Treating the addiction is the key to managing a heart infection (endocarditis) in people who inject drugs, the American Heart Association says. Without addiction care, many patients leave the hospital early. They do not finish the 6 weeks of intravenous (IV) antibiotics the infection needs. So the infection keeps coming back.
Summary: A heart infection, or endocarditis, is unusually common in people who inject drugs because of dirty syringes. The AHA says its treatment often fails in people who inject drugs and have opioid dependency. That is because many of them do not finish the long course of IV antibiotics. So the AHA says treating addiction is key to managing this infection in people who inject drugs. A dedicated opioid addiction treatment program can be the key factor here.
Antibiotics have made heart infections less and less common. Still, they remain a major problem in some groups. One is people who inject drugs. The problem is common among people with drug addiction. Yet there has been no treatment advice made just for this group. The AHA (American Heart Association) has now put out a new statement in its journal Circulation.
Managing any infection is hard in people who inject drugs. Many live with several infections at once. Many are immunocompromised, which means their immune system is weak. Their health is poor. Heart infections are hard to treat even in people without addiction. In people who inject drugs, they are much harder. A large number of people with endocarditis inject drugs. So the AHA has issued detailed guidelines.
The AHA says treating the infection in this group is hard in many ways. It also notes the infection is unusually common in people who inject drugs. And it found that without treatment for substance use disorder (SUD), these patients are unlikely to benefit. So the heart infection in people with SUD must be treated by teams from several fields. Otherwise, it will stay hard to stop the infection from coming back again and again.
About infective endocarditis:
- Each year more than 35K cases of endocarditis are reported in the US.
- The condition has a high mortality rate of about 20%.
- Heart valve problems are common in people with endocarditis. Infected heart valves are also hard to treat, because valves lack a blood supply.
- There are many sources of heart infection, such as poor dental health and burns. Injecting drugs is one of them.
- Studies show a significant increase in endocarditis from drug injection from 2002 to 2016. These patients now make up 16% of all cases, up from 8% in 2002.
- People who inject drugs are more likely to get endocarditis at a young age. Their average age is 38 years. But people who do not use drugs rarely get it before the age of 45 years.
Specialists say treatment for this heart infection often fails in people who inject drugs. It needs a long course of antibiotics: 6 weeks. But people with drug addiction often leave the hospital before they finish. So doctors are also looking at other options. One is IV antibiotics that need a shorter course. Another is to switch patients who use drugs to antibiotic pills so they can finish treatment.
Experts also say that to treat the heart infection in people who inject drugs, it is vital to start addiction care. That means using FDA-approved medications for substance use disorder. These can ease withdrawal. That lowers the chance that patients quit their heart treatment too early.
Experts also say doctors should screen patients for drug use. This helps them give care without judgment, including opioid addiction treatment. People who use drugs also need to know more about their risk of this heart infection. That matters because safer injection habits may significantly reduce the risk.
Last, doctors should keep in mind that people who use drugs often lack health insurance and have money problems. These may also hurt treatment results. People who use drugs are also more likely to live with other mental health issues.
It is also vital for doctors and hospitals to get past their bias against people addicted to drugs. For example, many hospitals may not give enough help once they learn a patient injects drugs. They may also not accept the patient for valve surgery. Yet studies show that valve surgery results are quite similar in people who use drugs and people who do not.
Related reading: Severe Infection and Mood Disorders · Groups at Greater Risk of Opioid Addiction: UC Study · Drug Addiction Treatment, St. Louis