- Intravenous injection of hydromorphone, an opioid drug may be linked to increased incidence of infective endocarditis, a potentially fatal heart infection
- A substantial increase in the prescription of hydromorphone coinciding with the time period during which there was an increase in the rates of infective endocarditis
- Intravenous drug use has been on the rise since 2000 in North America; further studies are needed to characterize the effects of intravenous drug use and associated serious complications such as infective endocarditis
An increasing use of hydromorphone may be associated with the rise in infective endocarditis in intravenous drug users according to a recent retrospective study in Canada.
“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,” write the authors, including first author Dr. Matthew Weir, associate scientist at Lawson Health Research Institute and assistant professor at Schulich School of Medicine & Dentistry, Western University, London, Ontario.
‘Intravenous injection of hydromorphone, an opioid drug may be linked to increased incidence of infective endocarditis, which is a potentially fatal heart infection.’
The findings of the study titled ‘The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis’ appear in CMAJ (Canadian Medical Association Journal).
Intravenous Hydromorphone Use and Risk of Infective Endocarditis
- The team analyzed Ontario data on drug users from administrative databases at the Institute for Clinical Evaluative Sciences (ICES) from April 2006 to September 2015
- During this period, there were 60529 hospital admissions of intravenous drug users and among them, 733 persons were found to have infective endocarditis associated with IV drug injections
- Despite admission rates of IV drug users remaining relatively stable over the study period, the rates of infective endocarditis rose from 13.4 admissions every three months (fourth quarter 2011) to 35.1 admissions every three months thereafter until the end of the study period
- Interestingly, the proportion of opioid prescriptions of controlled-release oxycodone declined rapidly as it was removed from the market by its manufacturer in the fourth quarter of 2011; concurrently hydromorphone prescriptions rose from 16 percent at the start of the study to 53 percent at the end of the study period
The findings of the study suggest that the rise in infective endocarditis cases in IV drug users might be linked to increased use of the opioid hydromorphone.
- However, the rise in infective endocarditis cases did begin to increase slightly even before controlled release oxycodone was removed from the market. The rise in infective endocarditis cases associated with IV drug use is consistent with similar studies but the noted time of increase was something unexpected
“Although our observations do not support our hypothesis that the loss of controlled-release oxycodone increased the use of hydromorphone, they do support our suspicion that hydromorphone may be playing a role in the increasing risk of infective endocarditis,” says co-author Dr. Michael Silverman, associate scientist at Lawson and associate professor at Schulich School of Medicine & Dentistry.
What is Infective Endocarditis?
Infective endocarditis is a serious infection affecting the innermost layer of the heart including the heart valves. It is usually caused by bacteria and is termed bacterial endocarditis but occasionally fungal and other infections can also cause endocarditis.
The symptoms of endocarditis may be similar to other infections with symptoms of fever, chills, fatigue, nausea and vomiting, and can be easily missed. Fortunately, it is rare in persons with healthy hearts.
However, certain persons are at risk of developing infective endocarditis including persons with previously diseased hearts, congenital heart disease and IV drug use. Persons at risk especially should immediately see a doctor if they develop any of these symptoms.
It is a potentially life-threatening infection and needs prompt treatment with antibiotics and other supportive measures.
Scope of Study
The increased incidence of infective endocarditis in IV drug users and possible association with hydromorphone warrant further studies.
Increased risk of infective endocarditis in IV drug users may be associated with increased use of intravenous hydromorphone, an opioid drug and needs to be further studied and validated.
- The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis – (https://doi.org/10.1503/cmaj.180694)