Among young people, intravenous drug users constituted nearly 20% of endocarditis deaths in 2020, up from about 10% in 1999, according to the report.
“This is a continuation of the story of death by despair that we have seen. It is unfortunate that these data and findings confirm what we have been seeing clinically for years,” said Dr. Wael Jaber, a cardiologist with the Cleveland Clinic in Ohio.
Humans have layers upon layers of skin and immune defenses to prevent germs from freely circulating in the bloodstream, but drug users who shoot up bypass all that protection, said Syros and Kampaktsis.
“Intravenous injection can introduce bacteria directly to the blood circulation,” Kampaktsis explained. “Bacteria can be present in the skin or the needle. Once the needle enters the vein, it allows bacteria to enter the circulation and travel to the heart.”
The risk is even greater given that drug users often inject themselves regularly, Syros added.
“These guys repeatedly breach the barrier,” Syros said. “They’re not injecting once in a lifetime. They are injecting perpetually, and they’re also sharing needles. That multiplies the risk of getting exposed to something that can cause infective endocarditis.”
Treatment options are limited, typically involving heavy doses of intravenous antibiotics, the experts said.
“‘Sterilizing’ the bloodstream is often difficult and the risk of infection return is high, especially with continuous drug use,” Jaber said.
If the infection has damaged the heart valves, high-risk open-heart surgery might be needed to replace them with prosthetic valves, he noted.
“There really is no good way to ‘cure’ this heart complication,” Jaber said.
Needle exchange programs are likely the only way to immediately address this risk to heart health, Syros said.
“We should definitely try to give them clean syringes,” Syros said. “If you want to use, please use a clean syringe.”
Substance abuse soared during the COVID pandemic, with an increase in fatal drug overdoses of nearly 30% during the first full year of the crisis, Syros added.
“This is something that I have personally witnessed in the hospital,” Syros said. “There were people that were hovering there — before the pandemic, they were on the verge of using/not using drugs, drinking/not drinking alcohol. Because of the pandemic, it was like a slap, and then we saw numbers rising very, very, very fast.”