Via Nature News & Comment: The US opioid epidemic is driving a spike in infectious diseases. Excerpt:
Opioid addiction kills tens of thousands of people every year in the United States and the trend shows no signs of slowing. Now, public-health officials are worried about a surge in bacterial and viral infections linked to opioid abuse that threatens to compound the crisis.
This surge includes in unprecedented rise in bacterial infections — including those caused by Staphylococcus aureus, a bacterium that’s frequently resistant to antibiotics — and a spike in new cases of HIV and hepatitis associated with injecting opioids that threatens to undo decades of progress in corralling these diseases.
Research groups around the country are working to understand, identify and treat these outbreaks. But the lack of solid data on the number of new cases, and where they’ll crop up next, as well as stigma associated with drug use that can prevent people with infections from seeking early treatment, is hindering efforts.
“This is like HIV all over again,” says Judith Feinberg, an infectious-disease physician at West Virginia University in Morgantown, comparing the current crisis to the HIV epidemic that dominated US public health efforts in the 1980-90s. “People are stigmatized; they don’t feel they deserve to live. They hear people say it’s a lifestyle choice.”
Over the past 20 years, the use of opioids, including prescription pain medications, heroin and synthetic drugs such as fentanyl, has skyrocketed in the United States. As of 2017, there were roughly 15 opioid-overdose-related deaths per 100,000 people in the country, compared with 3 per 100,000 in 1999, according to estimates from the US Centers for Disease Control and Prevention (CDC).
An affair of the heart
One type of opioid-related infection that researchers are grappling with involves diseased heart valves. Bacteria such as S. aureus can enter the bloodstream as a result of practices such as needle sharing or not cleaning the skin before injecting a drug. If the infection reaches the heart, it can damage the valves. Severe cases can require a heart transplant.
In an ongoing study, microbiologist Cecilia Thompson at the University of North Carolina in Chapel Hill is sequencing DNA from heart valves collected from people who have had surgery to replace diseased valves with artificial ones. Thompson found that valves taken from people who had injected drugs were more likely to be infected with S. aureus than were those of non-users.
Thompson presented her results at the American Society for Microbiology meeting in San Francisco, California, on 21 June. But these are just the latest observations of what seems to be a worrying trend. In a study published in January, researchers found a tenfold increase in heart infections among drug users in North Carolina between 2007 and 2017. Doctors in the state used to perform less than 10 surgeries to treat drug-related heart infections five years ago, compared with more than 100 now.
Opioids themselves — rather than the method used to inject them — could also be making people more susceptible to infection. Another study, also published in January, looked at more than 25,000 people treated at veterans’ health facilities between 2000 and 2012. It found that people who took medium or high doses of prescribed opioids for pain management — especially people with HIV — were significantly more susceptible to pneumonia. It’s unclear why, but research in monkeys suggests that some prescription opioids, such as morphine, suppress the immune system.
