Fatal heart infections linked to opioid abuse have tripled among young Americans

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By Dennis Thompson

health day reporter

WEDNESDAY, November 9, 2022 (HealthDay News) — The opioid epidemic in the United States has been literally heartbreaking.

The risk of young adults dying from a devastating heart infection has doubled to tripled in the United States over the past two decades, according to a new study.

Researchers attribute the rise in fatal heart infections to the growing number of people between the ages of 15 and 44 injecting opioids.

“We found that people who inject drugs account for a larger percentage of deaths from infective endocarditis than they did 20 years ago,” said lead researcher Dr. Polydoros Kampaktsis, an assistant professor in the Department of Cardiology at Columbia University in New York City.

“This is more notable among the younger population,” he added.

Endocarditis occurs when the lining of your heart valves and chambers — the endocardium — becomes infected with germs, typically bacteria, that enter your bloodstream.

Left untreated, the infection “can destroy the heart,” said Dr. Georgios Syros, Director of Arrhythmia Services at Mount Sinai Queens in New York City.

“You can have strokes. You may have leaking valves. You may need to do open-heart surgery to replace these valves,” Syros said. “It’s devastating.”

The death rate for infective endocarditis in people ages 15 to 44 doubled between 1999 and 2020, rising from 0.3 deaths to 0.6 deaths per 100,000 people, according to the researchers’ analysis of state mortality data.

Worse, the endocarditis death rate tripled in people aged 15 to 34, rising from 0.1 to 0.3 deaths per 100,000 people, the results showed.

This happened even though the endocarditis mortality rate for the entire US population fell from 2.1 per 100,000 people in 1999 to 1.8 in 2020.

Overall, young people accounted for 10% of all endocarditis deaths in 2020, up from less than 7% in 1999, the investigators found.

Looking more closely at the statistics, the research team concluded that the opioid epidemic is likely responsible for the increase in deaths from endocarditis among young people.

People who inject drugs represent a growing percentage of all people who die from endocarditis, from 1.1% in 1999 to 3% in 2020.

According to the report, injecting drug users among young people accounted for nearly 20% of deaths from endocarditis in 2020, up from about 10% in 1999.

“This is a sequel to the story of death by despair that we saw. It is unfortunate that these data and findings confirm what we have been seeing clinically for years,” said Dr. Wael Jaber, a cardiologist at the Cleveland Clinic in Ohio.

Humans have layers upon layers of skin and immune defenses to keep germs from circulating freely in the bloodstream, but drug users who shoot up bypass all of that protection, Syros and Kampaktsis said.

“Intravenous injection can introduce bacteria directly into the bloodstream,” Kampaktsis explained. “Bacteria can be present in the skin or in the needle. Once the needle enters the vein, bacteria can enter the circulatory system and travel to the heart.”

The risk is even greater since drug users often self-inject on a regular basis, Syros added.

“These guys keep breaking the barrier,” Syros said. “You don’t inject once in your life. They squirt non-stop and they also share needles. That multiplies the risk of being exposed to something that can cause infective endocarditis.”

Treatment options are limited and typically involve high doses of intravenous antibiotics, the experts said.

“‘Sterilizing’ the bloodstream is often difficult and the risk of reinfection is high, especially with continued drug use,” Jaber said.

If the infection has damaged heart valves, high-risk open-heart surgery may be needed to replace them with prosthetic valves, he noted.

“There’s really no good way to ‘cure’ this heart complication,” Jaber said.

Needle exchange programs are probably the only way to immediately address this risk to heart health, Syros said.

“We should definitely try to give them clean syringes,” Syros said. “If you want to use, please use a clean syringe.”

Drug abuse surged during the COVID pandemic, with fatal drug overdoses rising nearly 30% in the first full year of the crisis, Syros added.

“It’s something I personally witnessed in the hospital,” Syros said. “There were people who were there – before the pandemic, they were on the verge of using/not using drugs, drinking/not drinking alcohol. It was like a bang because of the pandemic, and then we saw the numbers go up very, very, very quickly.”

Until the United States makes cultural and policy changes to effectively curb opioid use, Syros believes cases of endocarditis among young drug users will continue to rise.

“I think we’re going to see a surge in the coming years after the number of people taking opiates during COVID has increased,” Syros said. “I believe there will be a wave of infective endocarditis affecting youth in the post-pandemic years. It will be uphill.”

The new study was published on November 9 in the Journal of Internal Medicine.

More information

The Cleveland Clinic has more on endocarditis.

SOURCES: Polydoros Kampaktsis, MD, PhD, Assistant Professor, Department of Cardiology, Columbia University, Irving Medical Center, New York City; Georgios Syros, MD, Director, Arrhythmia Services, Mount Sinai Queens, New York City; Wael Jaber, MD, cardiologist, Cleveland Clinic, Ohio; Journal of Internal MedicineNovember 9, 2022



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