Writing in an early April 2019 issue of The Journal of Infectious Diseases, researchers from the National Institutes of Health and University of Maryland School of Medicine paint a bleak picture of just how far-reaching the current opioid epidemic is right now. As overdoses and deaths continue to add up from widespread opioid use disorder (OUD), the spread of serious, contagious diseases is adding to the problem, which many now consider a major public health crisis.
“Driven by injection drug use, OUD and infectious diseases are inextricably linked,” the authors wrote, noting that human immunodeficiency virus infection (HIV) with or without AIDS, viral hepatitis, infective endocarditis, and skin and soft-tissue infections have been directly associated with opioid use disorders. So, too are sexually-transmitted infections as people who abuse opioids are more likely to have casual, unprotected and transactional sex.
Furthermore, said the researchers, contamination of the drugs themselves, drug injection paraphernalia, and the injection site with bacterial and fungal pathogens can cause infections at the site of injection causing cellulitis, skin abscesses, or at other sites in the body through hematogenous spread (e.g., infective endocarditis and osteomyelitis)
The rate of methicillin-resistant Staphylococcus aureus infections among people who inject drugs is also increasing exponentially with evidence indicating opioids such as morphine and fentanyl impact the pathogenesis of HIV and HCV infections, which could then lead to increased cases of pneumococcal pneumonia and other pneumococcal diseases.
“However, a causal relationship between opioid use and immunosuppression has not been clearly established by definitive clinical trials,” the authors asserted. “Furthermore, it has been demonstrated that poor intestinal flow caused by opioid use may be associated with increased risk of severe Clostridium difficile infection during inpatient treatment. These risks and rates of infection will continue to affect people who inject drugs and those with OUD and will certainly increase in association with the opioid epidemic.”
Yes, despite these alarming developments, the researchers said infectious diseases and substance use disorder providers are well-positioned to take part in addressing the crisis. For example, administering medication for OUDs when treating infections in known to decrease the frequency of opioid use which leads to reductions in risky behaviors associated with transmission. “Studies have also shown that coadministration of OUD medication and antiretroviral therapy (ART) is associated with increased uptake of ART, improved ART adherence, improved retention, and increased likelihood of HIV viral suppression,” the researchers said. “Suppression of HIV viremia has clearly been associated with a dramatic decrease in transmissibility.”
