Using whilst on Treatment

[asle]

My friend started Incivo a month before me. He contracted HCV from injecting speed about 30 years ago.
He has been struggling with the sx, and has begun using heroin on the day after his Interferon injection to deal with the pain and sickness. he said that it is only this one day, and not even every week. About once a fortnight. He wonders if it is affecting his liver, so therefore affecting the tx.

[his3707]

I treated with incivek for the first 12 weeks of 48 weeks.  I was told not to take ANYTHING other than regular food that was not approved by the doctor because you cant take a chance of an interaction that would diminish or increase the affects of the treatment drugs.  I dont think they would approve the use of heroin.  You dont want to mess with these treatment drugs.  His doctor will have approved meds he can use for pain and nausea, anemia, rashes, etc.! I was not even able to take my statin drug.  

[can-do-man]

Well it's sure not a wise thing to be doing, that said I would think just like drinking alcohol that adherence to taking the meds and on time would be a major problem........... Is there an interaction from herion? Very well could be but not sure they would test for it......

[his3707]

yes, not adhering to the strict drug regimen during would be extremely risky.  Heroin might have more of an interaction with that part of the treatment than anything else

[asle]

He just said he's done it once, and wondered if it would just be like taking codeine. That said, he is intent on finishing the tx, and will probably just 'suck it up'. I told him about taking the Interferon late at night, with a couple of Panadol. I just did that, and I feel good, well.....

[gsx1250fa]

Why even bother to treat if he is going to continue the same old habits that got him here in the first place? "I'm only going to  shoot dope once a week....I promise". Gimme a break. LOL If he isn't getting puking off the H blast....then he is probably using alot more than you think!

[asle]

We could all be judgemental here. But the question was whether the heroin affects the liver whilst on tx, or is metabolized like codeine.
I certainly do not agree with his behaviour, but so saying, he deserves an answer to his question, if anyone knows one.

[mzkity]

Well said. But if HES concerned why not call a doctor. He doesn't have to say who he is. Also I don't know about your country but with hippa (u.s.) here it would be easy to find out.  In defense of this site (hep c) your not going to find a lot of us slamming. I know there's people on here that know the answer. But it seems so not related to well all the shi!! that comes with treatment. You can try the addiction sites, I bet you would get an answer:-) :-)  good luck--kitty

[pooh55811]

I went to:   www.drugs.com  

I checked the interactions. I put in the drugs Interferon, Ribavirin, Incivek, Heroin, Morphine (because Morphine is a derivative of Heroin and I figured if they did not have heroin, they might have Morphine).

This is what they said:

Drug Interactions Results

Drug interactions for the following 5 drug(s):

heroin  (the interactions information for this drug may not be up to date)
morphine
ribavirin
Incivek (telaprevir)
Pegasys (peginterferon alfa-2a)

Interactions between your selected drugs

No results found - however, this does not necessarily mean no interactions exist. ALWAYS consult with your doctor or pharmacist.

Other drugs that your selected drugs interact with

    heroin interacts with more than 40 other drugs.
    morphine interacts with more than 300 other drugs.
    ribavirin interacts with more than 10 other drugs.
    Incivek (telaprevir) interacts with more than 200 other drugs.
    Pegasys (peginterferon alfa-2a) interacts with more than 100 other drugs.

Interactions between your selected drugs and food
morphine ↔ food
Applies to: morphine
Do not drink alcohol or use medications that contain alcohol while you are using morphine. This can cause dizziness, feeling light-headed, shallow breathing, seizures, and coma. Do not crush, chew, break, or open an extended-release tablet or capsule. Swallow the pill whole. It is specially made to release medicine slowly in the body. Breaking or opening the pill would cause too much of the drug to be released at one time.

ribavirin ↔ food
Applies to: ribavirin
Food can enhance the levels of ribavirin in your body. Ribavirin should be taken with food or just after eating. This will make it easier for your body to absorb the medication. Do not take it on an empty stomach. Swallow the tablet or capsule whole.


http://www.drugs.com/interactions-check.php?drug_list=2759-0,1656-0,2009-0,3328-15346,1806-1159

[Idyllic]

The reason you may not get a response is because it has not been studied. People on methadone maintenance is the closest thing I can think of:

....as reported in the September 2007 edition of the European Journal of Gastroenterology and Hepatology, injection drug users are often denied Hepatitis C treatment because of concerns about adherence to the therapy. Most experts believe that these concerns are due to the stigma of drug addiction, not based on actual facts. As found in a study by researchers in San Francisco, the majority of methadone-maintained drug users can adhere to Hepatitis C treatment.

