Review examines effect of needle exchange, opioid treatments on hepatitis C transmission

A research review has concluded that a combination of needle exchange programs and opioid substitution therapies can dramatically reduce risk of hepatitis C transmission in injection drug users. However, the evidence was stronger for medication treatments than for needle exchange, and the researchers added that the overall evidence from the review was relatively weak because none of the identified studies were randomized controlled trials (RCTs).

The Cochrane review, published Sept. 18, encompassed 28 studies conducted through November 2015 (13 of the studies were from North America). It found that use of an opioid substitution drug within the past six months may reduce risk of contracting the hepatitis C virus by 50%. The evidence was less clear about whether regular attendance at needle exchange programs was associated with reduced risk of hepatitis C, but the researchers reported some evidence of reduced risk based on the results of European studies.

The researchers did conclude that combined use of needle exchange and opioid substitution therapies may reduce risk of hepatitis C infection by 74%.

They pointed out, however, that the vast majority of the studies they examined carried at least a serious risk of bias. “As none of the intervention effects were generated from RCT evidence, we typically categorized quality as low,” they wrote.