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Risk for infective endocarditis related to injection drug use increasing

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January 31, 2019

A recent study of people who inject drugs identified a “substantial and progressive” increase in their risk for infective endocarditis, and researchers suggested that the increase could be linked to a growing use of hydromorphone.

“The illicit use of prescription opioids is increasing in North America. Oral opioids diverted for illicit use are often crushed and dissolved for intravenous injection,” Matthew A. Weir, MD, MSc, associate scientist at Lawson Health Research Institute and assistant professor in the Schulich School of Medicine and Dentistry, Western University, and colleagues wrote in the Canadian Medical Association Journal.

“In addition to the risks of overdose and the transmission of bloodborne viruses, this method of opioid use confers a substantial risk of infective endocarditis through breaks in sterile technique and injection of excipients.”

Weir and colleagues noted a substantial increase in cases of infective endocarditis related to drug use at their facility and sought to determine if the removal of traditional controlled-release oxycodone from the Canadian market would lead to an increase in the use of hydromorphone and an increased risk for infective endocarditis. They analyzed data on injection drug users from health databases in Ontario between April 2006 and September 2015.

Their search showed 60,529 hospital admissions of people who inject drugs, 733 of whom had infective endocarditis linked to injecting drugs. They calculated that the risk for infective endocarditis increased from 13.4 admissions every 3 months before 2011, when traditional controlled-release oxycodone from the Canadian market, to 35.1 admissions in the period afterward. Results showed that hydromorphone represented 16% of all opioid prescriptions at the start of the study period and 53% by the end. Weir and colleagues concluded that the risk for infectious endocarditis increased with the rise in hydromorphone prescriptions.

“We observed a substantial increase in the risk of infective endocarditis among people who inject drugs, which is associated with hydromorphone’s increasing share of the prescription opioid market. Both the rise in this severe complication of injection drug use and the possible association with hydromorphone require further study,” they wrote.

“Although our data show a compelling temporal association between hydromorphone use and infective endocarditis, further research is required to make a case for causation. This work should endeavor to draw closer links between exposure and outcome, using individual prescription drug exposure, urine toxicology results or sampling of used drug injection equipment.” – by Caitlyn Stulpin

Disclosures: The authors report no relevant financial disclosures.

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