• DPMC Moderators: thegreenhand | tryptakid
  • Drug Policy & Media Coverage Welcome Guest
    View threads about
    Posting Rules Bluelight Rules
    Drug Busts Megathread Video Megathread

Endocarditis: Most Serious Infectious Threat to IV Drug Users

cduggles

Bluelight Crew
Joined
Nov 12, 2016
Messages
20,283
Endocarditis

HIV And Hepatitis C Are No Longer The Most Serious Infectious Threats To People Who Inject Drugs

March 25, 2017
No author attribution

I had dinner with my daughter Mimi the other evening, and was ruminating about how things have changed since I started workas an Infectious Diseases doctor around 25 years ago.

Here’s an excerpt of our chat:

Me: There are way more cases of endocarditis in young people than there used to be, a complication of injecting drugs. People in their 20s and 30s with life-threatening infections, getting admitted to the hospital, needing antibiotics for weeks, sometimes surgery … it’s awful. [I didn’t mean for this to sound like a cautionary speech to my 21-year-old daughter, but reading it now — guilty as charged.]

Mimi: Endocarditis?

vVu0Ccl_d.jpg


Me: Infection of the heart valves. It’s an incredibly serious problem, much more difficult to treat than HIV and HCV. Even with our best antibiotics, some people need major heart surgery — their lives are never the same. And sometimes the infection spreads through the blood to the lungs, spine, brain… Some even die!

Mimi: I’ve never even heard of it. And we never covered it in high school, and we had a ton of drug talks in health classes. It was all HIV and hepatitis. And overdoses, of course.

Me: Trust me, it’s a terrible problem.

Mimi: I bet if I asked 10 of my smartest friends, most would be like, “What?” Hey, I can’t even remember what you called it, and you just told me. Here, let me check something. What’s the infection called again?

Me: Endocarditis.

Mimi [takes out her phone, does some rapid-fire tapping]: Just did a Google search. “Endocarditis and injection drug use” has 179,000 hits, “HIV and injection drug use” has 1.6 million. And most of the endocarditis ones are in medical journals. Only doctors are going to read those.

Me: How do we get the word out?

Mimi: It needs a better name. Something like Zika — everyone can remember that.

Me: Can I steal that line?

Mimi: Provided there’s proper attribution, go right ahead!

For some context, Mimi is a college junior and, while not medical school-bound, is a smart kid. (Of course she is.) Having grown up with two doctor parents, she probably has a better than average fund of medical knowledge for her age.


But the above conversation exposes a major gap in the lay public’s understanding of the risks of injection drug use — one hinted at recently in a piece on the clinical and ethical challenges of heart surgery for people with addiction.

For whatever reason, endocarditis and other invasive bacterial infections are not nearly as feared as HIV and HCV, despite the fact that the former are far more immediately life threatening and way more difficult to treat.

It’s true even among those who have had endocarditis. One woman told me that the most upsetting part of her prolonged admission (complicated by cavitary lung lesions and spine infection at multiple levels) was not the days of fevers, the pain when breathing, the severe back pain from the infection, back pain that still plagues her.

It was when she found out her hepatitis C test came back positive.


Let’s compare:

Endocarditis due to Staph aureus: Prolonged hospital stay; 6 weeks of intravenous antibiotics; metastatic infection in the lungs and spine; possible need for valve replacement surgery; possible death.

Hepatitis C: 12 weeks of one pill a day. Even if untreated, unlikely to cause problems for decades.

Of course HIV is incurable, unlike endocarditis — but it too is treatable with 1 or 2 pills a day, treatment that essentially eliminates the chance of getting sick from AIDS. And in the United States, rates of HIV due to injection drug use are way down despite the opiate epidemic, accounting now for only 6% of new cases.

So why do we have this strange paradox? And does endocarditis need a new, more memorable name? Suggestions welcome.

And remember, Zika is taken.

