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Stroke and Endocarditis Linked to Injecting Opioid Drugs, Even in Young People

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young man in hospital bed being treated for endocarditis and stroke related to injecting opiates

As the opioid epidemic continues, the sad news keeps piling up about the effects of opioid drugs on people’s health and well-being. The risks of overdose, mental health problems, and infectious disease among people struggling with opioid addiction are well documented. Now, a new study by Setareh Salehi Omran, MD, fellow in vascular neurology at the Weill Cornell Medical Center and Columbia University Medical Center, reports that people who inject opioid drugs  including young people  face a significantly greater risk of stroke and endocarditis, a dangerous heart condition.

What Are Stroke and Endocarditis?

Endocarditis is an infection of the tissue of the heart. It is a relatively rare condition that tends to be seen in people with congenital heart problems, a recent heart valve repair or pacemaker placement, or a compromised immune system due to HIV or organ transplant. Recently, however, researchers identified a link between intravenous opioid use and endocarditis.

How the Heart Condition Endocarditis Develops

The heart is a complex organ made up of strong muscle tissue, enabling it to beat regularly. The heart valves and inner lining of the heart, called the endocardium, are more vulnerable. If these tissues become infected with fungi or bacteria, the result is a condition called infective endocarditis. Common symptoms of endocarditis include:

  • Chills
  • Fatigue
  • Fever
  • Night sweat
  • Muscle or joint aches
  • Persistent cough
  • Shortness of breath
  • Swollen legs or feet
  • Unexplained weight loss
  • Weakness

Endocarditis Can Be Treated, but the Heart Is Permanently Damaged

It is possible to treat endocarditis. Just like any infection, some cases of endocarditis may respond to high doses of antibiotic treatment, sometimes taken for six weeks or longer.
In other cases, a person may need heart surgery to replace valves or repair damaged tissue. Surgery comes with its own risks, particularly for intravenous drug users who continue using drugs after the surgery. Regardless of the type of treatment, heart tissue is permanently compromised by endocarditis, increasing a person’s lifelong risk of heart problems.

Stroke Is a Complication of Endocarditis

Without prompt treatment, people with infective endocarditis are at a very high risk of health complications. Stroke is one of the most common complications of endocarditis. Strokes occur when blood stops flowing to the brain, which can lead to long-lasting physical and cognitive changes or death.
doctor evaluates brain scans with stroke patient resulting from opioid use that caused endocarditis and stroke

Proven Link Between the Opioid Epidemic and Increase in Stroke, Endocarditis

In theory, anyone could develop endocarditis due to a fungal or bacterial infection. In normal circumstances, however, the immune system quickly clears the source of infection before it reaches the heart.
For certain people, such as intravenous drug users, however, heart tissue may be weaker and more damaged than usual. This damage allows bacteria to attach more easily to the lining of the heart or its valves.
Dr. Omran’s study examined data from the National Inpatient Sample. The research team focused on hospitalizations related to stroke and infective endocarditis from 1993 and 2015. They found that more than 5200 individuals had this type of hospitalization between 1993 and 2015, which reflected an increase from 2.4 per 10 million people in 1993 to 18.8 per 10 million people in 2015.
The increase in hospitalizations coincided with the escalation of the opioid epidemic in the U.S. Such hospitalizations were relatively infrequent until 2008 when opioid abuse began to skyrocket. The rate of infective endocarditis increased 20.3 percent after 2008, corresponding with high rates of opioid use nationwide. Young people, women, and non-Hispanic whites from the South and Northeast were most likely to be affected.

Heroin Users Face High Risk of Endocarditis and Stroke

Intravenous drug use — a common method for people who use heroin — can make people particularly vulnerable to heart infections and stroke. When a person uses a dirty needle or contaminated syringe, for example, foreign bacteria enter the bloodstream. The bacteria then enters the heart, where it takes root and causes an infection.
In about 20 percent of cases, clumps of bacteria break off and flow through the blood vessels to the brain. Once there, they block vessels, restricting blood flow to brain tissue. The result is a stroke, which can lead to permanent paralysis, major cognitive problems and death.

Science-Based Opioid Detox Offers Hope for Ending Opiate Dependence

Stroke and endocarditis are dangerous and potentially deadly medical conditions. Just 7 percent of endocarditis patients who were IV drug users survived for 10 years without reinfection or complications, compared to 41 percent of non-IV drug users.
If endocarditis reoccurs, patients require more treatment, such as surgery to repair and replace heart valves. These surgeries can cost $150,000 or more. In addition to the daunting prospect of heart surgery,  the stigma around intravenous drug use keeps many patients from getting the treatment they need to prevent the conditions from worsening or developing in the first place.

Medical Opioid Detox Can Get People Past Physical Opiate Dependence Quickly and Safely

A smarter, more cost-effective treatment approach than allowing people to reach the point of endocarditis is to increase access to science-based opioid treatment programs. Helping people stop injecting opioids significantly decreases their risk of heart infections or stroke. Freedom from a physical dependence on heroin or other opioids enables patients get back on their feet and increases their likelihood of a full recovery.
Fear of withdrawal symptoms is one of the biggest barriers to quitting opioids. Medical detox programs overcome that barrier by using individualized medical protocols to guide patients through the detoxification process. Rapid detox treatment allows people to be sedated through acute withdrawal. People who are not candidates for anesthesia-assisted detox can get the non-anesthesia medical detox alternative.
During these treatments, patients receive round-the-clock monitoring and medical support while they undergo detox. Once detox is complete, a person can begin the process of addressing the root causes of the addiction. This combination of medical opioid detox and supportive aftercare has been proven to help intravenous opiate drug users achieve a full recovery from opioid dependence.
Published on February 21, 2019
Reviewed by Clare Waismann, CATC, Founder of Waismann Method® Advanced Treatment for Opiate Dependence
All topics for the Opiates.com blog are selected and written based on high standards of editorial quality, including cited sources. Articles are reviewed by Clare Waismann, CATC and founder of Waismann Method®, for accuracy, credibility and relevancy to the audience. Clare Waismann is an authority and expert on opioid dependence, opioid use disorder, substance dependence, detoxification treatments, detox recovery, and other topics covered on the Opiates.com blog. Some articles are additionally reviewed by one of Waismann Method®’s specialists, depending on their field of expertise. For additional information and disclaimers regarding third-party sources and content for informational purposes only, please see our Terms of Service.

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