According to a Croatian study published in the December 2011 edition of Hepatitis Monthly, Hepatitis C virus is one of the major infectious diseases among injecting drug users – but most injecting drug users are not treated. Upon analyzing the outcome of Hepatitis C treatment (consisting of pegylated interferon and ribavirin) on injecting drug users over the course of seven years, the researchers determined that treatment of chronic Hepatitis C in this population should be strongly encouraged as they have positive predictors for achieving success, such as:

    younger age
    shorter duration of infection
    favorable histological stage of the disease
    good adherence to treatment

Additionally, the researchers found there to be no difference in safety and tolerability profiles of Hepatitis C treatment in intravenous drug users compared to patients without a history of drug abuse.

http://www.hepatitis-central.com/mt/archives/2012/03/hepatitis_c_tre_4.html
_________________

But since it difficult to resist offering an opinion as one in recovery myself I would submit that treatment can be triggering for some people and not having a system in place when starting treatment can result in a situation like the one mentioned in this post. I wish there was a way he could have had assistance in this area rather than risk getting strung out again.

[heart_in_the_keyes]

OMG OMG OMG is all I can say....OMG....no, no, no.  Has no one every done or been with someone who has done herion.  First of all...wouldn't this show up on his blood tests and disqualifiy him form doing the tx?  When I was going through the meetings for this last fall the guy sitting next to me did herion and was a drinker....he was disqualified.

I have worked detox...I dated someone who was brilliant but could not kick speed, coke, herion.  Injecting between his toes because he was so addictied. And heion, when you don't get it, you have major stomach cramps and get so sick.  How in the H could this even possibly help him.

Thought we are told that we can even take tylenol, have a beer or smoke...so how can hard drugs be okay???? H_ _ _s Bells...I can't eat red meat but I could do herion...how crazy is that???

Not casting judgement here but why is he doing this to himself....doesn't he want to get better... Someone help me understand this please.

[copyman]

Sometimes it is hard for an ex addict to use a syringe with legal meds. This can throw them right right back into bad habits. Which looks to be the case here.

Sounds like he is wasting a good treatment. Sad because there are people  who would give anything to treat but can't afford it, etc

Wishing your friend and you best of luck

[stormy456]

What would we all do without your incredibly informative posts?
Thanks for that, Pooh!

[pooh55811]

I just reread your post. I thought you had asked if there were drug interaction between Heroin and the Hep C treatment drugs. I see that was not your question. So here is another attempt to respond to your question.

"the question was whether the heroin affects the liver whilst on tx, or is metabolized like codeine. "

To be honest, I don't know the answer to that question. However, Heroin is metabolized to morphine so I looked up the metabolism of morphine. Unfortunately, there is really not a lot of information on the internet about the metabolism of Heroin or Morphine other than it is mainly metabolized by the liver.

I did find a couple of articles but I am not sure they will be helpful.

http://www.news-medical.net/health/Morphine-Pharmacokinetics.aspx

http://facta.junis.ni.ac.rs/mab/mab200503/mab200503-07.pdf

You can try looking up Heroin metabolism but I did not have a lot of luck with that path.

[asle]

I don't believe my friend is 'wasting a good treatment'. Just the fact that he has asked if this is going to affect his treatment, or damage his liver shows, I believe, that he doesn't want to waste this opportunity for wellness.
He also has not come from a past of using heroin, so I guess he still has general addiction issues, and is concerned about them.

[asle]

There WERE 2 parts to my friend's querie. And you have tackled them both. The first was whether heroin interacted or affected the treatment, and the second was that would heroin further damage a liver whilst on triple tx.
And thanks for your unending support for all of us here.

[creewoman]

I have decompensated Liver that can only be treated with transplant.I have not been told to stop my methadone"for pain in back".As long as I don't abuse my Methadone there is no reason I have to stop using it for pretransplant or treatment.Told to me by the Infectious disease doctor that evaluates for referrals for UWMC.There is a study that was done by the Veteran's Administration on using Methadone while on treatment for hep c. and that it did indeed help with side effects and other issues.The link is on my other computer I will send the info. tommorrow .So maybe there is hope for addicts with Methadone.Heroin has no effects that I remember either.I am not condoning this.I have been reducing my dosage over a 2 1/2 span because of the fear of the horrendous withdrawals.I tried cold turkey it did NOT work.You have my prayers and deepest understanding as I was saying ealier Alcholics and addicts have a special place in my heart.

