Opioid use disorder is a serious problem, and most people are aware of the consequences for individuals and society. This awareness centers on the problems and costs associated with overdoses, including issues within families, medical costs and other social problems. However, the opioid epidemic also has an additional effect on the field of cardiology. Opioid use is associated with increased incidences of endocarditis, which is a serious infection. Let’s explore the connection between opioid use and endocarditis a little further.
What Is Endocarditis?
Endocarditis is an inflammation that affects the inner lining of the heart, which is called the endocardium. The usual cause is a bacterial infection. It seldom occurs in healthy hearts, but if it does occur, it is a serious condition. Several risk factors are associated with developing endocarditis. These include:
- The damage that scars the heart valve and allows bacteria to grow
- Tissue damage caused by having a previous case of endocarditis
- A congenital heart defect
- Artificial heart valve replacement surgery
- Illicit drug use, including opioids
Injectable drug use has now risen to become the most prevalent cause associated with the development of endocarditis. It occurs when someone injects drugs using a dirty needle that is contaminated with bacteria or fungus. The bacteria or fungus travels through the bloodstream and into the heart where it can grow and become a serious infection.
How Is It Connected to Opioid Use?
The number of patients hospitalized with this type of infection has seen a rapid increase over the last decade. The pattern of these hospitalizations mirrors increases in opioid use. It is more prevalent in areas of the country that have experienced an economic downturn and where IV drug use is also problematic. The risk of developing a heart infection increases with opioid use.
The sharing of injection equipment and reusing it without proper sanitation are the most prevalent causes of infection of all types. Evidence to support this comes from cases where opioids are administered in a hospital setting using established protocols. This means that it is not associated with opioid use itself but rather the improper use and sanitation of injection equipment.
What Are the Chances of Getting It?</h3?
Endocarditis can occur any time bacteria, virus or fungus enters the bloodstream and travels to the lining of the heart. It can occur in people who are not using opioids, but its association with opioid use is more common among those who inject substances into their body. Any person who uses a needle to inject themselves for any purpose can develop it. It is about proper sanitation and good sterile practices.
Those who inject medications, such as diabetics who use insulin shots, are less likely to engage in unsafe practices that result in infection. Those who inject for medical reasons have access to a ready supply of fresh needles and syringes. They are also instructed on the proper use of their injection equipment. Among those who use opioids, this is not always the case; they do not have access to new supplies as readily, and they are less likely to be knowledgeable and vigilant about contamination risks.
If you or your loved one is using injectable opioids, you probably want to know the chances of contracting this or another serious infection as a result. Over the past 10 years, it is estimated that opioid use has increased 12-fold. This correlates with an increase in those admitted to hospitals for infective endocarditis from 0.922 to 10.95 per 100,000 persons.
In addition, the median age of those admitted to the hospital for heart infections associated with injectable drug use was 33 years old. This compares to the population of endocarditis patients that do not use injectable drugs at 56 years old. Injectable drug use lowers the age at which someone might have a chance of contracting it by about two decades. This has also led to a proportionate increase in the need for heart surgery at an earlier age to treat severe cases.
The ability to predict an individual’s chance of developing the condition if they are a user of injectable drugs is difficult. There are many other factors that come into play, such as the person’s immune system and other comorbid conditions including diabetes or obesity. The general health of the person will play an important role in whether or not the condition develops. The only thing that can be said for certain is that those who use injectable opioids have a greater chance of contracting it than those who don’t.
What Are the Symptoms?
The symptoms can be severe or mild. They may come on suddenly or develop slowly over time, similar to other infectious and inflammatory conditions. Many of the more common symptoms of infectious endocarditis can be confused with the flu and include:
- Fever or chills
- Night Sweats
- Muscle or joint pain
- Pale skin
- Decreased appetite
- A feeling of being full in the upper left part of the abdomen
- Weight loss
- Swelling in the legs, feet, or abdomen
- Shortness of breath
- Heart murmur
- Blood in the urine
- Tenderness in the area of the spleen
The person may exhibit a few or many of the above-listed symptoms. It is difficult to diagnose symptomatically and requires expert medical attention to make a proper diagnosis. Another symptom that occurs in a small number of people is the presence of tender, red or purple spots below the skin of the toes, fingers, inside the cheeks, on the roof of the mouth, on the chest or in the whites of the eyes. This is due to blood leaking from weakened capillary vessels.
