Hepatitis C Reduces Effectiveness of Opioid Treatment
Recent research from a team of American scientists indicates that the presence of the hepatitis C virus is associated with a reduced level of success for people enrolled in some buprenorphine-based opioid treatment programs.
Buprenorphine is an opioid-based medication frequently used temporarily to help people addicted to opioids achieve substance abstinence, or used long-term to control or eliminate the risks associated with uncontrolled opioid intake. In a study published in early 2015 in The American Journal of Drug and Alcohol Abuse, American researchers based in the U.S. and the United Arab Emirates assessed the impact that infection with the hepatitis C virus—a relatively common complication of injection drug use—has on the success of buprenorphine-based opioid treatment.
Buprenorphine and Opioid Treatment
Buprenorphine is a pharmaceutically produced medication based on naturally occurring opioid substances found in a plant commonly referred to as the opium poppy. Compared to most of the substances in the opium poppy (and most of the drugs/medications derived from those substances), the medication has a relatively modest mind-altering effect and a reduced ability to produce the euphoric feelings that frequently serve as an underlying motivation for opioid drug and medication misuse. Basically, this means that buprenorphine can provide enough of an impact in the brain to ease the craving for uncontrolled substance intake that characterizes opioid addiction while simultaneously failing to produce enough of an impact to function as a ready target of abuse for people accustomed to consuming stronger opioid substances.
Doctors sometimes use a course of buprenorphine as a stopgap measure to help people addicted to stronger opioids make it through opioid withdrawal, a highly uncomfortable physical and emotional condition that can easily derail opioid treatment if not properly addressed. Some doctors also use the medication as an ongoing substitute for heroin or other powerful opioids that present a much bigger risk for triggering uncontrolled, dangerous patterns of substance intake. In order to limit the chances that a person in treatment will try to abuse buprenorphine, pharmaceutical manufacturers often combine the medication with naloxone, a second medication that gradually renders buprenorphine ineffective over time.
All forms of hepatitis get their name because they produce inflammation in the liver, which plays a crucial role in the body’s ability to detoxify the bloodstream. There are three primary sources of viral hepatitis, known as hepatitis A, hepatitis B and hepatitis C. People with hepatitis C have liver inflammation caused by infection with the hepatitis C virus (HCV). Some individuals have an acute or short-term form of this infection; however, most affected individuals develop chronic hepatitis C, a lasting condition that can produce serious or fatal consequences such as liver cancer and permanent liver scarring (cirrhosis). In the U.S., needle sharing during injection drug use is the most likely route of HCV transmission, and many injection drug users have a hepatitis C infection.
Impact on Buprenorphine Treatment Success
In the study published in The American Journal of Drug and Alcohol Abuse, researchers from Washington State University and Cleveland Clinic Abu Dhabi used information gathered from 516 adults enrolled in the National Drug Abuse Treatment Clinical Trial Network to gauge the impact of the hepatitis C virus on the odds that any given person will benefit from temporary buprenorphine treatment while transitioning through opioid withdrawal. All of the study participants were addicted to opioids and received a tapering dose of buprenorphine after going through a month of buprenorphine-based treatment designed to facilitate a switch from uncontrolled substance intake. Some of the participants were weaned from buprenorphine in just one week, while others went through a more gradual tapering process that lasted for four weeks. All members of both groups were checked for HCV infection.
The researchers concluded that the presence of HCV was associated with worse outcomes for participants in the group of rapidly tapering buprenorphine users, as well as for participants in the group that transitioned more gradually from use of the medication. While enrolled in treatment and in the period just after the end of treatment, those individuals infected with the virus had a significantly lower chance of avoiding a relapse back into active, uncontrolled opioid intake.
The study’s authors believe that their findings may indicate a need to identify people with hepatitis C during buprenorphine-based opioid treatment in order to promote beneficial outcomes and productive use of available treatment resources.