Source: http://blogs.jwatch.org/hiv-id-obse...v-hcv-not-feared-time-better-name/2017/03/25/
 
Last edited:
Endocarditis scares me more than any other complication that's for sure. Rip Axl god I can't believe he's gone still.
 
I had it. Hospitalized for 6 weeks. Extremely painful. Pretty much one of the worse things that can happen. Never again
 
Reformatted and titled more appropriately.

Please understand I was a noob in this forum :) ; unfortunately, endocarditis is still topical so I hopefully improved the presentation of this article.
 
Reformatted and titled more appropriately.

Please understand I was a noob in this forum :) ; unfortunately, endocarditis is still topical so I hopefully improved the presentation of this article.

Reads much better :)

It's something so few have heard of, and a complete nightmare to try and treat :\ Definitely info that needs to be more readily promoted in our HR advice.
 
Reads much better :)

It's something so few have heard of, and a complete nightmare to try and treat :\ Definitely info that needs to be more readily promoted in our HR advice.

The problem is it's hard to prevent. Sure being sterile helps but unless you live in a clean room it's damn near impossible to be sterile enough to prevent it with 100 percent success. It's just one if those things that sometimes happens you can't really prevent. Granted you can minimize the chance by using alcohol swabs, clean rigs, clean spoons ect.
 
I do agree cj, you can't totally prevent. But it's the minimisation bit where the HR advice comes in. I wouldn't want to use stories like the above to scare people, but if it's accurate non-hyperbole info (unlike much anti-meth media, for example) it can - perhaps - help drive home the message for IV users to be as careful as they can.
 
More common are abscesses and amputations, but yeah this is serious shit. I used to IV/IM all kinds of stuff. Never again. Not that this has happened to me.
 
I do agree cj, you can't totally prevent. But it's the minimisation bit where the HR advice comes in. I wouldn't want to use stories like the above to scare people, but if it's accurate non-hyperbole info (unlike much anti-meth media, for example) it can - perhaps - help drive home the message for IV users to be as careful as they can.

For sure. Endocarditis is the scariest IV complication IMO.

This story from Reddit hammered it home for me.
https://www.reddit.com/r/opiates/comments/44utkd/just_witnessed_a_tragedy/
 
It is absolutely disgusting that this woman was not allowed opioids to ease the pain of her agonizing death because she was addicted to them. What reasonable purpose could it possibly serve to withhold them at that point?

I don't know but it made me sick thinking about it.
 
I had a close friend die from it. He used to save all of the residual powder and used cottons from his pill injections. then a week later or so he would compile them all together and extract the trace opiates and do a shot. He got cotton fever several times from this and I told him how dangerious it was.

I havn't been an IV opiate user in about 3 years. I still fantasize about injecting dilauded. Heroin or oxy I could ieasily just snort and pass up IV, but dilaudid is just something else IVed.

I always fantasize about getting some dilauded and having "just one more shot"
 
I had a close friend die from it. He used to save all of the residual powder and used cottons from his pill injections. then a week later or so he would compile them all together and extract the trace opiates and do a shot. He got cotton fever several times from this and I told him how dangerious it was.

I havn't been an IV opiate user in about 3 years. I still fantasize about injecting dilauded. Heroin or oxy I could ieasily just snort and pass up IV, but dilaudid is just something else IVed.

I always fantasize about getting some dilauded and having "just one more shot"

I have heard of more people getting it from pills then dope but that could just be bias on my part. Sorry about your friend.
 
Though this has never gotten the attention it deserves, it isn't new. When I was first doing IV drugs in the 70's, I lost a number of close friends to it, and had many more get sick and wind up having artificial valves put into their chests, etc. Part of the problem then was--and may well still be--that the way IV drug users were treated by the medical community made most of us willing to get extremely ill (non-withdrawal illness, that is) without seeking medical attention, especially if it was something that 'might' go away by itself. The early symptoms can be pretty general--chest pain, shortness of breath, things that could come from lots of things, including the flu or bad colds, or withdrawal. I remember one time in Seattle becoming unable to breathe to the point that I did seek medical help--I believe I went to Harborview or one of the other big hospitals. They diagnosed me with talcosis from IV use of Ritalin pills, but the thing I remember from the experience was that I was treated worse than I would ever treat an animal, and I swore that I would go ahead and die before I ever went to an ER again.

