London Ont. study finds controlled-release opioid may cause heart infections

The findings were published in The Lancet Infectious Diseases on Wednesday. David Silverman/Getty Images

A study released by the ICES, Lawson Health Research and Institute and Western University hints that injection drug users prescribed controlled-release hydromorphone are three times more likely to develop endocarditis, a serious bacterial heart infection, compared to those prescribed other opioids.

The findings were published in The Lancet Infectious Diseases on Wednesday.

The study supports growing evidence that some controlled-release opioids are capable of leading to higher risk of infectious disease among those who inject drugs.

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Controlled-release opioids release slowly once it enters the body to prevent rapid absorption of the drug.

It’s known to help patients battling painful illnesses over a long period of time such as cancer, according to Dr. Michael Silverman, Associate Scientist at Lawson and Associate Professor at Schulich Medicine & Dentistry.

Dr. Silverman says these opiods will occasionally reach the hands of people who are addicted, and feel the need to inject because they don’t feel that they get adequate levels with pills.

“They try to crush these drugs, and inject them, but when they inject the slow-release drugs, it causes specific problems,” explained Dr. Silverman on the Craig Needle’s Show Thursday morning.

He says a major problem is bacterial contamination from leftover undissolved opioid pills stuck in syringes.

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This can lead to endocarditis, an infection of the endocardium, which is the inner lining of the heart chambers and heart valves.

“It can be a devastating infection,” Silverman said.

“It sounds like it would be something extremely rare, but the frequency of this is rising dramatically.”

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According to Silverman, the infection comes with a very high mortality rate.

“About a third of people who get this infection will die from it, but even those who survive are often very damaged by what happened.”

In addition, a clump of infected material on the heart valve can “break off and fly to your brain and cause a stroke, it can fly to your spinal cords and make you paralyzed, [and] it can fly to the bones and cause fractures and severe infections,” Silverman warned.
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Reversing opioid overdoses

Researchers in the study analysed de-identified Ontario health data for hospital admissions related to injection drug use between 2006 and 2015.

Out of 60,529 admissions, 733 patients had infective endocarditis, researchers say.

The team also found that regions with high hydromorphone prescription rates had more than twice the cases of infective endocarditis (254 cases) when compared to regions with low prescription rates (113 cases).

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They say there was no increased risk for those prescribed the immediate-release form of hydromorphone.

Researchers believe these findings also provide explanations for the increase in infectious complications in the U.S. and other countries where controlled-release hydromorphone is not on the market.

Silverman is advising the public to be aware of the infectious risks of injecting opioids and, if necessary, practice harm-reduction techniques such as ‘cook your wash.’

“A cigarette lighter [can be used] to destroy bacteria and viruses by heating the cooker used to prepare the drug for about 10 seconds or until the mixture bubbles,” he said.

Until an alternative to relief severe pain is discovered, Silverman says eradicating all opioids is not possible.

“The goal is to control [the distribution of opioids], only use them where they’re the only option, and to reduce the use [when] opiods are not helpful.
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