Endocarditis Tied to Drug Use on the Rise, Spiked During COVID

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A new study provides more evidence that endocarditis associated with drug use is a significant and growing health concern, and further demonstrates that this risk has been exacerbated by the COVID-19 pandemic.

The rate of infective endocarditis among individuals in the United States with opioid or cocaine use disorder increased in the 11-year period 2011 to 2022, with the steepest increase logged during the COVID-19 pandemic (2021 to 2022), according to the study.

A diagnosis of COVID-19 more than doubled the risk for a new diagnosis of endocarditis in patients with either cocaine (hazard ratio [HR] 2.24) or opioid use disorder (HR, 2.23).

“Our data suggests that in addition to the major social disruption from the pandemic, including disrupted access to healthcare, COVID-19 infection itself is a significant risk factor for new diagnosis of endocarditis in drug using populations,” write authors Nora Volkow, MD, director of the National Institute on Drug Abuse (NIDA), and colleagues.

“Drug using populations, particularly those who use cocaine or opioids, have some of the highest risk for endocarditis, and here we show that having a COVID-19 diagnoses further increases this risk,” they add.

The study was published online December 13 in Molecular Psychiatry.

The researchers analyzed electronic health record data collected from January 2011 through August of this year for more than 109 million people across the US, including more than 736,000 with an opioid use disorder and more than 379,000 with a cocaine use disorder.

In 2011, there were 4 cases of endocarditis per day for every 1 million people with opioid use disorder. By 2022, the rate had increased to 30 cases per day per 1 million people with opioid use disorder.

For people with cocaine use disorder, cases of endocarditis increased from 5 per 1 million in 2011 to 23 per 1 million in 2022.

Among individuals with cocaine or opioid use disorder, the risk of being hospitalized within 180 days following a diagnosis of endocarditis was higher in those with than without COVID-19 (67.5% vs 58.7%; HR, 1.21). 

The risk of dying within 180 days following new diagnosis of endocarditis was also higher in those with than without COVID-19 (9.2% vs 8%; HR, 1.16).

The study also showed that Black and Hispanic individuals had a lower risk for COVID-19-associated endocarditis than non-Hispanic White individuals, which is consistent with a higher prevalence of injection drug use in non-Hispanic White populations, compared with Black or Hispanic populations, the researchers point out.

Volkow and colleagues say their findings highlight the need to screen drug users for endocarditis and link them to infectious disease and addiction treatment if they contract COVID-19.

“People with substance use disorder already face major impediments to proper healthcare due to lack of access and stigma,” Volkow said in a news release. 

“Proven techniques like syringe service programs, which help people avoid infection from re-used or shared injection equipment, can help prevent this often fatal and costly condition,” Volkow added.

The authors say it will also be important to determine exactly how SARS-CoV-2 viral infection exacerbates the risk for endocarditis in drug users.

Support for the study was provided by the National Institute on Aging, National Institute on Alcohol Abuse and Alcoholism, the Clinical and Translational Science Collaborative (CTSC) of Cleveland, and the National Cancer Institute Case Comprehensive Cancer Center. The authors report no relevant financial relationships.

Molecular Psychiatry. Published online December 13, 2022. Full text

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