Former Addicts Face Barriers to Treatment for HCV

Abstract

MOST INJECTION DRUG USERS, including those who succeed in kicking the habit, are left with a worrisome legacy: infection with hepatitis C virus (HCV). But for a variety of reasons, some former addicts who develop HCV-related liver disease—notably those receiving methadone maintenance therapy (MMT)—are confronted with barriers to getting much-needed treatment for their illness, barriers that sometimes force them to choose between dying of liver disease and risking relapse and a return to abusing drugs. The problem is not a trivial one. More than any other group of individuals in the United States, injection drug users are likely to acquire the infection. According to the National Center for Infectious Diseases, half or more of all HCV infections are associated with illegal drug use and injection drug users typically become infected with stunning swiftness. Despite the HCV burden in this group, physicians say that patients receiving MMT—including individuals who haven’t injected drugs for many years—are all too frequently turned away for medical treatment for HCV or liver transplantation for HCV-related end-stage liver disease, excluded solely because of their medically approved use of methadone. There are some legitimate concerns about the potential adverse effects of drugs used to treat hepatitis C for patients receiving MMT—including a possible risk of relapse to active drug abuse. But experts agree that these concerns do not mean that patients taking the opioid agonist should be denied access to potentially life-saving HCV treatment.