Exposure to COVID-19 appears to increase the risk of infective endocarditis in people with opioid use or cocaine use disorder, a report in Molecular Psychiatry has found. Infective endocarditis is a rare but often fatal inflammation of the heart valves.
“Drug-using populations, particularly those who use cocaine or opioids, have some of the highest risk for endocarditis, and here we show that having a COVID-19 diagnoses further increases this risk,” wrote corresponding author Nora D. Volkow, M.D., the director of the National Institute on Drug Abuse (NIDA), and colleagues.
Volkow and colleagues analyzed data from de-identified electronic health records (EHRs) of 109 million patients from 77 health care organizations across the United States from 2011 to 2022. The study population comprised 736,502 patients with a diagnosis of opioid use disorder, 379,623 patients with a diagnosis of cocaine use disorder, and 105,817,030 patients without a diagnosis of either condition.
The incidence rate of endocarditis (as measured by new cases per 1,000,000 person per day) among patients with opioid use disorder increased from 3.7 in 2011 to 30.1 in 2022. There was a plateau period between 2017 and 2020 followed by acceleration from 2021 to 2022. The incidence rate of endocarditis among patients with cocaine use disorder followed a similar trend as that of patients with opioid use disorder. The incidence rate of endocarditis among patients without either disorder did not increase significantly.
A clinical diagnosis of COVID-19 more than doubled the risk for new diagnosis of endocarditis in patients with either cocaine or opioid use disorder. Among these patients, the 180-day hospitalization risk following endocarditis was 67.5% in patients with COVID-19, compared with 58.7% in matched patients without COVID-19. The 180-day mortality risk following the new diagnosis of endocarditis was 9.2% in patients with COVID-19, compared with 8.0% in matched patients without COVID-19.
The authors noted that the use of contaminated syringes or injecting drugs in non-sterile environments may increase the entry of bacteria into the blood stream that then circulates throughout the various organs and can result in endocarditis.
“People with substance use disorder already face major impediments to proper health care due to lack of access and stigma,” Volkow said in a NIDA press release. “Proven techniques like syringe service programs, which help people avoid infection from re-used or shared injection equipment, can help prevent this often fatal and costly condition.”
For related information, see the Psychiatric News article “Most Patients Do Not Seek Follow-up Care After Non-fatal Opioid Overdose.”
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