Increasing Infectious Endocarditis Admissions Among Young People Who Inject Drugs

Abstract

People who inject drugs (PWID) are at risk for infective endocarditis (IE). Hospitalization rates related to misuse of prescription opioids and heroin have increased in recent years, but there are no recent investigations into rates of hospitalizations from injection drug use-related IE (IDU-IE). Using the Health Care and Utilization Project National Inpatient Sample (HCUP-NIS) dataset, we found that the proportion of IE hospitalizations from IDU-IE increased from 7% to 12.1% between 2000 and 2013. Over this time period, we detected a significant increase in the percentages of IDU-IE hospitalizations among 15- to 34-year-olds (27.1%–42.0%; P < .001) and among whites (40.2%–68.9%; P < .001). Female gender was less common when examining all the IDU-IE (40.9%), but it was more common in the 15- to 34-year-old age group (53%). Our findings suggest that the demographics of inpatients hospitalized with IDU-IE are shifting to reflect younger PWID who are more likely to be white and female than previously reported. Future studies to investigate risk behaviors associated with IDU-IE and targeted harm reduction strategies are needed to avoid further increases in morbidity and mortality in this rapidly growing population of young PWID.

Repeat Infective Endocarditis in Persons Who Inject Drugs: “Take Another Little Piece of my Heart”*

“…The opioid epidemic is a growing public health crisis in the United States, with drug overdose deaths, viral hepatitis, and infective endocarditis all increasing significantly over the past decade [16–18]. Compared with previous decades, a significant proportion of PWID now utilize prescription opioids intended for oral use [19, 20].…”

“…Compared with previous decades, a significant proportion of PWID now utilize prescription opioids intended for oral use [19, 20]. Further differences compared with the past are a higher number of rural dwelling and female PWID [16, 21]. Rural patients have different patterns of abuse than their urban peers, including an increased propensity to inject prescription opioids; the preferred prescription opioid in a region and its associated injection frequency and behaviors vary by geography [19, 22, 23].…”

“…Conceptually, the most effective intervention to reduce morbidity and mortality as well as the economic costs of rIE would be to address the root cause of these infections, which is substance use disorder [16, 26, 36]. In response to this crisis, our institution is working to expand its addiction treatment capabilities.…”

Addiction consultation services – Linking hospitalized patients to outpatient addiction treatment

“…Since the 1990s, a dramatic increase in mortality has been demonstrated among middle-aged, non-Hispanic white Americans, primarily driven by overdose and other substance use-related health problems (Case & Deaton, 2015). Hospital admissions related to opioid overuse have increased 5% annually since 1993 (Owens et al, 2014), with admissions for infections related to injection drug use rising >70% since 2000 (Wurcel et al, 2016). In Massachusetts, between 2007 and 2014, opioid-related hospital discharges in general increased by 84% and those specifically heroin-related increased by 201% (Health Policy Commission, 2016).…”

Buprenorphine‐naloxone treatment responses differ between young adults with heroin and prescription opioid use disorders

“…Moreover, heroin (~0.7%, MTF) and prescription opioid use (8.8%, NSDUH) among young adults is disproportionately elevated 6, 7 . In addition, the percentage of injection drug use-related infective endocarditis hospitalizations among young adults (15–34 years) in the US increased from 27.7% in 2008 to 42% in 2013 2 . There has been also an increase of the age-adjusted rates of deaths by drug overdose from 6.1 per 100,000 on 1999 to 16.3 per 100,000 in 2015, with a significant trend for younger adults (15–24 years) to increase but growing at slower rates compared to older adults 8 .…”