Medical Professionals Only: What are the chances of contracting HCV through sharing of sublingual tablets?

2 days ago at my clinic, a few issues were brought to my attention. One of my patients was diverting his medication. He had taken it out from under his tongue (after keeping it there for a few seconds). He then removed it when my nurse wasn't looking and gave it to another patient. Now this patient who diverted the meds is HIV and Hep-C positive. He gave his medication to another patient who doesn't have HIV or HCV. After this patient discovered that the meds he got was from a HIV+ and HCV+ person, he is now worried about getting infected. What are the chances for this guy to have contracted HCV this way (by placing the same medicine under his tongue and keeping it there for 15 mins). The chances are rather low I understand, but the chance is still there. I am very familiar with other modes of transmission but this is the first time I've come across this. (although I'm sure there would be plenty more). I'm not sure if either patient has any oral sores or bleeding gums.

Lady Isis: This isn't Methadone. This is Buprenorphine (Suboxone) sublingual tablets.

TweetyBird: Thank you. That was very helpful. Some of my patients divert their tabs to take it home and inject them. This is severely frowned upon and we are usually harsh with patients who do this. However it happens often especially when I'm not around. The chances are slim though to contract this by this way, but chances still exist. I think I'm going to send this kid for a test. Wish he didn't accept the tablets from the another patient. That other patient's viral load is currently very high. Thanks for your input. :)

Transmission by saliva is highly unlikely in either HIV or HCV. These diseases just aren't transmitted this way. Other types of viral and bacterial transmission is far more likely to happen.

The first thing that must be done, is that both patients must have oral exams to assess for intactness of oral membranes. The patient who received the SL med must be asked why he accepted medication from another person and why would he put anything in his own mouth that had been in the mouth of another. For medical purposes and to protect the clinic legally, this patient should be screened for both HIV and HCV at the clinic's expense. The 6 month follow up HIV retest should also be at the clinic's expense. It's most unfortunate, but it should be done because there may be a chance that this could have been avoided by clinic staff. You don't pass meds and walk away without knowing for a fact that it's been taken. When his results are available, he should be contacted immediately. If he should become ill due to transmission of other organisms, he should be treated by the clinic at no cost if he wishes.

If it's at all possible, the HIV/HCV patient should be given 30 day notice to find health care somewhere else. You really don't need a liability like him.

Without knowing the kind of clinic you work in, the type of patients these were and the precise circumstances of this med error (did the HIV/HVC patient bring the SL med with him or was it given to him there in the clinc? Did these patients know each other? Were they seated next to each other? What was the SL med and why did the other patient accept it?) this is the best I can offer.

The chance will always be there. Some methadone users have also been known to transfer their dosage onto another person. Even though they are closely monitored whilst taking it I have been told that they can have a device i.e a balloon to filter the methadone into.

My source, a friend that was on methadone and has seen all the ways of transference.

What I was trying to say was that anything can be transferred by mouth. Sublingual tablets usually disolve after a couple of minutes or less. Even after a couple of seconds I think the drug would have hardly been worth transferring as it would have already started disolving ? I was on temgesic sublingual and I would never had the chance to transfer it if I wanted to. I used methadone as an example. Sublingual tablets would be less transferable if they were like my temgesics.
Please excuse my ignorance.

Hey, AJ - great question. I found this study from the VA (US Office of Veteran's Affairs) that raises the same question. Here's the link:

http://www.rense.com/general63/dew.htm

Honestly, if it were my patient, I'd test him for Hep C following your accepted exposure protocol. When possible exposure to a treatable condition occurs, I've always tried to err on the side of caution. Good luck with your decision.

My husband has had hep c for over 40 years. We have gone to many many educational classes on Hep C and the other types of hepititis. You cannot get hep c from saliva. Period. It is blood to blood contact only. However, Hep B can be passed though bodily fluids. The doctors that head the class are experts on the subject and only treat hepititis patients. The VA study that your other answer spoke of, has already been disproven. By the way, my husband goes to the VA for treatment, and the doctor has discussed the possibliy of saliva...saying the risk does not exist. Only with Hep B

Even though there is a highly unlikeable mode of transmission, as you are aware, I would have the patient tested. A lesson has been learned from this. This particular patient will probably be fine but, to prevent any future incidents ( and to a patient who may not be lucky), it would be a great idea to crush the pill. But, some pills are not meant to crushed. Be sure that it is OK to so, if not, then the patient needs to open their mouth, look into the cheek region using a tongue depressor and under the tongue to be sure that the pill has been swallowed. And, their hands should be checked to be sure that the med hasn't been cupped. I hope that this has helped some. An interesting and informative question. ***4 U !
Ruth

Why are you giving these people stupid medications, why not go and live in the streets , not the hospitals.