'War on drugs' fuelling the hepatitis C epidemic among people who inject drugs

The global war on drugs has had a disastrous impact on the hepatitis C epidemic, a new report from the Global Commission on Drug Policy shows. The Negative Impact of the War on Drugs on Public Health: The Hidden Hepatitis C Epidemic is backed by seven former world leaders and cites evidence showing that the criminalisation of drug use is fuelling a hepatitis C “viral time bomb”. The report is being launched ahead of the 23rd International Harm Reduction Conference, which will be held in Vilnius, Lithuania starting on 10 June.

“The war on drugs is a war on common sense,” said Ruth Dreifuss, former president of Switzerland. “The hepatitis C epidemic, totally preventable and curable, is…proof that the drug policy status quo has failed us all miserably.”

The report highlights how countries with the most repressive drug policies have some of the worst hepatitis C virus epidemics among people who inject drugs.

Hepatitis C virus (HCV) is a blood-borne virus, meaning that it can be transmitted via injecting drug use. Of the 16 million individuals who inject drugs around the world, an estimated 10 million have hepatitis C. Chronic infection can lead to serious liver disease and is an increasingly important cause of illness and death among injecting drug users.

HCV is both preventable and curable. But the report argues that the ongoing war against drugs is fuelling new HCV transmissions and causing needless illness and death among people who inject drugs.

“It is a disgrace that barely a handful of countries can actually show significant declines in new infections of hepatitis C among people who inject drugs,” said Commissioner Michel Kazatchkine, who is the UN Secretary General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia. “Hepatitis C has to be one of the most grossly miscalculated diseases by governments on the planet.” He express especial concern about the situation in Eastern Europe and Central Asia.

In some settings with especially harsh policies on drugs, such as Thailand and Russia, up to 90% of injecting drug users have hepatitis C. There are especially high numbers of HCV infections among people who inject drugs in China (1.6 million), the USA (1.5 million) and the Russian Federation (1.5 million).

Harm reduction services – access to clean injecting equipment and opioid substitution therapy – can prevent HCV infections. However, the report cites research from around the world showing that repressive drug laws mean that drug users are being driven away from these public health services.

“Limited public funds continue to be wasted on harmful and ineffective drug law enforcement efforts instead of being invested in proven treatment and prevention strategies,” says the report.

The imprisonment of people who inject drugs is also leading to the spread of the virus. Of the 158 countries reporting drug use in prisons, only ten provide needle and syringe exchange to inmates and only 41 have opioid substitution programmes. The report highlights the situation in the US, where between 12 and 35% of people in prison have hepatitis C compared to a prevalence of between 1 and 2% in the general population. Despite this, the rate of testing among prisoners is low, and health authorities in the US do not recommend the provision of clean injecting equipment to prisoners.

HCV is a potentially curable infection, and more efficacious and tolerable combinations of antiviral drugs are doing well in clinical trials. However, even in a setting such as Lithuania, where there has been real progress in the provision of free HCV therapy, treatment is reaching only 5% of those in need.

Scotland is highlighted as an example of best practice. The report praises key achievements following from the launch of the country’s National Hepatitis C Action Plan. These include increased access to clean injecting equipment; increases in the number of people tested for the virus; increased awareness of HCV; a doubling of the number of people receiving therapy and a “clear downward trend in the rate of new HCV infections”.

The report recommends that governments should reform existing drug policies, ending the criminalisation and mass imprisonment of people who use drugs. It also suggests that resources should be directed away from the “war on drugs” and into public health interventions that maximise HCV prevention and care. 

“Government must remove any legal or de facto restrictions on the provision of sterile injection equipment and other harm reduction services,” says the report. “Governments should ensure that people who use drugs are not excluded from treatment programmes.”

The authors call for urgent action, concluding “the ‘war on drugs’ has failed, and significant public harms can be averted if action is taken now”.