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Seeking Solutions for Endocarditis in People Who Inject Drugs

“People don’t recognize that at least 1 in 5 of the deaths from opioids may result from endocarditis,” said National Institute of Drug Abuse (NIDA) director Dr. Nora Volkow, adding that endocarditis is “100% preventable.”

Endocarditis, the inflammation of the heart valves, has been on the rise for the past several years, and increase largely attributed to the opioid epidemic. Injection drug use accounts for 1 in 10 infective endocarditis hospitalizations.

A recent study, published in the Journal of the American Medical Association (JAMA) examined the most cost-effective and clinically beneficial treatment for infective endocarditis in people who inject drugs.

The study was partially sponsored by the National Institute on Drug Abuse (NIDA). “Endocarditis is basically an infection of the heart,” said Dr. Nora Volkow, the director of NIDA, said in an interview with Contagion. Volkow said NIDA’s mission is to develop technologies and treatments for drug addiction. She said that NIDA sponsors most research on drug addiction worldwide. “It’s the main resource to accelerate knowledge on treatment and prevention.”

Volkow explained that endocarditis is commonly driven by using contaminated injection equipment, which sends bacteria directly into the bloodstream. “Almost any organ can be infected with injection of contaminated materials, because the blood is the main source of circulation.” Volkow said that injecting substances into the blood is essentially “feeding” it to the organs.

Volkow mentioned that the most widely recognized intersection between drug abuse and infectious disease is HIV infection. In the US, more than 10% of new HIV cases are attributed to injection drug use, a proportion that is much higher in other countries. However, endocarditis is another major infectious disease that can result from injection drug use. “People don’t recognize that at least 1 in 5 of the deaths from opioids may result from endocarditis,” Volkow said. “One of the infections with the highest mortality is endocarditis.”

Volkow emphasized that endocarditis is highly treatable, which is what makes it so frustrating when healthcare facilities neglect preventative measures. Syringe service programs are community-based prevention centers that offer resources, support, and access to and disposal of sterile syringe and injection equipment.

“If someone has endocarditis, their risk of dying within 1 year is 20%, even when they are treated,” Volkow explained, “because they relapse, and when they relapse, they get infected again.” Endocarditis is very expensive and timely to treat, requiring approximately 3 weeks of hospitalization and often the replacing of a heart valve. “It makes no sense to subject people to infections that are going to be so, so costly.”

Volkow said that endocarditis is driven by people sharing injection equipment, which is why syringe service programs are so vital. “The solution is 100% preventable,” she said.

In addition to preventing endocarditis, Volkow said that syringe service programs can prevent other expensive and deadly infections, like hep C and HIV infections, at the source. Given the high mortality rate and burden on the healthcare system, Volkow said, “From the perspective of medicine and healthcare prevention…there is no justification not to provide syringes.”