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Hepatitis C Treatment for Drug Users

Nicole Cutler L.Ac. March 23, 2012

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The stigma surrounding addiction may discourage Hepatitis C treatment for drug users – but the evidence encourages these individuals to do triple therapy.

Across a variety of cultures, the ability to receive quality medical treatment is not uniform. Unfortunate for some with chronic Hepatitis C, access to the latest drugs can be unjustly withheld. Having health insurance coverage, being considered a good candidate for treatment and assumption of a low relapse risk can be determining factors in who gets the most advanced medications for fighting the Hepatitis C virus. Despite being a population particularly inundated by this viral infection of the liver, intravenous drug users are often excluded from the latest approved Hepatitis C drug regimen.

Clinically acknowledged as a disabling disease, drug addiction is found in every socioeconomic class, within every ethnic group and gender. Addicts typically have extremely strong physiological and psychological cravings to use drugs despite their negative effects. The cravings can be as strong as a human’s desire for food and water. Society imposes stigma on addicts because many still believe that addiction is a character flaw or weakness that is incurable. Despite addiction being a treatable disease, the stigma against addicts remains deeply rooted.

Stigma is responsible for many instances of social, legal and medical discrimination. Discrimination hurts drug addicts because they are excluded from rules that apply to “normal” people. As such, insurance companies get away with refusing to pay for drug treatment – or by charging higher deductibles and co-pays than treating other diseases.

As reported in the September 2007 edition of the European Journal of Gastroenterology and Hepatology, injection drug users are often denied Hepatitis C treatment because of concerns about adherence to the therapy. Most experts believe that these concerns are due to the stigma of drug addiction, not based on actual facts. As found in a study by researchers in San Francisco, the majority of methadone-maintained drug users can adhere to Hepatitis C treatment.

According to a Croatian study published in the December 2011 edition of Hepatitis Monthly, Hepatitis C virus is one of the major infectious diseases among injecting drug users – but most injecting drug users are not treated. Upon analyzing the outcome of Hepatitis C treatment (consisting of pegylated interferon and ribavirin) on injecting drug users over the course of seven years, the researchers determined that treatment of chronic Hepatitis C in this population should be strongly encouraged as they have positive predictors for achieving success, such as:

  • younger age
  • shorter duration of infection
  • favorable histological stage of the disease
  • good adherence to treatment

Additionally, the researchers found there to be no difference in safety and tolerability profiles of Hepatitis C treatment in intravenous drug users compared to patients without a history of drug abuse.

Now that there are two new drugs available to aid pegylated interferon and ribavirin (boceprevir and telaprevir), the success rate of Hepatitis C treatment has risen dramatically, from about 50 percent to nearly 80 percent. Providing an update on new treatment approaches for substance abusers with Hepatitis C, researchers collaborated from Texas and Missouri. As published in a March 2012 edition of Current Opinions in Psychiatry, the researchers concluded that the newer treatment approaches for Hepatitis C will help many more patients than ever before to overcome the virus. However, changed attitudes and innovative approaches to patients with substance-use histories are needed to bring these scientific advances to those with a drug addiction problem.

Because it enables so many more people to successfully eliminate the virus, the new drugs added to Hepatitis C treatment have the ability to transform the burden of chronic Hepatitis C. Since drug users make up a large proportion of Hepatitis C infections, the new drug protocol is essential for this population. However, drug users, medical professionals and society in general must recognize that drug use should not be a barrier to receiving treatment. Made even more obvious by the dramatic increase in treatment effectiveness, the negative stigma associated with addiction remains as one of the largest obstacles to curing drug users of the Hepatitis C virus.

References:

http://www.allaboutaddiction.com/addiction/addiction-stigma-making-addiction-recovery-harder, Addiction Stigma, Retrieved March 11, 2012, allaboutaddiction.com, 2012.

http://www.hbo.com/addiction/stigma/52_coping_with_stigma.html, Coping with the Stigma of Addiction, David L. Rosenbloom, PhD, Retrieved March 11, 2012, Home Box Office, Inc., 2012.

http://www.ncbi.nlm.nih.gov/pubmed/17700258, Adherence to hepatitis C treatment in recovering heroin users maintained on methadone, Sylvestre, DL, et al, Retrieved March 10, 2012, European Journal of Gastroenterology and Hepatology, September 2007.

http://www.ncbi.nlm.nih.gov/pubmed/22368683, Intravenous Drug Users Can Achieve a High Sustained Virological Response Rate: experience From Croatian Reference Center for Viral Hepatitis, Kurelac I, et al, Retrieved March 11, 2012, Hepatitis Monthly, December 2011.

http://www.ncbi.nlm.nih.gov/pubmed/22395769, Hepatitis C and substance use: new treatments and novel approaches, North CS, et al, Retrieved March 10, 2012, Current Opinion in Psychiatry, March 2012.

http://www.womenshealth.gov/illnesses-disabilities/types-illnesses-disabilities/alcoholism-drug-addiction.cfm, Alcoholism and drug addiction, Retrieved March 11, 2012, US Department of Health and Human Services, 2012.

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HepatitisCentral.com provides information regarding hepatitis and liver disease. Comments are available to the community in order to discuss these topics and obtain answers to questions through community members. The Editors at HepatitisCentral.com will not be responding to questions or comments posed in article comments.

  • Ajp

    This is an excellent paper. Addicts deserve treatment for Hep C just like everybody else. They are human beings and should not be discriminated against because of their disease. I agree that insurance companies use the current social bias against addicts to refuse Hep C treatment for them. It isn’t because there is a real correlation between addicts and non-conformance to treatment regimens, rather it is to increase profits for insurance companies. 
    It seems that our country has stepped backwards over the last 12 years. Some of us no longer view problems like drug addiction, mental health problems and other chronic conditions with empathy for those effected. If the hard facts show that the myth is wrong, then we should be able to accept the evidence and move on.

  • Kathy White

     I agree that addicts deserve treatment, but I think they should be remanded into rehab beforehand.  All the treatment in the world won’t help if there’s a relapse into using needles again.

  • As a former heroin addict infected with hep c i have found it almost impossible to get treatment. I have been clean from drugs and alcohol for over three years. If anyone can give me some advice on where or who to turn to I would appreciate it… [email protected]

    • PsychoPato

      I don’t know where you’re from, but in my region, this kind of treatment is in every government hospital and it’s “Free”. the free stuff are only supportive medications. No Interferone. However, some rich countries provide full medications to people that hold their nationality only, and you can also go to red cross in your country, there are many people funding.

  • The blog was absolutely fantastic. I am looking forward for more contents. Great job, keep it up.

  • Mjarchslc

    When my daughter was just 25 years of age and my health insurance covered her, only one physcian was available through that insurance to treat her.  My daughter was young,female and the virus was still in a low infectious stage, we were denied treatment by this physcian.  She said that the interferon treatment would be too hard for her as it was a dangerous drug and it was an expensive drug more than I could afford out of pocket, so she received no help.  She is now 32 and still involved in drugs and is looking very sickly.  Because she is a drug addict she cannot hold a job and now she is always sickly, and has  no insurance.   Since my insurance no longer covers her, she has not been tested since she was twenty five.  I would like to be able to have her retested to see where her level of infection is with the virus.  Without insurance that is impossible right now.  She is sickly and very thin and said her body itches her all over and is very miserable, she has no appetite and vomits sometimes.  How can I get her help?  My email address is [email protected],com

  • Jonnes

    Can anyone tell me if the(ca covered) kaiser Silver plan will cover hep c drugs or is i better to get gold plan thks so much