Diagnosis may include a blood test, an echocardiogram, electrocardiogram, chest x-ray, CT scan or MRI scan. This may include the area of the heart or other areas of the body if the physician suspects that the infection may have spread. Blood cultures are used to identify the organism that is causing the infection so that the right antibiotics are prescribed.
How Is It Treated?
Treatment of endocarditis typically involves a long course of antibiotics. This may be given in a hospital setting or using home-based care depending on the severity and type of infection. This inflammatory condition can cause damage to the heart and valves, which may need to be repaired after the infection has cleared. Regular tests will be conducted to make sure that the treatment is working.
Endocarditis is serious and can lead to death in some individuals. As soon as one suspects that something is wrong, it is important to seek medical attention. This can be a complication among those who use injectable substances because they may be reluctant to seek medical help. In this case, the person must be encouraged to seek help due to the severity of the condition. An infection such as this can escalate quickly without proper medical attention.
You also need to know that any opioid use may complicate the treatment of the infection. Opioid use could affect the type of drug therapies that can be given and could increase the risk of complications if surgery is needed. In addition, opioids can have an effect on the heart muscle or cause irregular heartbeats, particularly in higher or repeated doses.
In addition, long-term opioid use compromises the functioning of the immune system, which can complicate the treatment process. It also makes the person more susceptible to this infection in the first place due to unsafe needle practices. Opioids also cause liver injury and increase the chances for an adverse drug reaction and other side effects during treatment. This is important to know. Not only does opioid use increase the chances of developing the condition, but it also compromises the body’s own defense systems and its ability to fight the infection.
This infection can lead to permanent disability. If the infection is severe enough, the person may develop heart conditions that affect them the rest of their life. Also, once someone has endocarditis, the damage to the heart increases the chances of contracting it again in the future.
The Big Picture
Now that you have the facts about opioid use and the potential for developing infectious endocarditis, it paints a scary picture. This factor only compounds the complications and risks associated with opioid use and other injectable substances that already exist. The good news is that for most of the population, this is a preventable occurrence.
First, this may be considered a wake-up call to take action and seek help if you or a loved one uses injectable substances. However, if that is not possible at this time, it is important to practice safety when it comes to the use of syringes and other equipment. Infectious endocarditis is only one of the potentially harmful effects. Using dirty needles also puts you at risk for contracting:
- Hepatitis C
- Hepatitis B
- Other diseases
It is important not to share syringes or needles with another person. Many people have the misconception that it is okay to change the needle and reuse the syringe, but this is not the case. Both the syringe and the needle should be new every time an injection is used. Any pathogens that make their way into the syringe can begin to grow and multiply quickly.
It is also important to clean the injection site with alcohol or another disinfectant. You cannot see whether a needle or syringe is contaminated with dangerous infectious diseases. It only takes one time to contract a serious condition such as infectious endocarditis.
The Best Choice
If you must use injectable substances, it is important to practice safety, but that in no way condones their use. The best solution is to reduce the chances of contracting this serious condition. This means tackling the problem at its root: Seeking help is the best action that you can take to avoid the risks associated with opioid use.
As you can see, the association with infective endocarditis is a frightening thought, but even without that possibility, opioid use still has long-term effects on the body. One of the side effects is that opioid use reduces the body’s ability to fight disease, and it may lead to long-term liver damage. You cannot assume that you are safe if you are only an occasional user; it also depends on how much is used each time and other factors, including your general health. There is no such thing as safe opioid use. It will eventually have a long-term consequence on the body.
If you or loved one uses injectable substances such as opioids, it is time to do some soul-searching and weigh the risks. The best news is that you do not have to do it alone. There are many people out there who have walked your path and many who have dedicated their lives to helping others in recovery. A professional can help you get your life back on track and look to a brighter future.
The prospect of seeking help may be a scary one. It represents change and an unknown path. As humans, we always tend to pick the path of least resistance. However, the consequences of not taking action are even scarier than taking the first step and seeking help. Seeking help, or encouraging a loved one to do so, is an act of love that shows you care for them and want what is best.