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Safer Injection Practices for HCV Patients Who Inject Drugs

Hepatitis C has emerged as the most serious problem in Australia for people who inject drugs. The majority of people who have injected drugs have hepatitis C. This means that people who inject drugs who do not yet have hepatitis C are at great risk of infection

An estimated 65 to 90% of people who have shared equipment to inject drugs have the virus. Even those people who have shared injecting equipment once or twice have possibly caught hepatitis C. It doesn't matter what is injected - heroin, methadone, pills, speed or steroids. It is how the drugs are injected that is a potential risk for transmitting infection .

Like anyone with hepatitis C, if you inject drugs you need adequate medical follow-up after a hepatitis C diagnosis is made. Awareness of infection is important, as is knowledge of safe injecting practices and recommended lifestyle changes.

Harm minimisation:
If you inject, you should consider three health risk factors.
Firstly, there is the unknown strength of street drugs and that people have different drug tolerances.
Secondly, street drugs may contain dangerous impurities.
Finally, if you already have hepatitis C, there is the possibility of reinfection with another strain of hepatitis C or other viral infections like HIV or hepatitis B.

Some drugs, due to their specific effects, impair health and increase susceptibility to illness. If you inject, you may be advised to consider the possible health complications involved.

You can reduce risks by:

  • Swallowing, snorting or smoking drugs (don't share 'straws' if snorting)
  • Washing your hands before and after shooting up
  • Wipe down all surfaces where you'll be preparing your hit
  • Avoid all contact with anyone else's blood, including traces you might not be able to see
  • Use a new fit for every hit - as a last resort, use fits cleaned as described below
  • Don't share any equipment when preparing and injecting your drugs - use all your own gear
  • Don't use hits prepared by someone else at some other time
  • Immediately after each use, flush your fit with clean cold water even if you don't think you'll use it again. This helps remove blood and infection particles from the fit and has the added advantage of removing all traces of whatever drug you're shooting up
  • Dispose of your fits safely - eg. put them in sharps bins, back in your fit pack or into empty plastic resealable drink bottles
  • Avoiding binge drug use
  • Avoiding drinking alcohol heavily when using.

Cleaning fits:
We don't know that disinfection or cleaning really works so be safe and use all new equipment every time you hit up. Reusing fits should be a last option only. If you're cleaning fits, remember the following guidelines:

Immediately after use, rinse fit in cold water until signs of blood are gone. Squirt water down sink or into an old drink bottle. Do this as soon as you've used the fit since dried or clotted blood is hard to wash out and can block the fit. Always use cold water as hot water will clot blood in the fit and block it.

Fill the fit with fresh high-strength bleach. Use the strongest bleach available (which is usually the most expensive). With the fit full of bleach, replace the cap over the needle and shake it for 30 seconds or more. Time this on a watch or count it out slowly. Then squirt the bleach out into the sink or an old drink bottle. Now repeat the bleach process, again shaking for thirty seconds.

With another container of fresh clean water rinse the fit out at least two times. Again, squirt the water down the sink or into an old drink bottle, not into your containers of bleach or clean water. Empty all your containers down the sink when you are finished.

Remember that this way of cleaning fits can't be guaranteed to kill the hepatitis C virus. Taking time with the above steps improves your chances of avoiding transmission of hepatitis C, but ideally, use new clean equipment for every hit. Look for your nearest needle and syringe exchange service.


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