Profile of Hepatitis C & Injection Drug Use in Canada

Executive Summary

Recently, there has been growing international concern about the spread and revalence of the hepatitis C virus among those who inject drugs. Worldwide prevalence estimates range from 50% to 100% infection rates among drug injecting populations (Finch, 1998). In Canada, injection drug use and the sharing of needles is the main cause of hepatitis C transmission, accounting for approximately 70% of all prevalent infections (LCDC, 1999). For this reason, people who inject drugs are a key group, and central to the persistence of the hepatitis C virus in Canada. This report examines injection drug use in Canada, characteristics of those who inject drugs, and the identification of high-risk behaviours. This information is intended to provide direction for future initiatives and programming in efforts to reduce the spread of the hepatitis C virus in this country.

In Canada, much of hepatitis C programming has consisted of an extension of existing HIV or STD programs. As a result of significant differences in the nature of transmission, these efforts have not been successful (Crofts et al., 1997; 1999; Van Beek et al., 1998). The hepatitis C virus is transmitted more easily through blood than HIV, is more potent than HIV, and is acquired earlier after the sharing of needles. Compared to HIV, the hepatitis C virus is 10 to 15 times more infectious by the spread of blood (Heintges and Wands, 1997). This situation is further exacerbated by high prevalence rates of hepatitis C infection among populations that inject drugs, such that even occasional sharing of needles and other drug paraphernalia carries an extreme risk of infection. As such, those who are contemplating injection drug use or are new initiates of this behaviour are critical populations in efforts to prevent HCV infection.

Due to the illegal nature of injection drug use, as well as the negative societal view, it is difficult to obtain reliable information on the extent of injection drug use in Canada, and the characteristics of people who inject drugs. Most of the available information is based on responses from needle exchange participants or addictions treatment clients. It is estimated that there are between 75,000 to 125,000 people in Canada who inject drugs (Single, 2000). Presently, a young, single person at the low end of the economic scale is characteristic of those at greater risk of sharing needles and other drug paraphernalia (Single, 2000). Within the larger population of those who inject drugs, sub-populations have been identified that have unique characteristics that place them at greater risk. These include prison populations, street-involved youth, women and Aboriginal people in Canada who are engaging in injection drug use.

Canadians incarcerated in prison have relatively high rates of hepatitis C and other blood-borne infections and injection drug use is the predominant risk factor underlying their higher risk (Jürgens, 1996). The presence of injection drug use and the sharing of needles in prisons increase the spread of the hepatitis C virus among inmates as well as the community at large upon their release. There is a pressing need for an examination of possible harm reduction initiatives that can be provided within the prison system.

The use and misuse of drugs in general, and injection drug use in particular, is particularly high among street-involved youth (Anderson, 1993; Roy et al., 1998). For many, drug use is symptomatic of family dysfunction and a hazardous street environment (Adlaf, Zdanowicz and Smart, 1996). Unless youth are able to remove themselves from street culture, success of intervention is low. These realities necessitate the provision of comprehensive prevention interventions that are sensitive to the environment in which unsafe behaviour occurs, as well as the provision of basic needs.

Increasingly, women who inject drugs are becoming more visible. There is evidence to suggest that females are becoming involved in injection drug use at a younger age than males (Rothon et al., 1997; Roy et al., 1998). For women who inject drugs, sexual or physical abuse may be a critical underlying factor. Research has found that women are less likely than men to inject illicit drugs alone and more likely to be influenced by others to inject drugs (Whynot, 1998). Women are often less able to resist pressure by their males partners to share needles or engage in unsafe sexual practices.

Aboriginal people in Canada have many social disadvantages that are frequently associated with the use and misuse of drugs, including poverty, low education, unstable family structure, physical abuse and poor social support networks (Scott, 1997). The number of Aboriginal people who inject drugs is not known. However, the evidence suggests that a disproportionately high number of Aboriginal people are users of injection drugs. It is imperative that prevention strategies incorporate ethnocultural differences that may impact upon risk-taking behaviour and hepatitis C infection.

The control of the hepatitis C virus epidemic will require more intense concentration on prevention and reducing needle-sharing than was required to reduce the incidence of HIV. In meeting these demands, it is critical that the factors underlying the use of injection drugs are appreciated and considered in the development of targeted approaches.

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