Still there is a massivly growing prevalence for BBVs in western and even more in eastern European,Asian and developing countries. Harm reduction is a key issue in addiction-medicine. After saving patients sheer life (which already is quite a challenge) fighting other immediate threads is next. Already manifest disorders like Abscesses,severe organic affections like pneumonia or pancreatitis,HIV and Hepatitis A-B-C (blood born viruses,BBVs) must be diagnosed and classified. In case of immediate impact they must be treated already in that early stage. Status of vaccination has to be explored,as co-infections significantly aggravate each other (HIV speeds HCV-infection/cirrhosis by 2-10x; normally 100%-healing HAV becomes a live-threatening,fulminant infection). Data suggest excellent effects of early-counseling on incidence-rates of BBVs. Decisions have to be made,whether,how and when to treat BBVs:Data suggest excellent sustained response for early treatment of acute hepatitis. When after 3-6 months a stabile methadone-(MMT) or better buprenorphine-maintenance-treatment (BMT,which doesn’t interfere with antiviral drugs) is reached,BBV-treatment should not be further delayed. Substitution-therapy with its daily contacts is an effective tool to reach compliance-rates comparable to non-addicted patients. High prevalence of comorbidity with psychiatric-disorders like major depression was considered as counter-indication for potential psychoactive interferones. Recent studies (M. Schaefer et al.) and own data suggest excellent compliance and adherence even in this cohort when closely followed in a substitution-setting (daily direct dosing) and treated for side effects (SSRIs). SVR-rates above 90% for all genotypes could be demonstrated in these cohorts (M. Waizmann et al.,V. Rehak et al.)In a ongoing national,multicenter,open trial (502 patients 77,5% male included,10,5y IvDU,ST:61,3% methadone,20,5% L-methadone,15,9% buprenorphine,genotypes GT1 41,1%,GT2 5,6%,GT3 50%,GT4 3,3%,virusload >400 000 57,7%,to date 339 patients completed and evaluated) we could show,that patients with intense collateral consumption of illicit substances or non-prescribed medications reach excellent RVR,EVR and SVR-rates-generally significantly higher rates than in non-consuming cohorts.Data from earlier studies (D. Sylvestre et. al.) support this trend at least for THC-consumption. It seems a fatal misunderstanding of the hippocratic oath to treat addiction successfully for many years and than see patients die on BBV-related problems soon after,putting up the question,why not having opened the therapeutic window in time given the promising data shown in this and other mentioned studies! Still there is a massivly growing prevalence of BBVs in western and even more in eastern European, Asian and developing countries. Harm reduction is a key issue in addiction-medicine. After saving patients sheer life (which already is quite a challenge) fighting other immediate Already manifest disorders like Abscesses, severe organic affections like pneumonia or pancreatitis, HIV and Hepatitis ABC (blood born viruses, BBVs) must be diagnosed and classified. In case of immediate impact they must be treated already in that early stage. Status of vaccination has to be explored, as co-infections significantly aggravate each other (HIV speeds HCV-infection / cirrhosis by 2-10x; normally 100% -healing HAV becomes a live-threatening, fulminant infection). Data suggest excellent effects of early-counseling on incidence-rates of BBVs. Decisions have to be made, whether, how and when to treat BBVs: Data suggest excellent sustained response for early treatment of acute hepatitis. ter 3-6 months a stabile methadone- (MMT) or better buprenorphine-maintenance-treatment (BMT, which does not interfere with antiviral drugs) is reached, BBV-treatment should not be further delayed. Substitution-therapy with its daily contacts is an effective tool to reach compliance-rates comparable to non-addicted patients. High prevalence of comorbidity with psychiatric-disorders like major depression was considered as counter-indication for potential psychoactive interferones. Recent studies (M. Schaefer et al.) and own data suggest excellent compliance and adherence even in this cohort when closely followed in a substitution-setting (daily direct dosing) and treated for side effects (SSRIs). SVR-rates above 90% for all genotypes could be demonstrated in these cohorts (M. Waizmann et al., V. Rehak et al.) In a ongoing national, multicenter, open trial (502 patients 77, 5% male included, 10,5y IvDU, ST: 61,3% methadone, methadone, 15,9% buprenorphine, genotypes GT1 41,1%, GT2 5,6%, GT3 50%, GT4 3,3%, virusload> 400,000 57,7%, to date 339 patients completed and evaluated) we could show, that patients with intense collateral consumption of illicit substances or non-prescribed medications reach excellent RVR, EVR and SVR-rates -generally significantly higher rates than in non-consuming cohorts.Data from earlier studies (D. Sylvestre et. al.) support this trend at least for THC-consumption. It seems a fatal misunderstanding of the hippocratic oath to treat addiction successfully for many years and than see patients die on BBV-related problems soon after, putting up the question, why not having opened the therapeutic window in time given the promising data shown in this and other mentioned studies!