Condition

Injection of any drug or other substance not prescribed by a qualified physician or other healthcare professional. This encompasses, for example, drugs of addiction such as heroin, and use of non-prescribed injected anabolic steroids.

Individual at risk

Recipient

Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)

ACCEPT.

Guidance at CT/WORK-UP

• ACCEPTABLE if:
  • injected drugs of addiction greater than 3 months prior to donation regarding infectious disease risk. Depending on individual risk assessment of donor physical and mental health a longer deferral may be appropriate. Consider offering cryopreservation with IDM follow up testing. Ensure only necessary information is discussed with transplant centre.
• ACCEPTABLE if:
  •  injected non addictive medications greater than 3 months prior to donation.

Regarding recipient risk of other non-addictive medications less than 3 months prior to donation, they may proceed at the discretion of the requesting transplant centre. Day of donation NAT testing is advised if potential window period use.

Regarding donor risk the pathophysiology of the specific drug should be considered eg potential for thrombotic risk associated with high HCT in users of anabolic steroid (ref: medication page)

Consider informing TC if unregulated drug injected as these may originate from animal tissue with potential risk of eg prion disease

Justification for guidance

Use of non-prescribed injected drugs of addiction is associated with a considerably higher risk of transmission of blood borne infectious diseases.

Although case reports of transmission of hepatitis C have been reported in users of androgenic steroids have been reported, the exposure risk remains very low and such donors may proceed at the discretion of the requesting transplant centre.

References

Elghouzzi MH, Bouchardeau F, Pillonel J, Boiret E, Tirtaine C, Barlet V et al. Hepatitis C virus: routes of infection and genotypes in a cohort of anti-HCV-positive French blood donors. Vox Sang 2000; 79(3): 138-44.

Aitken C, Delalande C, Stanton K. Pumping iron, risking infection? Exposure to hepatitis C, hepatitis B and HIV among anabolic-androgenic steroid injectors in Victoria, Australia. Drug Alcohol Depend 2002; 65(3): 303-8.

Midgley SJ, Heather N, Best D, Henderson D, McCarthy S, Davies JB. Risk behaviours for HIV and hepatitis infection among anabolic-androgenic steroid users. AIDS Care 2000; 12(2): 163-70.

Rich JD, Dickinson BP, Merriman NA, Flanigan TP. Hepatitis C virus infection related to anabolic-androgenic steroid injection in a recreational weight lifter. Am J Gastroenterol 1998; 93(9): 1598.