Abstract
Opioid dependence and overdose have increased to epidemic levels in the United States. The 2014 National Survey on Drug Use and Health estimated that 4.3 million persons were nonmedical users of prescription pain relievers (1). These users are 40 times more likely than the general population to use heroin or other injection drugs (2). Furthermore, CDC estimated a near quadrupling of heroin-related overdose deaths during 2002-2014 (3). Although overdose contributes most to drug-associated mortality, infectious complications of intravenous drug use constitute a major cause of morbidity leading to hospitalization (4). In addition to infections from hepatitis C virus (HCV) and human immunodeficiency virus (HIV), injecting drug users are at increased risk for acquiring invasive bacterial infections, including endocarditis (5,6). Evidence that hospitalizations for endocarditis are increasing in association with the current opioid epidemic exists (7-9). To examine trends in hospitalizations for endocarditis among persons in North Carolina with drug dependence during 2010-2015, data from the North Carolina Hospital Discharge database were analyzed. The incidence of hospital discharge diagnoses for drug dependence combined with endocarditis increased more than twelvefold from 0.2 to 2.7 per 100,000 persons per year over this 6-year period. Correspondingly, hospital costs for these patients increased eighteenfold, from $1.1 million in 2010 to $22.2 million in 2015. To reduce the risk for morbidity and mortality related to opioid-associated endocarditis, public health programs and health care systems should consider collaborating to implement syringe service programs, harm reduction strategies, and opioid treatment programs.
Highlights
Other infections Hepatitis C virus Human immunodeficiency virusThe MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S Department of Health and Human Services, Atlanta, GA 30329-4027
0 2015 incidence of endocarditis, if the costs of infectious complications of injection drug use, including endocarditis and HCV, continue to rise. These findings suggest a need to focus preventive interventions on harm reduction strategies such as syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies (10)
The cost for each hospitalization for endocarditis exceeded $50,000, and 42% of hospitalizations were among persons on Medicaid or without insurance
Summary
The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, et al, if more than six.] [Report title]. MD, MPH, Deputy Director for Public Health Scientific Services Michael F. MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services. Weatherwax, Lead Technical Writer-Editor Soumya Dunworth, PhD, Kristy Gerdes, MPH, Teresa M.
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