Can Drug Use Affect Your Hep C Treatment?

Despite the stigma, direct-acting antiviral medications are effective at curing hepatitis C among people who use drugs.

The Centers for Disease Control and Prevention (CDC) lists drug use—particularly the use of drugs that are injected—as one of the top risk factors for contracting a hepatitis C infection. As a result, a significant number of people who will be treated for hepatitis C will be people who inject drugs (PWID) or people with a history of drug use.

More than half of hepatitis C infections are chronic, meaning they do not go away on their own. Hepatitis C infections also tend to be asymptomatic—they cause no symptoms or no noticeable symptoms. Because of this, hep C is sometimes referred to as a “silent” disease. As a result, many people are unaware that they have hep C and are unaware of the damage it is causing.

Left untreated, hepatitis C can lead to cirrhosis (scarring of the liver), liver cancer, and liver failure—serious, potentially life-threatening complications. With treatment, the majority of hep C infections are curable.

Here, we look at some of the challenges that people with a history of substance use may face when seeking treatment for hepatitis C.

Drug use and treatment effectiveness

Can drug use make hep C medications less effective? Research shows that the direct-acting antiviral (DAA) medications used to treat hep C infections are effective among people who are active drug users. Results of treatment, as well as side effects, are similar to patients who are not using drugs.

Treatment adherence

Treatment for hep C can take several months. During that time, a person must take their hep C medication every single day—and ideally at the same time each day. Missing doses or taking medications inconsistently can reduce the effectiveness of the medications and reduce the chances of the infection being cured. It can also cause the hep C infection to become resistant to medications, which can make treatment much more difficult.

Treatment for drug use

Stopping the recreational use of drugs or seeking treatment for addiction can benefit mental and physical health. If you are using drugs, be honest with your healthcare provider and ask about resources that can help you address substance use. Continuing the use of drugs does increase the chance of contracting hepatitis A and hepatitis B, as well as reinfection with the hepatitis C virus.

Treatment eligibility

Some states and insurance plans have different eligibility requirements for people seeking treatment for hep C. For example, some will only approve treatment for people who have moderate-to-severe liver damage. And some have sobriety restrictions, where person must abstain from drugs and/or alcohol for a specific length of time—usually 6 months—in order to be eligible for treatment.

Work with a healthcare provider

Whether seeking treatment for hepatitis C, drug use, or both, the best thing you can do is work with a healthcare provider.

In addition to working with a provider who is experienced in treating hepatitis C, it’s important to work with a healthcare provider you feel comfortable talking to. Some signs that you have found the right healthcare provider include:

  • You feel you can be honest without being judged—for example, when sharing information about drug use.
  • You feel that your questions or concerns are taken seriously.
  • You understand how the treatments or recommendations your provider prescribes have a positive impact on your health and meet your healthcare needs.

Hepatitis C may be treated by a primary care physician, or a specialist such as a gastroenterologist, hepatologist, or an infectious disease specialist.

Medically reviewed in May 2021.

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Centers for Disease Control and Prevention. "Hepatitis C Questions and Answers for the Public."
UpToDate. "Patient education: Hepatitis C (Beyond the Basics)."
American Academy of Family Physicians. "Patient Education: Hepatitis C."
U.S. Department of Health and Human Services. "Hepatitis C: A Silent Epidemic."
Gottfried Hirnschall. "There’s a reason viral hepatitis has been dubbed the “silent killer.'" World Health Organization. September 2, 2015.
Mayo Clinic. "Hepatitis C."
U.S. Department of Veterans Affairs. "Hepatitis C medications: An overview for patients."
Seyed Amineh Hojati, Elham Maserat, et al. "Hepatitis C Treatment in Patients with Drug Addiction Is Effective or Not Effective?" Journal of the Academy of Medical Science in Bosnia and Herzegovina, 2018. Vol. 72, No. 5.
Alberto Grassi and Giorgio Ballardini. "Hepatitis C in injection drug users: It is time to treat." World Journal of Gastroenterology, 2017. Vol. 23, No. 20.
American Addiction Centers. "Hepatitis C and Addiction."
U.S. Department of Health and Human Services. "Hepatitis C & Injection Drug Use."
Hepatitis C Online. "Treatment of HCV in Persons with Substance Use."
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Rachael McGuirk. "Should you tell your doctor about your drug use?" The Ohio State University Wexner Medical Center." August 19, 2020.

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