High hepatitis C prevalence in injecting drug users
Hepatitis C (HCV) infection is common in illicit drug users, and can lead to severe morbidity and mortality. Although all illicit drug users may put themselves at risk of acquiring HCV infection, a new study confirms that those with a long history of drug use and those who inject (particularly with shared needles or using preparation equipment such as spoons) are most at risk.
The study recruited 482 illicit drug users in Canada, who had used opioids regularly for at least one year and were not currently in treatment. Each participant completed an interviewer-administered questionnaire and was tested for HCV and HIV infection.
The study found that 54.6% of the study population were HCV positive. Virtually all the HCV-positive participants had injected drugs in their lifetime (99.2%), and it was found to be the primary risk factor for HCV transmission in illicit drug users (adjusted OR 25.8).
The study also showed that those with poor social circumstances, such as unstable housing and involvement in criminal activity, those who use opioids in addition to other substances and those who have not engaged with formal drug treatment programmes are all at increased risk.
GPs' roles within GMS or PMS contracts extend to the delivery of harm reduction advice to illicit drug users they may see. The potential benefit of this is not only in reducing the risk of the patient contracting a serious health problem, such as HCV infection, but also in limiting a significant disease burden on society.
This study highlights the problem of HCV infection in illicit drug users and identifies those at greatest risk. Simple information and advice on risky behaviour from a GP, together with signposting to a local treatment service, is likely to be a useful health intervention for this at-risk group.
Firestone Cruz M, Fischer B, Patra J et al. Prevalence and associated factors of hepatitis C infection (HCV) in a multi-site Canadian population of illicit opioid and other drug users (OPICAN) Can J Public Health 2007;98:130-133Reviewer
Dr Jez Thompson
Former GP, Clinical Director, Leeds Community Drug Services