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The Connection Between Heroin Abuse & Hepatitis C

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Heroin is a highly addictive illegal opioid that can be used in a number of ways. People who inject heroin have an increased risk of contracting the hepatitis C virus, which is the most common bloodborne infectious disease in America.1 Untreated hepatitis C can have dangerous consequences on a person’s health. Read on to learn signs and symptoms of hepatitis C to look out for, complications resulting from contracting it, and how to prevent it.

The Progression to Intravenous Heroin Use

Heroin, also known as hell dust, smack, horse, and big H, is an opioid that can produce euphoria, relaxation, and pain-relief.1  There are many prescription medications that belong to the category of opioids as well, including hydrocodone, oxycodone, morphine, and codeine.2  People may initially be prescribed these medications to manage pain, and then begin misusing them. If they continue to misuse these pain medications they may develop a tolerance, meaning that they need more of the substance to experience the same effects.2  Because it can be expensive and difficult to continue getting a prescription or buying painkillers on the street, people may turn to a cheaper and easier-to-obtain option, like heroin.2  In fact, research has found that approximately 80% of Americans using heroin misused prescription opioids before their heroin use.1

People might smoke, snort, or inject heroin.1 Some heroin users begin by smoking or snorting it, but then progress to intravenous use for an especially rapid and intense high, as this method allows heroin to enter the bloodstream and, next, the brain very quickly.1

Regardless of the mode of administration, heroin abuse is dangerous and poses many serious risks, such as:1

  • Nausea and vomiting.
  • Severe itching.
  • Decreased mental functioning.
  • Insomnia.
  • Constipation.
  • Stomach cramps.
  • Sexual dysfunction.
  • Irregular menstrual cycles.

If someone has progressed to intravenous heroin abuse, they may experience adverse consequences, such as:1,3
  • Collapsed veins.
  • Track lines.
  • Abscesses, or swollen tissue that is filled with pus.
  • Infection of the heart lining and valves.
  • Liver and kidney disease.
  • Skin infections, such as cellulitis.
  • Infectious diseases, such as HIV and hepatitis C.
  • Clogged blood vessels leading to brain, kidney, liver, or lung damage.

A particularly concerning risk mentioned above is the possibility of contracting an infectious disease, such as hepatitis C or HIV, by using an unsterile needle. Such diseases are transmitted through contact with blood or other bodily fluids, which may occur when sharing needles or other equipment used during intravenous use.1

What is Hepatitis C?

Hepatitis is inflammation of the liver, with the three most common types being hepatitis A, hepatitis B, and hepatitis C. All three types may have similar symptoms, but they have different modes of transmission and can affect the liver in different ways. Currently, there are vaccinations to protect against hepatitis A and B, but no vaccinations for hepatitis C.4

Once contracted, there are 2 broad phases of hepatitis C infection: acute and chronic. Acute hepatitis C is short-term, and typically emerges within the first 6 months after exposure. Most cases of acute hepatitis C progress to a chronic phase. Chronic hepatitis C is a long-term condition that happens when the hepatitis C virus remains in a person’s body; it may last a lifetime and often results in profound liver issues.4

Hepatitis C is contagious. It is transmitted through contact with blood or other bodily fluids, including when blood or other bodily fluids are on surfaces, equipment, or other objects contaminated with infected blood.1,4  The hepatitis C virus can actually survive outside of the body on dry surfaces, for up to 6 weeks.5  Furthermore, it can still spread even if the amount of infected blood present is too small to see.5  People who use heroin and other substances intravenously are at an increased risk because they may get hepatitis C from the following:5

  • Sharing or reusing needles
  • Sharing or reusing syringes
  • Using syringes with detachable needles, which poses an even greater risk due to retaining more blood after use
  • Contaminated preparation equipment (i.e. cookers, cottons, water, ties, alcohol swabs)
  • Fingers and hands that have come in to contact with infected blood and/or equipment
  • Contaminated preparation surfaces

Signs and Symptoms of Hepatitis C

Signs and symptoms of hepatitis C include the following:4,5

  • Fever
  • Fatigue
  • Decreased appetite
  • Upset stomach
  • Vomiting
  • Dark urine
  • Gray-colored bowel movements
  • Joint pain
  • Yellow skin and eyes

There are many serious signs and symptoms of hepatitis C; however, up to 80% of people with hepatitis C do not have any symptoms and therefore do not know that they are infected.4,5  This is dangerous because asymptomatic hepatitis C can still be spread, and acute hepatitis C is more likely to progress to chronic hepatitis C if it is not treated.4,5

What Are the Risks?

