Modeling infective endocarditis mortality associated with injection opioid use

by Sarah Gutkind, MSPH

October 12, 2020

Injection-related infective endocarditis (IE) is a serious and expensive medical complication among people who inject drugs (PWID). In some states, such as North Carolina there has been a 12-fold increase in injection-related IE between 2007 and 2017. Approximately 1.3% of people who inject drugs report IE within the past year, and between 0.5% and 11.8% report IE within their lifetime. Higher injection frequency, unsterile injection practices, and injection equipment sharing are all associated with greater risk of injection-related bacterial infections, including IE.

In a recent study published in Clinical Infectious Diseases, CHERISH Research Affiliate Joshua Barocas and colleagues sought to understand the effect of injection frequency and injection behaviors such as skin cleaning or equipment sharing on IE mortality risk among PWID. They developed, calibrated, and validated a Monte Carlo micro-simulation model called the Reducing Infections Related to Drug Use Cost-Effectiveness (REDUCE) Model. Using the REDUCE model, they found that approximately 257,800 people in the United States are expected to die from injection-related IE by 2030, which equates to about 7.26 million years of potential life lost. The risk of injection-related IE death was more pronounced among people who did not use sterile injection practices such as skin cleaning or sterile injection equipment, whereas injection frequency had little effect on the risk of injection IE death.

These findings suggest that an individualized patient-centered approach to intervene with injection behaviors and increase education about sterile injection practices could significantly decrease injection-related IE deaths among PWID. The authors emphasize the importance of adopting a harm reduction approach, including expansion of syringe service programs, to decrease the mortality associated with the opioid crisis in the U.S.