The Dangers of Requiring Sobriety for Hepatitis C Treatment

Hepatitis C (HCV) is a virus that is passed on through blood and can cause chronic liver disease. More than 95 percent of HCV cases can be cured by antiviral drugs. These treatments can prevent HCV from developing into serious conditions such as cirrhosis or liver cancer. However, HCV diagnosis and access to antiviral drugs can be difficult.¹

HCV infections continue to rise in the United States. Most of those infections are related to IV drug use. However, people who inject drugs (PWID) face many barriers to HCV treatment. One of these barriers to treatment is legal restrictions around substance use. A recent study looked at these states to see how the restrictions affected those living with HCV.²

HCV treatment restrictions

Researchers studied Medicaid programs in the United States from 2017 to 2020. They found that many states require a 6-month to 1-year period of sobriety before someone can start HCV treatment. In 13 states, it is a crime to transmit HCV to another person. However, 12 states do not allow needle exchange programs.²

Over the 3-year period, researchers found that many states loosened these restrictions. Some states reduced their sobriety requirement. Other states took away the requirement entirely.²

How do these requirements affect those living with HCV?

Barriers to treatment affect the spread of HCV and increase the stigma around PWID. If those living with HCV cannot access treatment or clean needles, they may develop more serious liver diseases. These conditions can be fatal. They also may unintentionally pass on HCV to others. These restrictions further stigmatize people who use drugs who may have HCV, and create further burdens to accessing treatment and care.²

These restrictions do not meet the standard of care for treating those with HCV. Previous studies have shown that PWID respond well to antiviral treatment. There is no evidence that supports HCV treatment restrictions. These conditions unfairly affect PWID and often keep them from being treated.^2,3

What is “harm reduction?”

Needle exchange programs and removing treatment barriers are both forms of harm reduction strategies. Harm reduction is a public health concept that focuses on people’s needs, no matter their situation. These policies exist to offer people knowledge and tools to keep themselves and others safe.³

Harm reduction policies understand that people sometimes do risky things like inject drugs. Not everyone is ready to stop doing those things. However, everyone deserves access to healthcare and opportunities to be healthy. Harm reduction focuses on getting people the care they need with minimal restrictions. It also sets up a friendly environment so people can access more resources when they are ready.³

Needle exchange programs are particularly helpful to prevent the spread of HCV. They help PWID access clean needles and equipment to prevent needle sharing as well as HCV and HIV transmission. They also have resources for HCV and substance use treatment if someone is interested. Research shows that areas with needle exchange programs have lower rates of HCV infections.³

What is next?

There is no scientific evidence right now that supports sobriety requirements for hep C treatment. These requirements encourage stigma around drug use. They also conflict with the Americans with Disabilities Act. This act bans discrimination around those with disabilities and also includes those with substance use disorders.⁴

It is possible to eliminate HCV in the United States. It is necessary to use harm reduction strategies. Needle exchange clinics and removing sobriety requirements are steps to increase access to live-saving HCV care. Changes in laws can significantly improve public health and the lives of those living with HCV.^2,4