The risk for infective endocarditis related to drug injection increased in tandem with an increase in hydromorphone prescriptions, new study results suggest.
Researchers for the retrospective study, publishing in the Canadian Medical Association Journal, looked at data on drug users collected in a database between 2006 and 2015. A total of 60,529 admissions of people who injected drugs, 733 of whom had infective endocarditis linked with drug injection. The authors looked at quarterly risk of admission for infective endocarditis related to injection, as well as changes in opioid prescription rates during the study duration. The intervention timepoint was when traditional controlled-release oxycodone was removed from the Canadian market.
The risk of infective endocarditis among people who inject drugs: a retrospective, population-based time series analysis. https://t.co/CsequFJ2F2
— Andrew Morris (@ASPphysician) January 28, 2019
According to the results, there was a mean of 13.4 admissions per quarter prior to the intervention, and 35.1 admissions after the intervention timepoint. While there was no observed change in risk at the intervention timepoint, the authors did report a rise in hydromorphone prescriptions that was parallel with an earlier increase in the risk for infectious endocarditis. By the end of the study period, hydromorphone prescriptions were at 53%, up from just 16% at the start of the observation period.
When I worked as support staff at @HealthCentre in @LondonOntarioCA, there always seemed to be so many cases of IE. Brilliant work by the team there. Now, how can we use this information to support folks who use? https://t.co/t7geYh50dy
— Ashley Warnock (@a_varnock) January 28, 2019
“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,” study co-author Michael Silverman, MD, an associate scientist at Lawson and associate professor at Schulich School of Medicine & Dentistry, said in a press release. “Both the rise in this severe complication of injection drug use and the possible association with hydromorphone require further study.”