I hear that things aren't that bad any more, but having spent the past 10 years as a normal square citizen, but on Suboxone maintenance, I have reave reason to believe that the stigma is no better. Thank God my Sub doctor, who is also my shrink, doesn't treat me like a dog--in fact, he's supportive and is OK with my decisions about staying on, getting off, whatever--but many of the other medical providers I have to see, being an old, crippled-up, sick person, are about as judgemental and negative as those Seattle doctors were 50 years ago.

I've also heard that people are getting things like horrible spinal infections that I'd never heard of until recently, wound botulism, MRSA, and that flesh-eating disease I can't spell from IV use. Those things were unheard of in the early days of my drug use. I did get hepC, managed to miss HIV somehow, but it seems there's just a lot of new infections, not all from drug use, hanging around out there. My personal opinion is that much of it is caused by the antibiotics we put in our food supply, but I don't have anything to back that up with.

I am so glad that the second time I got clean for a few years, the compulsion to use needles, which I had had in a big way, entirely aside from the compulsion to do the drugs themselves, had gone away completely. I did go out with a pill habit for a few more years before I cleaned up again--8 years ago--but it was only taking pills. I count myself lucky, considering the dangers out there today. Speaking of luck, it was sheer good fortune that I didn't get HIV or SBE (sub-acute bacterial endocarditis, as we called it in those days) from IV or IM use, as I did absolutely nothing to keep myself safe. Shared everything with everybody, really funky practices--by all rights I should have gotten everything out there! Glad I didn't. Namaste, Sherry
 
^ I think the horrible treatment by the medical community is due to the way we raise kids to fear drugs. From the time we are children we are told they are the most evil and disgusting thing. Little kids aren't told about to many negative or bad things, so when you brainwash them at a young age it sticks. These kids grow up, and if they don't have experience with drugs, these attitudes carry on to adulthood.

Its my theory.
 
We are still treated like we shot somebody by most doctors. I don't go to the ER unless I'm half dead.
 
We are still treated like we shot somebody by most doctors. I don't go to the ER unless I'm half dead.

agreed if I get seriously injured but am not in danger of dying I would go to a heroin dealer before the ER. I would ask the abmulance to swing my the heroin dealers corner first.
 
We are still treated like we shot somebody by most doctors. I don't go to the ER unless I'm half dead.

It's amazing how doctors continue to treat people with substance abuse disorder. I have been trying to find a doctor to help me deal with my issues with anxiety, depression and insomnia. They exist well prior to any actual drug use or experience of a use disorder. Anyways, I'm open with doctors when they ask me about my prior medical conditions.

When I mentioned to the first doctor I saw basically said, "no I don't want to deal with helping you because you have a history of substance use disorder, you have to see a specialist." There is some validity to that, but it was clear he was more concerned with not getting involved with me simply because I mentioned a history of substance use disorder.

Then, the when I saw a "specialist" psychiatrist I saw (someone who was supposed be a worldwide expert in his field) he became very judgmental and even defensive. Like it was really amazing how he made an effort not to listen to what I was telling him. Very disheartening experience, being treated like a POS junkie even though that kind of identity has nothing to do with who I am or have been for years now. He was anything but secure or healthy as an individual or mental health professional - which him supposedly being an expert was very disheartening.

The second psychiatrist I was was straight forward and basically said "no I don't treatment substance use disorder because I don't have the training, I only treat other mental health disorders." Which is bullshit of course, but there is some validity again there (hiding behind some supposed professional need for specializing in addiction when treating addiction is something every mental health professional should be open to working with). Anyways, I basically told him, "Great! I not her for help with substance use disorder - I'm here for help with anxiety, depression and insomnia." That was good enough for him, and this doctor proceeded to actually listen to what I had to say and suggested medications appropriate to my condition (for now gabapentin and propranolol).

