North Carolina has been battling a growing opioid addiction epidemic. New Centers for Disease Control and Prevention data from North Carolina hospitals show the rise in intravenous drug use is also causing a sharp increase in the rate of heart infections.
Infections including endocarditis have increased more than twelvefold since 2010, with especially big upticks beginning in 2013. The majority of patients are young, rural residents, and 42 percent of them are either uninsured or on Medicaid, accounting for $9.3 million in healthcare costs.
Host Frank Stasio talks with CDC epidemiologist Aaron Fleischauer about the new study, the impact of the rising number of heart infections on the state’s hospitals and taxpayers, and possible strategies to address these trends.
On how intravenous drug use causes heart infections:
It’s a well established link. In fact, it’s been described since the 1950s, and it’s a relatively simple mechanism. Essentially injection drug users are pushing bacteria from their skin into their bloodstream. It finds its way to the heart or heart valve where it grows and damages heart valves and causes a whole mess of problems. There are probably three common ways endocarditis can be an outcome of injection drug use. One could be unsterile equipment like an unsterile syringe. The other could be a contaminated product – the drug is contaminated. Or poor cleaning of the injection site. Any of those mechanisms can introduce bacteria into the bloodstream.
On what he expected to find in the data:
All of our indicators of the opioid epidemic have been demonstrating that it’s increasing quite significantly in the past few years, whether it’s overdose fatalities or Hepatitis C. So we were expecting to see it increase. I think we were quite alarmed to see a thirteenfold increase in just the past couple years alone. We only went back about seven years, so I can’t necessarily compare it historically. But what I can say is there’s been a significant rise beginning, really, in 2013. So we’re not talking about that long ago where it really jumped from a low baseline to a quite high incidence rate.
On who is getting heart infections and the costs they impose:
The data is suggesting that they are mostly persons of younger age between 18 and 30. They tend to be more white – living in more rural areas. And when we’re looking at some of the census data they tend to be poorer or unemployed. So all of those risk factors tend to be associated with this outcome. In fact 42 percent of our patients were either uninsured or on Medicaid which suggests a heavy taxpayer cost. Then we went ahead and looked at what those hospital costs were … The average inpatient cost is in excess of $50,000. And that total cost has increased twentyfold in just the last five years alone.
On harm reduction strategies:
I think harm reduction is probably one of the most effective interventions on this epidemic. And it’s not just syringe exchange programs. It’s not just giving out clean needles and disposing of infected needles. It is establishing that client relationship and linking them to substance abuse treatment, and the data has demonstrated overwhelmingly positive impacts when harm reduction is implemented locally.