Opioid Use Disorder Demographics Shifting

Women, Caucasians, and young adults disproportionally affected by infective endocarditis from injection drug use.

A recent analysis found that hospitalizations for infective endocarditis, a heart valve infection commonly associated with injection drug use, are on the rise.

Scientists found that young adults, particularly Caucasians and females, are more likely to be hospitalized for this condition. These findings suggest a demographic shift associated with opioid use disorder, according to a study published by Open Forum Infectious Diseases.

“We're seeing a shift toward youth, white youth, and women, and it's likely that we'll continue to see even higher increases. It's a much more suburban problem than most people realize,” said senior author Thomas Stopka, PhD. “We need to identify these different subgroups and better understand how they are affected by the opioid epidemic and associated complications, so that we can try to design a more comprehensive approach to prevention, intervention, and care.”

Patients born with abnormal heart valves and older adults with valve problems also have an increased risk of developing infective endocarditis. However, injection drug use-related cases can cause increasing financial burden on the healthcare system, since many of these patients rely on pubic insurance, such as Medicaid.

For injection drug users, bacteria can be introduced into the blood stream and trigger the infection, according to the study. Scientists in the study analyzed data from the Nationwide Inpatient Samples database, and calculated the estimated injection drug use-related cases by excluding patients with a congenital heart defect.

They discovered that 12% of all hospitalizations due to infective endocarditis in 2013 were attributed to injection drug use. This statistic was only 7% in 2000.

They estimate that the amount of injection drug use-related infective endocarditis hospitalizations increased from 3578 in 2000 to 8530 in 2013, according to the study. Young adults, specifically, accounted for 42% of hospitalizations for injection drug use for infective endocarditis in 2013, which increased from 28% in 2000.

Caucasian patients made up 40% of cases in 2000, which increased to 68% in 2013. Young Caucasian adults, who accounted for 57% of cases in 2000, accounted for 80% in 2013, according to the study. Females comprised 53% of young adult cases in 2013.

“As clinicians, we have observed a major increase in young people with opioid addiction cycling in and out of the healthcare system, and many end up with devastating complications of injection drug use like infective endocarditis,” said first author Alysse Wurcel, MD. “Our study confirms that this trend is increasing across the US and represents yet another indicator of the challenges we face with the national opioid epidemic.”

Scientists stress that more information is needed about the population that is most effected by the opioid epidemic, so that more effective treatments and prevention tactics can be put into place.

“The current systems we have in place for the opioid epidemic are like bandages for much bigger, oozing wounds,” Dr Wurcel said. “The focus should be to catch people in the early stages of addiction, and to try and educate them about how to reduce their risks for disease and, if possible, to initiate drug treatment. Or if not, try to find a way to help them into opioid replacement projects where they can somehow break the cycle they're in. Otherwise this epidemic will continue.”