People who take opioids or cocaine are more susceptible to developing endocarditis, a life-threatening condition where the inner lining of the heart's chambers and valves becomes inflamed, new research from Case Western Reserve University Medical School found.
The study also found people with opioid use disorder or cocaine use disorder and who were also infected with SARS-CoV-2 were up to eight times more likely to develop endocarditis than COVID-19-positive people who didn’t have the disorders.
The study's co-author said the findings show yet another side effect of COVID-19 infection in an understudied and vulnerable population.
“As the scientific understanding of long COVID develops, we can now include endocarditis as one long-term effect on key organ systems for people who inject drugs. Our study is one of the first to show this,” said Rong Xu, a professor of biomedical informatics at Case Western Reserve.
Endocarditis is caused when bacteria in the blood multiply and spread across the inner lining of the heart, called the endocardium, according to the Cleveland Clinic.
The researchers said people who inject heroin, cocaine and prescription opioids into the bloodstream through a vein already had a higher risk of developing endocarditis, as germs can be more easily introduced and travel to the heart. Without quick treatment, endocarditis can damage or destroy the heart valves.
Xu and her colleagues wanted to learn how much more likely people with drug use disorders were to get the condition. So they analyzed more than 109 million U.S. patient health records over a period of 11 years, breaking them into two groups: those with opioid use disorder or cocaine use disorders and those without.
Opioid use disorder is defined by the U.S. Centers for Disease Control and Prevention (CDC) as a problematic pattern of opioid use that causes significant impairment or distress. About three million people in the U.S. meet the criteria for opioid use disorder, according to the National Institutes of Health (NIH).
Xu — who co-authored the paper on the findings that was published earlier this month in the journal "Molecular Psychiatry" — documented the number of people with substance use disorders who developed endocarditis significantly increased since 2015, with the biggest increase occurring last year.
Xu said the rise in the number of those suffering from the condition over time is driven in part by the rise of intravenous drug use and later the arrival of COVID-19.
“We don’t know what’s the underlying reason before the pandemic, but we see a big spike during the COVID-19 pandemic,” she said. “We found COVID-19 is indeed associated [with an] about two times increased risk for endocarditis among people who use opioids or cocaine, compared with those who did not contract COVID-19 from the same pandemic period.”
Xu said more studies need to be done to further understand how SARS-CoV-2 infection damages the heart and vascular endothelium, the inner cellular lining of arteries, veins and capillaries.
“It’s just speculation because COVID-19 can incur an inflammatory response in many organ systems including the heart,” she said.
In the meantime, Xu and the other researchers said immediate changes should be implemented to help protect those at most risk, including endocarditis screenings for people with drug dependence who are positive for COVID-19 and more safe needle exchanges for those dealing with drug use disorders. Too it's important that those who use drugs receive COVID medications after they test positive for the virus, she said.
“I think the best recommendation is probably not getting COVID.” she said. “If you already had COVID just try not to get re-infected.”
Xu said overall more analysis of the serious effects of COVID-19 should be paid to people with opioid or cocaine use disorders.
“Endocarditis … is a very significant health consequence among people who use opioids or cocaine. We just want to see if people get COVID-19 they’re going to have … significant risk for this medical condition,” she said. “Not many people focus on this vulnerable population.”
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