[creewoman]

Please forgive me I thought you were posting about yourself.Pas the info along to friend.Snow

[Dee1956]

Hi, it is nice of you to try to help your friend.  I think Pooh gave you the best, most informative answer.  She is very good.
I wish your friend a lot of luck.  
While I am sorry to say I do not have more information, if people can take Methadone, then I don't think it would hurt.
On another note, if I were your friend, I would worry about infecting myself with Hepatitis
Good luck
D

[pooh55811]

One thing I would be very concerned about would be the possibility of getting an infection while on treatment. The risk for a blood infection (septicemia) is always present when injecting IV drugs under less than sterile circumstances. But the risk is probably higher while we are on treatment. I am not talking about reinfection with Hep C, although that is also a possibility. I am talking about a bacterial infection of the blood, something  which could lead to infections of the brain, heart, or other organs. That would be a major concern to me if I was injecting IV drugs while on treatment.

So, while I don't think it is a good idea to inject IV drugs on Tx, if someone is going to do it, then a new sterile needle and syringe would be advisable. The new sterile needle and syringe may help to prevent bacterial infection, but there is still the rest of the paraphernalia and the drugs themselves, which are not sterile.

[Idyllic]

I am not sure the extent your is in the clear if he is trying to heal his liver by treating his Hep C and shooting dope. But truly this is a question for his doctor or someone with knowledge of his medical history and other factors. All we can really do is search the internet and post links.

Either way I hope he clears the virus. This is tough treatment and I did a lot of things I would not otherwise do just to get through it.

Chronic Intravenous Heroin Abuse: Impact on the liver
Pretty grim but difficult to slog through
http://tinyurl.com/atntwfh

I think this is that study in brief
http://www.ncbi.nlm.nih.gov/pubmed/20499735
The study showed that the most present change in the hepatocytes of drug addicts was vesicular degeneration, and it is the only direct consequence of the effect of heroin.

http://www.ncbi.nlm.nih.gov/pubmed/9220152
Lobular hepatic fibrosis and the presence of myofibroblasts were studied in heroin abusers, by quantitative automatic image analysis.



There was a recent easy to follow one that was a slide presentation but I can't find it anymore. It was heroin use in HCV and HIV/HCV (co-infected) people.

[ppmguy]

        i was hospitalized in week 2 for kidney failure. i was on morphine for a few days.  when i questioned the dr about the morphine he said it was  fine. i have chronic MS also.  i am on many meds, and dr. discussed each  one.  when we talked about pain relief, my dr. said hydrocodne or oxycodone with little or no tylenol was best. opiates are removed by kidneys.  i was still und all the way thru 48 weeks.
        i am not being judgemental, but why fix on tx.  the chances of addiction relapse goes up significantly. i shot heroin and speed for 14 years, then methadone for 5 years. for those of you who are worried about getting off methadone. went down 5 mg. every 2 months and then off.  an anti depressant may be a good substitute for sx. tylenol(650 mg) will help more then you expect.  sorry but heroin is over kill.    barry

[creewoman]

I AM NOT prescribed Methadone for addiction it is for pain only.A much safer alternative to true opioids if you ask me.I voluntarily chose to reduce my dosage because I do not want anything to have that much control over me and I felt I was missing out on some emotions that I should have had.
Anyone on long term pain medication will experience physical withdrawal symptoms whether you are an addict of not you can cold turkey .
Anyway the stress of withdrawals and shame that goes with it seems it could be just as big of danger to his tx.The best thing we can do is to offer all angles without Judgement.We are all unique and are just humans trying to make our way in this world.
Preach STERILE equipment only.No one will stop if they are judged or shamed or are forced to get sick.They will just stop the treatment!
Snowbank Woman I AM!

[ppmguy]

         i have no problem with methadone. i used it for 5 years, sucessfully.  and for longterm pain, it is the way to go.   no tolerance buildup and its safe and legal. in all honesty ,i did not read your posts.  i just wanted to give the writer my perspective. one that comes from someone that used narcotics.  sorry if i offended.      barry

[creewoman]

VIII. PATIENTS ON METHADONE MAINTENANCE/OPIATE REPLACEMENT THERAPY

Patients receiving stable methadone doses and who have not used injection drugs for six months may benefit from peginterferon-ribavirin treatment (64, 65) . Patients receiving methadone maintenance have higher discontinuation rates, but the SVR rate among those who completed treatment was similar to the SVR among patients not on methadone. Limited data are available about the use of peginterferon-ribavirin-protease inhibitor therapy in patients receiving methadone. When co-administered with telaprevir, methadone levels in the blood are reduced but only clinical monitoring and possible methadone dose-adjustment are recommended (63) . Co-administration with boceprevir can potentially either raise or lower blood levels of methadone or buprenorphine; clinical monitoring is recommended (62) .

Recommendations for patients on methadone:
Antiviral therapy should be offered to patients enrolled in a methadone maintenance program who meet criteria for therapy (Class I, Level A).
Treatment should be coordinated between HCV treatment providers and substance abuse specialists (Class I, Level B).