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

by Dennis Thompson

Reporter of Health Day

WEDNESDAY Nov. 9, 2022 (HealthDay News) — The U.S. opioid epidemic has been heartbreaking — literally.

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

Researchers attribute the rise in fatal heart infections to the growing number of people between 15 and 44 who inject themselves with opioid drugs.

“We found that people who inject drugs have a higher rate of death from endocarditis infection compared to 20 years ago,” said senior researcher Dr. Polydoros Kampaktsis, assistant professor of cardiology at Columbia University, in New York City.

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

Myocarditis occurs when the lining of the heart valves and heart chambers – the heart – becomes infected with germs, usually bacteria, that enter the bloodstream.

If left untreated, the infection can “destroy the heart,” said Dr. Georgios Syros, director of cardiac arrhythmia services at Mount Sinai Queens in New York City.

“You can have a stroke. You may have leaking valves. You may have to have open heart surgery to replace these valves,” Syros said. “It’s devastating.”

The death rate from infective endocarditis among people aged 15 to 44 doubled between 1999 and 2020, rising from 0.3 deaths to 0.6 deaths per 100,000 people, according to an analysis by researchers of the Federal Bureau of Investigation.

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

This happened even as the death rate from endocarditis 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 deaths from endocarditis in 2020, up from less than 7% in 1999, the researchers found.

When the statistics were examined more closely, the research team concluded that the opioid epidemic is likely responsible for the increase in endocarditis deaths among young people.

People who inject themselves are a growing proportion of all those who die from endocarditis, rising from 1.1% in 1999 to 3% in 2020.

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

“It’s a continuation of the story of death by despair that we’ve seen. “Unfortunately, these data and results 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 freely circulating in the bloodstream, but high-profile drug users bypass all those defenses, Syros and Kampaktsis said.

“An intravenous injection can introduce bacteria directly into the bloodstream,” Kampaktsis explained. “Bacteria can be present in the skin or the needle. When the needle enters the vein, it allows bacteria to enter the bloodstream and travel to the heart.

The risk is even greater given that drug users often inject regularly, Syros added.

“These guys repeatedly break the barrier,” Syros said. “They’re not injecting once in their life.” They inject themselves endlessly and also share needles. It multiplies the risk of exposure to something that can cause infective endocarditis.”

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

“It is often difficult to sterilize the bloodstream, and the risk of re-infection is high, especially with continuous drug use,” Jaber said.

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

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

Needle exchanges are likely the only way to immediately address these heart health risks, Syros said.

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

Drug use skyrocketed during the COVID-19 pandemic, with a nearly 30% increase in fatal drug overdoses in the first full year of the crisis, Syros added.

“This is something that I have personally witnessed in the hospital,” Syros said. “There were people hovering there – pre-pandemic, they were on the verge of using/not using drugs, drinking/not drinking alcohol. Because of the pandemic, it was like a click, and then we saw numbers go up very, very, very quickly.

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

“I think we’re going to see an increase in the coming years due to the increase in people taking opiates during COVID,” Syros said. “I believe there will be a wave of infectious endocarditis affecting the young in the years after the pandemic. It’s going to go up.”

The new study was published in November. 9 in 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, cardiac arrhythmias, Mount Sinai Queens, New York City; Wael Jaber, MD, cardiologist, Cleveland Clinic, Ohio; Journal of Internal Medicine, Nov. 9, 2022

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