Experts predict rise in heart infection with increase of heroin use

Legislation to be proposed in the statehouse is being praised for taking a more health oriented approach. (Jens Finke/Creative Commons)

By Dani Anguiano

An infectious disease that can affect intravenous drug users is expected to increase as a result of rising rates of heroin use across the United States, according to Sharon Kelley, CEO of Associates in Emergency Medical Education based in Tampa, Florida.

“We’re already seeing increases of Endocarditis from all the increase in IV drug use,” Kelley said of the potentially life-threatening heart infection that affects heart valves by causing them to malfunction.

According to Dr. Robert Sade, a cardiothoracic surgeon at Medical University of South Carolina in Charleston, there is a relationship between the condition and intravenous drug use.

“IV drug abusers run a much higher high risk of infecting a heart valve than a non-abuser,” Sade said.

The use of heroin has increased substantially in recent years and doctors say they expect to see a rise in Endocarditis among intravenous drug users. Standard treatment consists of antibiotics and surgery, but success of such treatment is limited if patients return to intravenous drug use. A patient’s decision to continue using drugs, said one substance abuse expert, is not a matter of choice, but rather a consequence of addiction. When patients who undergo the operation continue to use drugs, it can create an ethical dilemma for doctors of whether to operate again on a non-compliant patient. There are also increased risks with additional operations.

Heroin abuse is reportedly on the rise across the country. According to a report from the Centers for Disease Control and Prevention, from 2009-2012 there was a 74 percent increase in the number of heroin users. In 2013, the Drug Free Northern Kentucky organization released a report that revealed they expected a rise in infectious diseases, including Endocarditis, because of the increase in injection drug users.

According to Kelley, doctors expect to see a rise in infections, particularly among young people.

“The people coming in, they’re so young,” Kelley said. “They’re 22 or 23.”

Between 2 to 5 percent of intravenous drug users are infected each year, according to Sade. The infection can be treated with antibiotics, surgery to remove valves and put in prosthesis, and in some cases, both. The average cost of hospitalization for aortic valve replacement is about $165,000, Sade said, adding that in order for the valve replacement to be successful, patients must abstain from using drugs.

“If a valve replacement is necessary and the drug abuser continues using IV drugs, he runs an extraordinarily high risk of reinfecting the prosthesis and surrounding tissue,” Sade said. “The patient is warned of this possibility after the initial procedure and told that the infection is likely to return if he continues to use drugs.”

However, Sarah Suzuki, a substance abuse counselor in Chicago, said abstaining from drugs is not an easy feat for those with serious addiction issues.

“Contrary to popular belief, people who are addicted to heroin don’t experience a rush of pleasure or joy when they use, Suzuki said. “Rather, they stave off withdrawal symptoms and maintain a sense of equilibrium.

“Recovering opioid addicts are rarely able to function normally. Months into sobriety, people who are recovering from heroin dependence can be struggling with crippling anxiety and depression – all due to permanent changes in the brain caused by heroin.”

If patients do become infected again and require additional surgery, repeat operations are more difficult, result in longer hospitalizations and cost much more, Sade said.

“What do we do when we replace their valves and they just keep using heroin? “ Kelley said. “And yet ethically the physician is placed in a really bad position.“

Kelley said this issue is an ongoing “ethical quandary for doctors.”

Increased risk of death is associated with this condition, Sade said, adding that even among patients who undergo proper treatment and manage to abstain from drugs, a quarter to a third will die from the infection.

According to Sade, there are only a few ways for intravenous drug users to avoid contracting the infection in the first place.

“Take their medications as directed and don’t abuse drugs of any kind, and above all, don’t use recreational IV drugs,” Sade said.

Some experts expect a nationwide increase in heroin use to result in more cases of Endocarditis, an infection of the heart.(Jens Finke/Creative Commons)