Again, many people with both acute and chronic hepatitis do not experience symptoms.4,5 What is very unfortunate is that when someone who has chronic hepatitis does begin to experience symptoms, it is likely that liver issues have already developed.4  Some of the serious consequences associated with chronic hepatitis C are:4

  • Cirrhosis
  • Liver cancer
  • Liver failure
  • Death

Clearly the risks are very severe, and what makes these consequences even more concerning is the alarming number of people who use heroin and other drugs intravenously.

Statistics and Data

It has been estimated that 90% of people who inject opioids, such as heroin, contract hepatitis C.6  Therefore, the risk is extremely high for those who use intravenously. Furthermore, research has found that each intravenous drug user with hepatitis C infects approximately 20 other people.7

Another risk associated with intravenous drug use is the potential to contract HIV. It has been found that approximately 80% of intravenous users who have HIV also contract hepatitis C.8 In fact, liver disease due to hepatitis C is the most common cause of non-AIDS related death in those intravenous users who have HIV as well.8

The serious risks associated with hepatitis C and the staggering number of intravenous users who contract the disease can make this issue extremely scary. But know that there are ways to decrease your chance of contracting hepatitis C.

Preventing Hepatitis C and Other Infections

The best way to prevent hepatitis C and other diseases is to stop injecting heroin and any other substances. However, if you are not willing to quit or are unable to, there are other ways to reduce your chances of contracting infectious diseases. These include:5

  • Avoid sharing needles, syringes, equipment, or prep surfaces with another person.
  • Use new, sterile needles, syringes, and other equipment for each injection.
  • Clean prep surfaces before setting down materials.
  • Wash hands before and after injecting.
  • Do not use syringes with detachable needles, since they tend to leave more blood in the syringe after injection.
  • Clean injection site with alcohol before injecting.
  • Do not let anyone else handle your equipment, do not handle anyone else’s, and do not set yours next to anyone else’s to reduce your chances of mixing up your equipment with someone else’s.

It’s important to get tested regularly for hepatitis C, HIV, and other infectious diseases so that you can seek appropriate medical interventions to minimize the consequences. Remember, the best way to prevent hepatitis C and other diseases is to stop using. There are many treatment options available that can help you stop using heroin and maintain sobriety over time.

Recovering from Heroin Abuse

Addiction treatment can help you reach and maintain recovery. Treatment can also teach you how to identify and cope with triggers and other factors that lead to use so that you can avoid relapse once treatment is completed. There are a variety of treatment centers available, but some of the services that may be included in these settings are:

  • Individual Therapy: Individual therapy helps you explore the connection between thoughts, feelings, and behaviors and can provide you with the tools you need to cope with stressors and drug-using triggers.
  • Group Counseling: Group counseling will likely be led by a professional who specializes in substance use. These meetings may include exploring relationships, sharing experiences related to drug abuse, improving coping skills, and building sober social skills.
  • Peer-to-Peer Support Meetings: These also take place in a group setting, but may not be led by a professional. Rather, peers meet to share stories and experiences, connect with one other, and provide support with the main goal of helping each other maintain their sobriety.
  • Family Therapy: Family therapy can help you communicate effectively with family members and can also educate family members about your substance use, related concerns, and how to best support one another.
  • Medication Assisted Treatment: There are medications available for the treatment of heroin addiction, including buprenorphine, methadone, and naltrexone.1 These medications are often utilized as part of detox and, later, as part of a longer-term recovery program, although buprenorphine can be prescribed by specially-certified doctors directly out of their office or clinic.
  • Aftercare Planning: Aftercare planning will focus on what needs to take place in order for you to maintain sobriety and overall recovery. This may include continuing to see an individual therapist, engaging in family therapy, or joining a support group.

Remember, it is never too late to seek treatment and turn your life around. There are many treatment settings and options available, so it’s important that you find a program that best suits your individual needs.


  1. National Institute on Drug Abuse. (2017). Heroin.
  2. Substance Abuse and Mental Health Services Administration. (2016). Opioids.
  3. Ebright, J.R., & Pieper, B. (2002). Skin and Soft Tissue Infections in Injection Drug Users. Infectious Disease Clinics of North America, 16(3), 697-712.
  4. U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. (2016). Hepatitis C FAQs for the Public.
  5. U.S. Department of Health and Human Services: Centers for Disease Control and Prevention. (2016). Hepatitis C & Injection Drug Use.
  6. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Fifth Edition. Arlington, VA: American Psychiatric Association Publishing.
  7. National Institute on Drug Abuse. (2014). Heroin: Why Does Heroin Use Create Special Risk for Contracting HIV/AIDS and Hepatitis B and C?
  8. Substance Abuse and Mental Health Services Administration. (2017). HIV, AIDS, and Viral Hepatitis.

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