February is for the heart.
It’s Valentine’s Day season, when we’re besieged with images of love, cupid’s arrows, and heart-shaped everything. Whether we want to or not, it’s a time when we receive messages about our hearts, in the romantic sense.
So it’s not a coincidence that the Powers That Be who choose seasonal observations picked this month to educate people about our hearts, in the biological sense. February is American Heart Month, and also the month for the American Heart Association’s signature initiative for women’s heart health, “Go Red for Women.”
Heart disease remains the number one killer of American men and women, leading to one in four deaths in the United States. The goal of American Heart Month is to spread awareness about healthy choices that can help prevent heart disease, including smarter food choices and increased physical activity.
But there’s another risk to heart health that has been steadily growing: opioid addiction.
A recent study, 22 years in the making, has found that the opioid epidemic and IV drug use has fueled an alarming rise in strokes. Infections known as bacterial endocarditis can be caused by dirty or shared needles; when injected into the bloodstream they can enter the brain and lead to a massive stroke.
Decades ago, bacterial endocarditis used to be common in patients who had childhood rheumatic fever, a disease that is virtually extinct now.
"It used to be rare that we saw anybody with bacterial endocarditis-related stroke," said Dr. Carl McComas, a neurologist at St. Mary’s Medical Center in West Virginia, to the Charleston Gazette-Mail. "Now we see one at least every week.”
Hospitalizations have increased 10-fold
The new study, which will be presented next month at a conference for the 2019 American Stroke Association, found that cases of bacterial endocarditis have sharply increased in tandem with the escalation of the opioid epidemic between 2008 and 2015. Stroke hospitalizations increased by 20 percent per year during that time, with rates notably increasing amongst women and people younger than 45 years old.
Meanwhile, heroin overdose-related complications and deaths tripled between 2010 and 2015, according to S. Salehi Omran, MD, a fellow in vascular neurology at the Weill Cornell Medical Center and Columbia University Medical Center.
“Our findings add to the urgency of addressing the underlying opioid epidemic in the United States,” Omran said in a release, “and suggest that people need to be more aware that stroke can be a devastating complication of injecting opioids.”
A separate study, published online in Annals of Internal Medicine late last year, found that annual hospitalizations related to drug-associated infective endocarditis increased more than 10-fold from 2007 to 2017, in step with the opioid crisis in North Carolina.
Each case of hospitalization and surgery for this infection costs more than $250,000. This is "almost certainly" a more expensive way to treat the problem than through comprehensive outpatient treatment programs, according to the study’s leader, Asher Schranz, MD, of the University of North Carolina in Chapel Hill.
There’s no Narcan for strokes
With the widespread distribution and availability of the overdose-reversing drug Narcan, some complacency has set in amongst people with addiction. An alarming perspective has emerged: it’s ok if they overdose as long as they have Narcan nearby. First responders in many communities are reporting the rise of “Narcan parties,” where people freely consume illicit opioids with plenty of Narcan on hand to handle any accidental overdoses.
In case the danger of this sort of folly wasn’t apparent, the new study makes it clear that overdoses aren’t the only risk of opioid addiction. The massive strokes caused by bacterial endocarditis can leave people permanently disabled, where they may need to live in a nursing home.
“Once you tell people that they’re at an increased risk of stroke, I think a lot of people can relate to that in some way because they either know someone who had a stroke or have seen advertisements about how to prevent a stroke from happening,” Omran said to TCTMD.
Strokes caused by bacterial endocarditis present like a typical stroke, with numbness or weakness on one side of the body, in the face, arm, or leg. This can lead to speech impairment, confusion, and loss of vision and balance.
“It adds another layer to the whole concept of what are the complications associated with it,” Omran told TCTMD. “As clinicians, we can counsel our patients that you may end up having a stroke and that can cause you to not be able to do everything you were able to do before. You might become very functionally impaired because of it.”
Besides the devastating effects of a stroke, bacterial endocarditis can also lead to death.
Stroke treatment complicated, expensive, and repetitive
Bacterial endocarditis requires extensive hospitalization, often six weeks of IV antibiotics, drug withdrawal and addiction treatment. Patients may even need to have heart valve replacement surgery.
Relapse rates are high, and hospital staff are often faced with patients needing a second or even third heart valve replacement. Some hospitals refuse.
"You reach a point and you ask yourself, 'We know the drug addiction is not solved in this person. At what point do you finally say no?'" McComas said to the Gazette. "I don't have an answer to that, but people do raise that question."
According to Schranz and his colleagues, “A rational public health approach would prioritize funding of inpatient and outpatient drug use disorder treatment, harm reduction, and other activities to prevent infective endocarditis.”
Protecting your heart
How can we protect our hearts, in every sense of the word?
For people with addiction, the new information about the high risk of strokes might be the extra push they need to enter treatment for their disease. If they aren’t ready for recovery, they can help protect their hearts through safe practices with needles, perhaps even finding a needle exchange program in their area, which will reduce the risk of infection.
For those engaged in recovery, they may realize that their past actions have broken the hearts of friends and family. Understanding what to expect from loved ones during the healing process can help pave the way for mended hearts.
If you need more information about coping with the emotional challenges of recovery, download our Pocket Guide:
Family and friends of those suffering from addiction know how tough it is to help someone who isn’t ready to recover, even with more information about added, dire risks of illicit opioid use. Protecting their own hearts comes with a better understanding of the journey of recovery, which is almost always a winding path.
If you need more information about coping with the addiction of a loved one, download our Pocket Guide:
CleanSlate treats patients suffering from opioid or alcohol addiction with medications and a continuum of care to support each individual's journey to recovery. If you or someone you love needs help, contact us at 833-505-HOPE, or visit our website at www.cleanslatecenters.com to find the center nearest you.