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Hepatitis C is a blood-borne viral infection that is common among injecting drug users. In Ireland, as in other developed countries, injecting drug use accounts for most Hepatitis C infections, with prevalence rates of 62%-81%. Therefore, researchers in Ireland conducted a study investigating Hepatitis C testing, management and treatment among current and former injecting drug users. They used a sample made up of individuals in addiction clinics, those who were using a local drop-in centre, and those accessing an infectious diseases clinic.

Hepatitis C infection causes liver inflammation that may damage the liver over time, potentially progressing to cirrhosis. Factors that increase this progression include the presence of HIV as well as Hepatitis C, and heavy alcohol intake, both of which are common among injecting drug users.

Accessing care for Hepatitis C is poor among injecting drug users. A survey found that 27.3% of these individuals had seen a health care provider since receiving a positive Hepatitis C diagnosis, and just 4.8% had initiated treatment. A survey of injecting drug users attending a heroin detox clinic found that whilst most affected individuals were having their Hepatitis C monitored, almost one-quarter had unsuccessfully attempted to obtain treatment, and one-third had declined treatment.

Several barriers to Hepatitis C treatment have been reported, including active substance abuse, presence of psychiatric and medical issues, patient refusal of treatment, and loss of patients to follow-up. However, this information was taken from healthcare providers, and so does not provide any insight into the reasons why patients refuse treatment or do not return for follow-up appointments. Therefore, two surveys were carried out which asked injecting drug users directly why treatment had not been sought, accepted or initiated.

Reasons cited for not being successful in obtaining treatment included their liver disease not being advanced enough, long waiting lists for treatment, being a current injecting drug user, and heavy alcohol intake. Reasons for declining treatment included concern about treatment side-effects, reluctance to have a liver biopsy, not feeling sick enough, and having other health priorities.

The research found that perceptions of Hepatitis C were minimised and normalised in comparison to HIV. It is a common perception that HIV is a certain death sentence, while Hepatitis C is viewed as non-fatal, and by some, curable. HIV is considered rare, whilst Hepatitis C is seen as common. This attitude presents Hepatitis C infection as relatively benign, undermining perceptions of the seriousness of the infection and any perceived need for medical attention. Stigma and embarrassment were also mentioned as factors.

These findings suggest that it is vital to bring Hepatitis C education into the mainstream to target people before they begin injecting drugs. It also highlights the need to reach those who used drugs many years ago to make them aware that they may be infected.

References

Swan et al (2010). Barriers to and facilitators of Hepatitis C testing, management, and treatment among current and former injecting drug users: A qualitative exploration. AIDS patient care and STDs, 24(12), 753-762.

Article published on 06/12/2020 by PCUG Addiction Treatment