A Forgotten Risk

The risk of HIV and hepatitis C infection from the sharing of syringes and related injection equipment gets the most attention; it is important to keep HBV at the forefront of our prevention efforts, too. Indeed, one of the first needle exchange programs was started in Amsterdam by a group of people who inject drugs (PWID) and their allies in response to an HBV outbreak.

As the opioid crisis rages throughout the United States, we are seeing increases in HBV rates among PWID, and in pregnant women infected due to injection drug use that can lead to mother-to-child transmission if gone unchecked. See below for some prevention and harm reduction tips to reduce the risk of infection among PWID.

HBV prevention tips for PWID:

HBV vaccination. This is easily the most important recommendation: Get vaccinated and you don’t have to worry about getting infected later. All PWID should be vaccinated against HBV. Test to make sure you don’t already have it or are already immune to it (see page 42). If you’re still at risk of infection, get vaccinated.

Safe injection practices. New, unused injecting equipment—syringes, cookers, cotton, water, etc.—for each injection is the best way to prevent HBV (as well as HCV and HIV). Check to see where you can get these in your local area: Syringe access sites may be available, or you may be able to purchase syringes from a pharmacy.

Other harm reduction practices. New, unused injection equipment is the gold standard for prevention, but if you have no access to them and have to share or reuse them, rinsing them with bleach is the next best thing. In lab settings, bleach has been shown to be effective in disinfecting and killing HIV, HCV, and HBV. You should rinse with cold water, draw up the bleach (ideally keep the bleach in there for 2 minutes, then rinse it out with cold water again. For more information on how to use bleach to disinfect a syringe, check out this video at harmreductionworks.org.uk.

Reducing or stopping injection drug use. If you are ready for drug treatment or can get into opioid replacement therapy, you won’t be injecting drugs any longer and thus not at risk. This is easier said than done, so if you’re not ready, you may consider different, non-injecting ways of taking your drug of choice. If you snort drugs, don’t share straws. If you smoke them, don’t share pipes or try to cover the mouthpiece to avoid any potential blood contact. If you choose to stop (or are forced to stop due to incarceration or other reasons), be mindful of the risk of opioid overdose should you use again. Be safe: If possible, don’t use alone (each person using their own injecting equipment) and carry naloxone to reverse an overdose should one occur. Naloxone is available at many syringe access sites.

Practice safer sex and other prevention strategies. While preventing infection from injection drug use, don’t forget about other ways to get it. Minimize your risk of sexual transmission through the use of condoms or other barriers.


The Harm Reduction Coalition


An advocacy and education organization that offers a safer injecting booklet, “Getting Off Right,” found at harmreduction.org.

The Chicago Recovery Alliance


A racially and ethnically diverse group comprised of people living with HIV, hepatitis, and substance use who work to improve the health of people impacted by drug-related harm. They have an excellent safer injection guide, “Better Vein Care—Safer Injection Guide,” along with educational videos, found at anypositivechange.org.