Sniffing, Snorting Drugs May Raise Hepatitis C Risk

People who snort or sniff heroin in combination with cocaine may be at increased risk of developing hepatitis C, according to a new study. But transmission of the hepatitis C virus (HCV) could easily be prevented if people simply did not share implements used to sniff or snort drugs, experts said.

It is already known HCV can be transmitted through injecting drugs when syringes are shared. HCV can also be transmitted sexually, although it is spread mainly through contact with infected blood.

Dr. Thomas Kresina, a spokesperson for the National Institute on Drug Abuse, which funded the study, said that any of the drugs might actually cause bleeding in the nose. HCV can be transmitted when objects such as straws used to sniff or snort drugs are shared. "Obviously, the more drugs you put in intranasally, the more you're going to irritate your [nasal] vascular wall, and that's going to result in a little bleeding in the nose," he explained. "Then that blood goes on the instrument you use [to sniff or snort], and you transfer that to the next person. That's where the risk occurs," said Kresina.

Kresina noted that there is a difference between sniffing and snorting drugs. Sniffing involves inhaling a drug into the lower part of the nostril, while snorting sucks the drug into the upper part of the nostril. Straws or rolled up dollar bills are typically used to snort drugs.

In the study of 276 people who had ever smoked crack or who sniffed or snorted cocaine or heroin, 4.7 percent were infected with HCV. Participants who sniffed or snorted heroin and cocaine together were most likely to be infected with HCV. The reason for the increased risk of HCV infection among those participants may be related to the damaging effects of the drugs on the delicate nasal mucosal lining. "Further study is necessary to clarify the role of heroin and cocaine use in [the] acquisition and transmission of HCV infection," said Dr. Beryl A. Koblin of the New York Blood Center and the study's lead author.

"The prevention message here is not to share" drug instruments, Kresina said. "Any time you have bodily fluids being transferred, you have a risk of transmission of hepatitis C."

The full study, "Hepatitis C Virus Infection Among Noninjecting Drug Users in New York City," is published in the July issue of Journal of Medical Virology (2003;70(3):387-390).

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