Earlier this week, a prominent vascular neurologist who spoke at the recent annual conference of the American Stroke Association shared a grim report: opioid abuse is driving a rise in the number of strokes. Dr. Setareh Salehi Omran, lead author of a study soon to be published in the journal Stroke, told her colleagues at the conference that the current opioid addiction crisis has led to a sharp increase in the number of infection-related strokes requiring hospitalizations.
The infection that is behind these statistics is known as infective endocarditis. This infection develops in the interior heart lining, causing inflammation of the chambers and valves. It results from bacteria or a fungus that enters the bloodstream (in the present case, by means of a contaminated needle), and can be fatal if not treated quickly. Even if the infection clears, however, pieces of dead tissue can break off into the bloodstream, where they can be carried to the brain, thereby causing a stroke.
Dr. Omram and her research team examined hospitalization records from 1993 to 2015. Over that period, they noted an increase of over 800 percent in the number of admissions due to infective endocarditis. Most of that increase took place after 2008, reflecting the corresponding rise in opioid abuse. In a press release from the American Heart Association (AHA), Dr. Omran notes that “The rise in hospitalizations for infective endocarditis-related stroke associated with opioids parallels the rise in heroin overdose-related complications and deaths, which tripled between 2010 and 2015.”
It should be pointed out that the trend is not driven directly by prescription opioid abuse. Rather, it is due to people with an addiction to prescription opioids who turn to less expensive, more easily obtained street drugs such as heroin when those prescription medications are unavailable. Dr. Omram says that for this reason, “…[public] efforts to minimize prescription opioid abuse are important in addressing this public health problem.”
Infective endocarditis is not the only connection scientists have found between opioid abuse and stroke. Last November, the AHA published an abstract of a study that found an association between opioid use and an elevated risk of atrial fibrillation (AF) – which is another risk factor for stroke. That study, based on an examination of over 850,000 VA records, found that opioid use can result in a 34 increase in AF risk.
The lead author of that study, Dr. Jonathan Stock of Yale New Haven Hospital, said their results “…suggest that the toll may be even greater when we consider the cardiovascular effects opioids may have.” They also pointed out that the findings of their study highlight the dangers of opioid use by itself, even when abuse or addiction is not an issue.
Dr. Stock said, “Opioid use, by itself, must be taken seriously and efforts should be made not only to reduce opioid abuse and overdoses but to ensure patients are being prescribed opioids only when absolutely necessary.”