Hepatitis C and Opioid Use Disorder: What’s the Link?

Nearly 5,000 new cases of hepatitis C were diagnosed in the United States in 2022. The risk is especially high for people who inject drugs. Hepatitis C is often called a “silent” disease because many people don’t know they have it until years later. It’s caused by a virus that attacks the liver and, over time, can cause serious health problems if left untreated.

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In this article, we’ll look at the link between hepatitis C and opioid use disorder (OUD). We’ll also cover common symptoms of hepatitis C, how it’s diagnosed and treated, and where to find more resources.

What Is Hepatitis C?

Hepatitis C is a viral infection that affects the liver. Normally, the liver works like a filter — it cleans the blood, helps digest food, and processes medicines. When the hepatitis C virus (HCV) enters the body, it attacks the liver and can cause serious damage over time.

HCV spreads mainly through blood-to-blood contact. Today, the most common way people get infected in the U.S. is by sharing needles, syringes, or other injection equipment. Less often, it can spread through unprotected sex, unsterilized medical tools, or from mother to baby during birth.

Hepatitis C can be acute (short-term) or chronic (long-term). In about 25 percent of people, acute HCV infections can clear on their own. But, in most cases, the infection becomes chronic. Chronic HCV can last a lifetime if untreated and may lead to:

• Liver disease
• Cirrhosis (liver scarring)
• Liver cancer

Symptoms of Hepatitis C

One of the hardest parts of hepatitis C is that many people don’t have symptoms for years. You can live with a hepatitis C virus infection for a long time and not know it. When symptoms do appear, they may be vague and easy to overlook. Early signs may include:

• Fatigue (extreme tiredness)
• Nausea or upset stomach
• Fever
• Loss of appetite
• Jaundice (yellowing of the skin and eyes)

Later on, chronic hepatitis C can cause:

• Joint or muscle pains
• Itchy skin
• Stomach pain
• Problems with short-term memory and concentration
• Depression or anxiety

Diagnosing Hepatitis C

Because symptoms aren’t always present, the only way to diagnose hepatitis C is through testing. To do this, doctors use a simple blood test to look for HCV antibodies — proteins your body makes when exposed to the virus. If this test is positive, a follow-up blood test can check whether the virus is still active.

Testing is quick and widely available. Health experts recommend that all adults be tested for hepatitis C at least once in their lives. People with higher risk factors — including those who inject drugs — should be tested more often. Testing for hepatitis C is important because most people don’t feel sick until serious damage has already happened.

Early diagnosis is important. If hepatitis C is found early, doctors can treat it to cure the infection before it has a chance to harm the liver and cause long-term problems.

Testing also protects others, since people who don’t know they’re infected can spread HCV through shared needles or syringes. Early diagnosis can stop the virus from spreading, save lives, and protect communities.

What’s the Link Between Hepatitis C and Opioid Use Disorder?

Opioid use disorder happens when someone can’t stop using opioids, such as prescription opioids, heroin, or fentanyl. For some, OUD leads to injecting drugs, which is one of the main risk factors for an HCV infection.

Because hepatitis C spreads through blood, sharing needles or syringes puts people at higher risk. That’s why people who inject drugs have some of the highest rates of HCV transmission. Studies show that up to 39 percent of people who inject drugs within the past year have HCV. The rise in acute hepatitis C cases is closely tied to the ongoing opioid epidemic.

The opioid crisis has fueled sharp increases in both opioid overdoses and hepatitis C infections. Young adults are especially at risk. Many start with prescription opioids and then move to illicit drugs, sometimes injecting within a few years. Without access to harm reduction services, such as syringe exchange programs, new cases and total cases of chronic HCV can rise quickly.

Treating Hepatitis C and Opioid Use Disorder Together

The good news is that thanks to recent medical advances, hepatitis C virus infection is treatable. Today, many people can be cured with direct-acting antiviral medications. These drugs are highly effective, are often taken for only 8 to 12 weeks, and have few side effects. Successful hepatitis C treatment can prevent serious liver disease, cirrhosis, and liver cancer. Still, routine follow-ups are important, since reinfection can happen.

Opioid use disorder is also treatable. Treatment often includes medications that act on opioid receptors — the proteins on cells that opioids work through. These medicines reduce cravings, lower the risk of opioid overdose, and help bring stability to people in recovery. Many treatment programs combine medication with counseling, talk therapy, and harm reduction services for the best results.

The Importance of Treating Both Conditions

Studies show that treating both hepatitis C and OUD together improves outcomes for both conditions. When primary care providers or specialty clinics treat hepatitis C alongside OUD, people are more likely to stick with treatment programs, avoid relapse, and reduce high-risk behaviors like sharing injection equipment. This lowers the incidence of HCV transmission and protects against reinfection.

Stigma and Other Barriers to Care

Even though hepatitis C and OUD are both treatable conditions, many people don’t get the care they need. One big reason is stigma. People who inject drugs often face judgment or discrimination when seeking help. This can make them avoid HCV testing and treatment.

Access is another barrier. In many areas, there aren’t enough clinics that offer both hepatitis C treatment and OUD treatment. Some health systems still require people to stop using drugs before starting hepatitis C treatment — even though research shows treatment works even if a person is actively injecting drugs. Cost and lack of insurance can also keep people from getting proper care.

Knowing about these barriers and combating them is key to improving outcomes. When people are treated with respect and given easy access to medicine and support — instead of stigma and shame — they’re much more likely to stay healthy and prevent the spread of HCV.

Public Health Resources

Public health groups play an important role in addressing both hepatitis C and OUD. Many offer free testing, treatment access, harm reduction services, and education on preventing the spread of HCV and overdoses. Syringe exchange programs, for example, provide clean needles and safe supplies. These programs can lower the risk of infection by up to 50 percent.

For reliable information about hepatitis C and OUD, visit the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Harm Reduction Coalition websites.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

If you or a loved one are living with opioid use disorder and hepatitis C, have you been able to access care? Let others know in the comments below.