The current drug-abuse epidemic driven largely by the use of opioids is also being linked to a stark rise in hospitalizations among young people for a rare type of heart infection often caused by injection drug use, according to a new study.
The number of hospital admissions for infective endocarditis that resulted from injection drug use grew from 7% of all infective endocarditis cases in 2000 to 12% in 2013, according to the findings of an analysis published this week in the journal Open Forum Infectious Diseases.
The most significant change has been the uptick in the number of cases involving young people, particularly among white Americans, the study found. The proportion of cases involving young adults between the ages of 15 and 34 grew from 28% in 2000 to 42% by 2013.
The number of hospitalizations from infective endocarditis due to injection drug use among young white adults saw the biggest rise, going from representing 57% of such cases in 2000 to 80% by 2013.
Women made up 41% of such cases in 2013, but accounted for more than half (53%) of endocarditis infections due to injection drug use among young adults.
Endocarditis can be a lethal infection to the heart valve that usually occurs in those born with abnormal valves or in older adults as they age. The condition can also develop as a result of injecting drugs, which can carry an infection into the bloodstream.
“The young people that we're seeing who are being hospitalized related to opioids are often coming in with very, very severe complications of opioid use,” said the study's lead author, Dr. Alysse Wurcel, an assistant professor at the Tufts University School of Medicine. “The question that we have to ask ourselves is why is it the young people that are coming in with these complications.”
The increase in such infections among young people carries some long-term health implications. There's a high likelihood many patients will require a heart valve replacement, which among its side effects carries a higher lifetime risk of developing infections. “What complicates the whole situation is someone who has a new heart valve related to injection drug use goes back to using injection drugs again,” Wurcel said.
The increase in infections appears to overlap with a steady rise in the use of heroin among young people in recent years.
In 2014, an estimated 28,000 Americans between the ages of 12 and 17 were reported to have used heroin at some time over the previous year, according to figures from the American Society of Addiction Medicine (PDF), with as many as 18,000 estimated to have a heroin use disorder in that year. Heroin overdose deaths among women tripled between 2010 and 2013 from 0.4 deaths per 100,000 people to 1.2 deaths.
Many see the resurgence in heroin use after years of decline as the result of widespread availability of prescription opioid pain relievers over the past 20 years. Regulators instituted more restrictions in prescribing opioids a few years ago, which resulted in a decrease in their use. But many who were already addicted shifted to heroin as a cheaper and more accessible alternative.