or through injection, including entecavir (Baraclude), telbivudine (Tyzeka), tenofovir alafenamide (Vemlidy), tenofovir disoproxil fumarate (Viread), interferon alfa-2b (Intron A), and peginterferon alfa-2a (Pegasys).
Treatment for HCV includes:4
- Antiviral medications, of which there are several older and newer medications such as daclatasvir (Daklinza), elbasvir/grazoprevir (Zepatier), ledipasvir/sofosbuvir (Harvoni), ombitasvir/paritaprevir/ritonavir (Technivie), ombitasvir/paritaprevir/ritonavir/dasabuvir (Viekira Pak, Viekira XR), simeprevir (Olysio), sofosbuvir (Sovaldi), sofosbuvir/velpatasvir (Epclusa), sofosbuvir/velpatasvir/voxilaprevir (Vosevi), ribavirin, peginterferon alfa-2a (Pegasys), or peginterferon alfa-2b (Pegintron).
Importance of Treating Addiction
In addition, if you have hepatitis and inject drugs, you should consider addiction treatment. You can minimize the risks of additional hepatitis contraction (and other health problems) from continued IV drug use.
Medication-assisted treatment (MAT) is effective for treating opioid addiction. You can even undergo MAT if you take antiviral medication. MAT combines counseling and the use of medications, such as buprenorphine and methadone, to address opioid withdrawal symptoms and treat opioid addiction. Medications help normalize your brain chemistry, block the euphoric sensations associated with opioid abuse so you are less likely to use, and alleviate cravings. Counseling helps to address the underlying issues that may have led to or contributed to your addiction and provides you with the tools you’ll need to live a healthier, drug-free life.9
Tips for Preventing Hepatitis
You can protect yourself from contracting hepatitis while injecting drugs by following some safer drug use and health practices, including the following.10,11
- Get vaccinated for HAV and HBV.
- Stop injecting and seek drug treatment with methadone or buprenorphine.
- Don’t share drug injection or preparation equipment.
- Always use a new, clean sterile needle, syringe, and prep equipment.
- Ensure that you have a clean prep surface in advance.
- Do not divide and share drug solution with used equipment.
- Wash your hands with soap and water before and after injecting.
Addiction treatment can also help reduce risky behaviors that may increase your chances of contracting hepatitis.
Testing and Vaccinations
If you use intravenous drugs, you should think about getting tested for hepatitis. Testing involves providing a small blood sample. This sample is tested for the presence of foreign substances known as antigens and antibodies that indicate you have (or had) the virus that causes hepatitis.12
You should also consider having a vaccination for hepatitis A and B. The combination hep A and B vaccine is effective for at least 10 years, and if you complete the full series of vaccinations will likely be effective for the rest of your life. You receive 3 injections: the initial dose, another dose one month later, and another dose at 6 months. It can also be given in a series of 4 injections: the initial dose, and then doses that occur after 7 days, 21 to 30 days, and one year.13
There is no vaccine for hepatitis C.4
What if I Have It?
If you have hepatitis (or suspect that you might), you should see your doctor to determine whether you need treatment.
People who have hepatitis should be aware of proper health and hygiene practices and maintain a healthy lifestyle to help prevent the virus from worsening. In addition, you should:1,14
- Avoid drinking, smoking, or using drugs to help reduce the impact on your liver. Drugs, smoking, and alcohol can make your condition worse.
- Talk to your doctor before taking nutritional or herbal supplements and any over-the-counter drugs, as they can have an impact on the liver.
- Schedule regular visits with your doctor to monitor the health of your liver.
If you or someone you know has a problem with drugs or alcohol, consider seeking help at a drug rehabilitation program. You can get treatment for drug use as well as get tested for hepatitis and other health conditions.