Needle/syringe progammes and opioid substitution therapy for reducing hepatitis C infection in people who inject drugs

Providing clean injecting equipment to people who inject drugs, along with opioid substitution therapy, could reduce transmission of Hepatitis C (HCV) finds new research published today in Addiction and a Cochrane Review.

Over 70 million people live with hepatitis C and there are 3 to 4 million people newly infected each year. Hepatitis C remains highly prevalent in the UK with approximately 200,000 cases nationwide with the majority of cases among people who inject drugs.  Roughly half of people who regularly inject drugs are infected with hepatitis C in many countries.

While it is known that the provision of sterile injecting equipment through needle syringe programmes (NSP) or providing Opioid substitution therapy (OST) such as methadone or buprenorphine reduces injecting risk behaviour, and there is evidence also that OST and NSP reduces HIV transmission among people who inject drugs.  Until now, there has been insufficient evidence that OST and NSP can also protect against HCV infection. 

A new study, funded by the NIHR Public Health Research Programme, has examined whether NSP combined with opiate substitution could help reduce the risk of new infections among this population.

Researchers from the London School of Hygiene and Tropical Medicine, the University of Bristol and other institutions around the world examined whether NSP and OST, provided alone or together, are effective in reducing the chances of becoming infected with hepatitis C in people who inject drugs.

The review suggests that providing opioid substitution therapy can reduce the risk of acquiring HCV by 50%. Combining opioid substitution therapy with NSP with OST may reduce risk of HCV infection by 74%. There was more uncertainty on the effectiveness of NSP alone.  Studies in Europe which tended to measure high coverage in terms of the people who receive 100 per cent sterile syringes per injection showed more than 50 per cent reduction in HCV, but studies in North America which often measured coverage in terms of frequency of NSP attendance showed little effect. 

Lead researcher Dr Lucy Platt, (Associate Professor in Public Health Epidemiology) said, “This is an important public health area and until now we have had limited research evidence on the effectiveness of needle/syringe programme and opioid substitution therapy in reducing the risk of hepatitis C transmission.

This is the first global systematic review of quantitative studies on the effectiveness of OST and NSP on reducing Hepatitis C. Our findings provide strong evidence that OST especially in combination with high coverage of NSP can reduce HCV transmission. Up to half of people who inject drugs have hepatitis C: there is an urgent need to scale up these interventions to prevent on-going transmission, unnecessary deaths and illness.”

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