Anyways, the first doctor I say for help with mental health concerns - not even related to addiction in this case - basically refused to get involved. The second doctor I saw was very judgemnental, didn't listen to anything I had to say, treated me like I was trying to doctor shop or some bullshit, and prescribed medication that was patently inappropriate to my situation (due to not listening to what I had to say and suspecting I was trying to get medication to use to get high or something just because I mentioned substance use disorder as part of my prior medical condition). The third doctor treatment me like a human being who was trying to get legitimate mental healthy care, but it took months to get to that point.

People who seek mental health care have enough barriers to affordable, quality treatment. We're often not treated at all like "normal" patients. It's all the worse for people with substance use disorder on their record. There are many great, humane, professional and compassionate health care providers out there like the third doctor I saw, but they are very few and far between.

Generally speaking it seems like about 1 out of every 10 health care professionals is capable and willing to treat people with mental health or substance use conditions fairly or appropriately - and by fairly and appropriately I mean like human being seeking health who deserve to be treated not as people who are trying to just game the system, but people trying to get help and become healthier!

Most doctors don't seems to have ANY IDEA the ways they reinforce stigma surrounding the conditions they are supposed to treat or the ways they victimize and "other" a whole demographic of people. It's similar to the "tough love" approach still being so popular. It's like the pimple on the ass of time.

Perhaps one day doctors will be trained how to engage in nonjudgemental practices, but that is something that will not happen any time soon. Things are changing in some areas of medicine, but chance in medicine happens rather slowly in cases like this.
 
The other side of the coin is people do try to get one over on doctors in order to obtain a prescription. Its probably fairly easy to recognize the people that do this as they probably dont realize how they come off to a medical professional, especially if the doctor already has their doubts about the legitimacy of the story. Unfortunately it probably doesnt take many people trying to get more prescriptions or even one in general under an assumed fraudulent means, even if its trying to get additional pain killers prescribed for a previous legitimate reason. The issue is conditioning, so they get predisposed to question anyone asking about or even needing prescription narcotics.

To be honest since I have been clean and dont care about opiates or want them ever again when i finally get to a dentist ill gladly tell them im a former junkie (need dental work so very badly) Because I dont care id prefer they know even if it excludes me from any type of medication, though I dont think it will and I realistically dont care. I am not going to "need" opiates again so i dont want them, I am far too relaxed a person to ever think ill need benzos and to be honest if someone tried to prescribe me even T3s id tell them to rip that paper up i dont want it within 5ft of me even though I have zero desire for opiates.

Watching my life get ruined, people dying, wondering if id ever get out the last thing i would ever want is a take home prescription. My ex on the other hand does need benzos and even though she was an addict at the time she found a doctor that gave them to her. He actually claims to be some kind of addiction psychiatrist but my ex was in a terrible state when she started going to him and he literally witnessed her get off all almost all of the benzos she was on to get on methadone, get clean from methadone from 90mg in 4 months all within a year and a half. She's happy she finally got refills from him, he does make sure she comes in every month, but last one he was MIA when she "ran out" of her valium and she didnt care she was out when he finally called her and i guess that was the turning point.

Long story short part of it is the way junkies behave. You cant fault someone for having a predisposition if every encounter they have had is negative, this doesnt make it right but its human psychology. As a former IV heroin addict the last thing I personally care about is ever getting opiates of any kind again however, my ex has and still is on benzos (was on 2mg kpins and 40mg of valium a day down to 5mg (recently went up to 10mg so she could save half... partly why she didnt care about "running out" haha) But since hes a psychiatrist and cant understand how she managed to quit benzos, dope, cigs, get a job etc all in a year and a half she pretty much broke that guys understanding and she says thats most of the meetings where he simply tries to understand her.
 
Top