New findings suggest that sharing paraphernalia used to cook and prepare injection drugs does not directly lead to transmission of hepatitis C virus.
According to Robert Heimer, PhD, professor of epidemiology and pharmacology at the Yale School of Public Health, and colleagues, this contrasts with past epidemiological studies that reported HCV incidence linked to sharing “cookers” and filters. Heimer said those studies were not clear on whether the results reflected the contamination of such paraphernalia or syringe-mediated contamination among people who inject drugs (PWID).
Heimer and colleagues used lab studies to show that transmission occurs via the needles used in preparing and injecting drugs, not through shared paraphernalia. In light of their results, they said syringe access programs should not spend their limited resources on providing “cookers” and filters to PWID. Instead, Heimer and colleagues said they should focus on distributing more syringes with fixed needles, which are less apt to harbor infectious HCV than those with detachable needles.
“These findings suggest it may not be HCV in shared ‘cookers’ and filters that leads to transmission, but instead that this kind of sharing is a surrogate for situations in which HCV-discordant injectors share drugs,” Heimer and colleagues wrote in The Journal of Infectious Diseases.
“In this scenario, injectors collectively prepare drugs. If a contaminated syringe was used to add water, dissolve and apportion the drug, then some of the contents of the contaminated syringe would pass through the ‘cooker’ and filter and into the syringe of the uninfected person. In such a case, the ‘cookers’ and filters may not even harbor infectious virus, and the distribution of clean ones and warnings about sharing them may have little or no impact on HCV incidence.”