Yes, it is safe for you to take Suboxone if you have hepatitis C, but you must work closely with your doctor. The medications that treat Hepatitis C generally do not interact with Suboxone, so taking these medications together is not usually a problem.
If you’ve injected drugs, you might have hepatitis C and not know it. If you have not been tested for Hepatitis C, ask your doctor to be tested.
Suboxone’s Ingredients & Your Liver
Suboxone contains two ingredients, both of which are processed through the liver:
- Buprenorphine: This medication can ease withdrawal symptoms and block cravings. Very rarely, it’s been linked to elevated liver numbers during treatment, especially in people with hepatitis C.
- Naloxone: This medication keeps you from overdosing if you attempt to misuse Suboxone by injecting it. This medication hasn’t been linked to liver problems.
Early Suboxone clinical trials excluded people with liver issues, so we don’t really know the long-term impact of this medication on people with hepatitis C. But right now, doctors think that Suboxone is generally very safe to take, even if you have hepatitis C. However, if you do have Hepatitis C, you should seek treatment.
Can Hepatitis C Be Treated?
Yes! In recent decades, medications have been developed to treat and essentially eradicate hepatitis C.  Hepatitis C is now considered a curable disease. However, if you do continue to use injectable drugs, you are at risk for getting re-infected with Hepatitis C even after initial treatment. Therefore, patients with a history of injection drug use should be encouraged to do all they can to prevent relapsing, including use of MAT like Suboxone.
Should I Be Tested for Hep C Before Starting Medications?
No, you do not need to wait to get tested prior to starting Suboxone. However, getting tested in general is a good idea, whether or not you are on Suboxone therapy.
Sharing needles and/or having unprotected sex can enhance your risk for hepatitis C. Unfortunately, it’s a common and serious infection in people who misuse drugs.
It is estimated that about 2.4 million Americans have hepatitis C. Since the symptoms can be nonexistent at first, most people don’t know they’re infected until they have progressed to advanced liver disease, unless they get tested. 
Testing is recommended regardless of whether or not you are on Suboxone.  If you have a history of injection drug use, you may be at high risk for getting Hepatitis C. Reach out to your Suboxone provider or your regular doctor about getting tested.
- Naloxone. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. https://www.ncbi.nlm.nih.gov/books/NBK548244/. March 2020. Accessed July 2022.
- Buprenorphine. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. https://www.ncbi.nlm.nih.gov/books/NBK548871/. November 2020. Accessed July 2022.
- Monitoring of Liver Function Tests and Hepatitis in Patients Receiving Buprenorphine/Naloxone. Physician Clinical Support System. https://www.naabt.org/documents/pcsshepatitisbupeliver.pdf. November 2015. Accessed July 2022.
- Effect of Buprenorphine on Liver Function Tests for Patients Undergoing Long-Term Maintenance Treatment. Addictive Disorders and Their Treatment. https://journals.lww.com/addictiondisorders/Abstract/2014/09000/Effect_of_Buprenorphine_on_Liver_Function_Tests.5.aspx. September 2014. Accessed July 2022.
- Intolerance of Sublingual Buprenorphine-Naloxone During Induction in a Patient with End-Stage Liver Disease: A Case Report. Mental Health Clinician. https://meridian.allenpress.com/mhc/article/6/3/131/102732/Intolerance-of-sublingual-buprenorphine-naloxone. 2016. Accessed July 2022.
- Effects of Methadone on Liver Enzymes in Patients Undergoing Methadone Maintenance Treatment. Addiction and Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3905544/. Summer 2012. Accessed July 2022.
- Viral Hepatitis: A Very Real Consequence of Substance Use. National Institute on Drug Abuse. https://nida.nih.gov/research-topics/viral-hepatitis-very-real-consequence-substance-use. Accessed July 2022.
- Hepatitis C and Injection Drug Use. Centers for Disease Control and Prevention. https://www.cdc.gov/hepatitis/hcv/pdfs/factsheet-pwid.pdf. 2016. Accessed July 2022.
- Suboxone Prescribing Information. U.S. Food and Drug Administration. https://www.suboxone.com/pdfs/prescribing-information.pdf. June 2022. Accessed July 2022.
Medically Reviewed By: Elena Hill, MD, MPH
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