COCAINE IS a drug with a glamorous reputation. It does not have the same seedy image as heroin, which is linked to HIV infection, dirty squats and needle-sharing.

The succession of famous people seen in the media seeking help for cocaine ad-diction in fashionable clinics, such as the Priory, has not served to dent its celebrity image: that of a relatively expensive drug that can be taken recreationally with few or no side-effects.

Because the drug has tradition-ally been snorted through straws or banknotes, and not intravenously injected, it is often thought to be a “safer” option – particularly as it was simply too expensive for the majority of potential users to even contemplate developing the “luxury” of an addiction.

However these stereotypes are far from the truth. According to a report in the Observer in May, the street price  of the drug has nearly halved in the last couple of years, dropping from around £70 to £40 per gram. As a result of easier avail-ability and falling prices, cocaine appears to be taking-over from ecstasy as the clubber’s drug of choice. These factors, reports the newspaper, combined with “the belief among young people that cocaine is ‘safe’”, has resulted in “87 deaths linked to its use for the first six months of 2003 – double the figure for the same period in 2002”.

And evidence is beginning to emerge of a possible link between the growing availability of cocaine and the escalating numbers of people infected with the hepatitis C virus.

A report in the London newspaper Metro in December last year claims that thousands of people may be putting themselves at risk of contracting hepatitis C through the sharing of rolled-up banknotes to snort cocaine.

According to the report, flecks of nasal mucus and blood on straws and banknotes were helping to spread the virus in the Capital. “Cocaine snorting,” said consultant hepatologist, Professor Graham Foster, “is a much underappreciated risk factor. Most people have no idea there is a link.”

The delicate nasal mucosal lining is frequently damaged when a person snorts drugs, leading to bleeding. In an infrequent user the bleeding may be very limited and may go unnoticed. A regular abuser of the drug, however, may suffer heavy nosebleeds which may take some time to stem.

Hepatitis C is extremely infectious – partly because the virus can survive outside the body for a much longer time compared with other viruses such as HIV – and can be transmitted in minuscule amounts of blood. A user carrying hepatitis C would only need to leave tiny traces of blood or mucus on the end of a banknote or straw, to potentially infect the next person to share it.

Often referred to as the “silent epidemic”, hepatitis C is a chronic inflammation of the liver which exhibits few symptoms. As well as being a leading factor in liver transplants, the American Centers for Disease Control and Prevention (CDC) estimates that between one and five per cent of all infected persons will die as a result of liver cirrhosis or cancer.

However, in the region of 20 per cent of those infected with the virus will manage to naturally eliminate it from their systems within six months of catching it without ever suffering any symptoms.

Although the World Health Organization (WHO) estimates that there are 170 million carriers of hepatitis C worldwide, the Health Protection Agency (HPA) says that Britain is still a “relatively low prevalence” country, estimating rates of chronic hepatitis C infection in England to be in the region of 0.4 per cent. The British Liver Trust estimates that around 400,000 people in the UK carry the virus.

Although it is difficult to ascertain a precise figure because hepatitis C infection is often asymptomatic, some experts believe rates could be higher, with as many as one in 50 people infected in London and one in 100 throughout Britain.

However the pressure group UKC, the UK coalition of people living with HIV & Aids, questions the findings.  Robert Fieldhouse, a representative of UKC, says that it is still “unclear” as to whether intranasal drug use is an independent risk factor for catching hepatitis C, or “an indication that a person practices both injecting drug use and snorting of drugs with shared notes or straws that could get contaminated with blood”.

People who use drugs, Fieldhouse-points out, are often reluctant to report their drug injection use, or whether they have been sexually promiscuous, but did later admit to the practice when questioned privately through a separate questionnaire.

According to the former chief executive of the British Liver Trust Nigel Hughes, two of the most common   modes of transmission are still either the result of blood transfusion prior to 1991 (before blood stocks were screened for the virus) or through sharing dirty needles. But, he agreed, “sharing straws to snort cocaine may also pass on the virus”.

So, whilst experts agree that this mode of transmission is theoretically possible, the jury remains out as to the degree to which the recreational use of cocaine is contributing to the spread of the virus.

In the meantime the danger remains that many young people may be putting their long-term health at risk through the sharing of snorting paraphernalia – a practice far more ubiquitous and socially acceptable than needle-sharing has ever been.