The Hepatitis C Coalition is a group of leading clinicians, patient organisations, professional groups, industry and other interested parties. The Coalition’s Vision[1] is to halve hepatitis C (HCV) related liver cancers and deaths by 2020; eliminate the virus by 2030; increase testing; get more patients into treatment; and improve prevention strategies, and coordination between agencies.
Hepatitis C cannot be eliminated without more being done to address infection among people who inject drugs – the group most affected by HCV in the UK. 92% of HCV infections diagnosed in 2016 in England were acquired through injecting drug use. Half of those who inject drugs have been infected at some point, with 2 in 5 living with the infection[2], about half of whom are unaware they have it. The overall level of HCV transmission among PWID in the UK has changed little in recent years[3], while testing remains inadequate.[4]
In England, Wales and Northern Ireland, 39% of people who inject drugs share mixing containers, filters and/or needles and syringes – the primary transmission route for HCV.[5] Out of the approximately 255,000 dependent opiate users in England[6], just 146,536 were in drug treatment in 2016-17.[7] UK drug related deaths are at record levels[8]. In 2016, 1707 people in the UK died from a heroin overdose.[9] Hundreds of them would have been HCV positive.
The Hepatitis C Coalition supports, in principle, the introduction of Supervised Injection Facilities, in areas with high levels of injecting drug use, because the evidence shows they would help achieve our Vision of eliminating the virus.
Our call is in line with the evidence and advice to the Government from the Advisory Council on the Misuse of Drugs (ACMD) which says Supervised Injection Facilities:
- Reduce injecting risk behaviours
- Reduce blood-borne viruses
- Reduce overdose fatalities – no one has ever died of an overdose in a Supervised Injection Facility
- Improve access to primary care, testing and other forms of drug treatment, particularly for hard to reach groups like the street homeless
- Reduce discarded needles and street injecting
- Save more money than they cost, due to the reductions in deaths and infections
- Do not increase injecting, drug use or local crime rates[10]
In particular, we call for the UK Government to immediately take the steps necessary to allow the proposed Glasgow Supervised Injection Facility to go ahead as a pilot, something that already has the support of the Scottish Parliament, and unanimous support in Glasgow City Council. This would provide the perfect opportunity to gather further evidence of the clinical- and cost-effectiveness of Supervised Injection Facilities in a UK environment. It would also ensure that future initiatives maximise reductions in the harms associated with injecting, including HCV infection, saving people’s lives, and improving their health and wellbeing, and that of the communities they live in.
[1] Hepatitis C Coalition Vision http://www.hepc-coalition.uk/about-us/
[2] Public Health England, ‘Shooting Up: Infections among people who inject drugs in the UK, 2016 An update, November 2017’, 2017 p9 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/663003/Shooting_Up_2017_report.pdf
[3] Ibid p10
[4] Ibid p12
[5] Ibid p26
[6]Public Health England, ‘Opiate and crack cocaine use: prevalence estimates for local populations’, Last updated 28 March 2018,
[7] Public Health England, ‘Adult substance misuse statistics from the National Drug Treatment Monitoring System (NDTMS) 1 April 2016 to 31 March 2017’, Nov 2017, p5 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/658056/Adult-statistics-from-the-national-drug-treatment-monitoring-system-2016-2017.pdf
[8] ONS, Deaths related to drug poisoning in England and Wales: 2016 registrations, Aug 2017
[9] The 1707 heroin overdose deaths in the UK in 2016 consists of 473 in Scotland https://www.nrscotland.gov.uk/statistics-and-data/statistics/statistics-by-theme/vital-events/deaths/drug-related-deaths-in-scotland; 1209 England and Wales https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2016registrations#main-points; 25 in Northern Ireland https://www.nisra.gov.uk/publications/drug-related-and-drug-misuse-deaths-2006-2016
[10] Advisory Council on the Misuse of Drugs, ‘Reducing Opioid-related Deaths in the UK’, Dec 2016, p35 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/576560/ACMD-Drug-Related-Deaths-Report-161212.pdf