Consequences of the Opioid Epidemic: Decade of Research Shows Spike in Drug Use-Associated Infective Endocarditis

As the opioid crisis grew into a national epidemic, the rate of drug use-associated infective endocarditis hospitalizations and valve surgeries increased more than 12-fold in one US state, according to a decade of research published this week in the Annals of Internal Medicine.

Investigators tracked instances of drug use-associated infective endocarditis in North Carolina over a 10-year period, from 2007 to 2017, and found that annual hospitalizations attributed to the condition increased from 0.92 to 10.95 per 100 000 persons. The rate of drug use-associated infective endocarditis requiring surgery increased from 0.10 to 1.38 per 100,000 persons.

The results also indicated a shift in the profile of infective endocarditis patients, one that investigators categorized as “dramatic.” The median age of patients with drug use-associated infective endocarditis was 33 years, compared with 56 for regular infective endocarditis. Patients tended to be female (47% vs. 33%) and white (89% vs. 63%).

“In this large statewide study, we observed a marked increase in overall hospitalizations and valve surgeries among patients with [drug use-associated infective endocarditis],” investigators Asher J. Schranz, MD; Aaron Fleischauer, PhD; and colleagues reported. “The rate of [drug use-associated infective endocarditis] hospitalizations with valve surgery rose 13-fold in North Carolina from 2007 to 2017. In the final study year, [drug use-associated infective endocarditis] was associated with 42% of all [infective endocarditis] surgeries, indicating a dramatic shift in the demographic and clinical profile of patients undergoing [infective endocarditis] surgery.”

Along with their findings of an increase in surgical valve replacement for patients with infective endocarditis from drug use, investigators noted the controversy surrounding such a procedure.

“The standard of care for [infective endocarditis] is a prolonged course of intravenous antibiotics, often accompanied by surgical valve replacement,” Dr. Schranz and his team reported. “However, the use of valve surgery for [drug use-associated infective endocarditis] has invoked controversy because of concern regarding postoperative injection drug use and the associated risk for prosthetic valve infection. Despite the lengthy and expensive course of [drug use-associated infective endocarditis] treatment, drug use disorders and harm reduction often go unaddressed during hospitalization, and the nationwide outpatient infrastructure for treating drug use disorders is often inadequate.”

As Contagion® reported in April 2018, the opioid epidemic has brought with it certain public health implications that go beyond addiction and overdose deaths. One of those is the uptick in infectious diseases like endocarditis, HIV, and hepatitis.

Doctors nationwide are growing increasingly worried about endocarditis in drug users as a serious health concern that is on the rise.

“On any given day we have half a dozen young people who are suffering from this,” Sarah Wakeman, MD, medical director of the Substance Use Disorder Initiative and the Addiction Consult Team at Massachusetts General Hospital, told Boston’s Fox 25 in April.

”It basically forms like a little clump of bacteria that grows over time and that infection can get very serious and in fact be life-threatening if not treated,” she continued.

A 2016 Tufts University study published in Open Forum Infectious Diseases reported similar findings—the rate of drug use-associated infective endocarditis is on the rise and is primarily affecting an increasingly younger demographic.